The Pan-London Post-COVID (Long Covid) Service was established in response to an urgent need for specialist services in Children and Young People (CYP). Our clinical experience has contributed to a framework used around the UK.
Persistent symptoms are not uncommon after COVID-19 infections and a small percentage of children have significant symptoms that get in the way of normal activities and need expert specialist care and support. We have evolved in response to the lived patient experience and growing recognition and understanding of Post-COVID symptoms in children and young people.
The post-COVID team experience is that early intervention and support is important in helping and improving the lived experiences of children and young people.
The service is for children and young people (aged 0-18 years) suffering from symptoms 12 weeks after a likely or proven COVID-19 infection. Usually, symptoms are severe enough to be impacting on the child or young person’s life. We accept patients from their paediatrician who will have undertaken an assessment to look for complications needing urgent management or another diagnosis to explain the symptoms. For young people, 17-18 years old in education who are too old for paediatric services we would accept a referral from GP.
The referring clinician (paediatrician if 16 and under; GP if 17-18) will fill in the attached referral form and is then allocated a virtual MDT slot.
All patients referred to the CYP Post COVID service should complete a modified ISARIC questionnaire from our team prior to MDT discussion. We will contact the patient to complete this via an online app (ELAROS). Please ensure you have provided an up-to-date email address and informed the patient to look out for this. This provides us with important information to assess multiple aspects of the patients’ presentation.
The paediatrician or GP will present the case for discussion at weekly virtual MDT(multidisciplinary team) meeting with specialists such as paediatrician, adolescent medicine, respiratory, infectious diseases, rheumatology, cardiology, neurology, psychiatry, psychology, physiotherapy, occupational therapy and clinical nurse specialist. Patients’ paediatricians remain involved throughout their care to ensure appropriate local service involvement as well.
After discussion, patients get specialist educational leaflets to manage the common symptoms and concerns. If patients meet a threshold, they will be referred for face to face assessment in UCLH or The Evelina Children Hospital multidisciplinary clinic.
Patients are seen face to face for an initial appointment by a paediatrician and one or more of psychology or psychotherapy, physiotherapy or occupational therapy.
MDT rehabilitation treatment will then continue in a mix of virtual and face to face appointments. Patients are usually discharged within a year.
Symptoms after COVID infection including:
- fatigue
- muscle aches and pains
- temperatures
- abdominal symptoms, such as pain, and diarrhoea
- anosmia
- sleep difficulties
- emotional and behavioural difficulties
- brain fog
- palpitations
- breathing difficulties
History:
- Confirm if/when the patient is believed to have had COVID-19
- Consider potential fluctuating symptoms and trends
- Consider potential cardiac, respiratory and autoimmune symptoms
- Gain understanding of patient’s functional baseline prior to contracting COVID-19
- PsychoSocial assessment: impact of condition on family, education etc.
Investigations:
- Pulse, oxygen saturations, blood pressure, urinalysis (protein, blood glucose)
- Blood tests (dependent on symptoms): FBC, blood film, U&E, creatinine, LFT, TFT, ESR, CRP blood glucose, coeliac screen, CK, ferritin
- Additional tests (depending on symptoms/clinical judgement): e.g. brain MRI, faecal calprotectin
Interim support:
- Trial of simple measures e.g.: gentle exercise, sleep hygiene, liaison with school.
- NHS London CYP Post-COVID Summary
Patient to complete ISARIC questionnaire
GP referral criteria:
- Rapid referral via local paediatric services (these patients should not wait months to be screened by paediatrics)
- Child or young person to be seen as per local protocol for paediatric or adult services
- Referral direct to Post Covid service if unable to be seen promptly by local paediatric services if:
- >12 weeks of persistent symptoms or sooner (4-12 weeks) if concerned
- And there is no local paediatrician e.g. for 17/18yr olds
- Red flags for referral include regularly missing school despite simple measures.
- Discuss with paediatrician if there is an unclear diagnosis.
- Referral forms below to be sent to london.
cyppostcovid @nhs.net
Visit here to read the NHS Post COVID Syndrome Pathway for Children and Young People; Pan-London Guidance for Referral, Assessment and Onward Access to Follow-Up Services.
For further information and advice, visit the North Central London GP Paediatric Post-COVID Syndrome Service website here.
Referral criteria:
- Inclusion criteria: <18 years, or 18 years and in education
- History of suspected COVID-19
Screening tests ahead of the virtual MDT (as appropriate):
- FBC, ESR, CRP, Blood film, Thyroid function, Liver function tests, renal and bone profile, CK, Ferritin, coeliac screen, ANA, SARS-CoV-2 serology, vit D, vitamin B12, iron studies, EBV and CMV serology and PCR.
- Additional investigative bloods including Troponin, D-Dimers and VWF/ADAMTS may be undertaken based on clinical judgement
- Faecal calprotectin (if abdominal symptoms)
- Urine albumin/creatinine ratio
- ECG (if palpitations, breathlessness etc); cardiac ECHO only following MDT discussion
- Imaging as appropriate (e.g CXR, abdominal USS)
- 1 minute sit-to-stand test (see summary document pages 16 - 18)
- Sit/stand BP and HR to exclude POTS (increase in HR 30bpm or to >120bpm after standing for 5-30 mins (see pathway for details of this) if tachycardia or dizziness
Ensure the ISARIC questionnaire completed
Visit here to read the leaflet for rehabilitation: self-management of long COVID for adolescents.
Click here to download the NHS London CYP Post-COVID Summary document.
Patient contact
General enquiries
Service management
Tracey Dowling
Address
Children and young peoples outpatient dept
Lower ground floor
Elizabeth Garrett Anderson Wing
University College Hospital
25 Grafton Way
London, WC1E 6DB
GP contact
Other referral information
To make a referral, please download and complete this form. Completed referrals should then be sent via email to the team at london.cyppostcovid@nhs.net. Please ensure that you have provided an up to date contact email address for the patient to complete an online questionnaire prior to MDT discussion.
Referral address
Post COVID and TRACCS admin team,
Paediatric department,
6th Floor,
250 Euston Road,
NW1 2PG
