Hints of COVID’s indirect impact in children emerge

The pandemic phase of COVID-19 might be fading from the collective memory of the public. However, paediatricians are now beginning to see the indirect impact COVID-19 has had on the health of children.

“We do not have any studies yet to reel out numbers or to establish a causal link with COVID-19. But we are seeing a definite increase in childhood obesity and a spike in Type 1 and Type 2 diabetes in the below-15-year-olds. Autistic disorders also seem to be showing an increase,” says I. Riaz, Associate Professor of Paediatrics, who heads the Paediatric and Adolescent Diabetes Clinic at SAT Hospital.

Type 1 diabetes is an autoimmune disorder in which the immune system attacks and destroys cells in the pancreas that produce insulin. Type 2 diabetes is said to be a lifestyle disease, the main triggers being obesity, unhealthy diet, and physical inactivity.

Many researchers in Europe have reported a significant increase in Type 1 diabetes in children after recovering from COVID-19. A study by the Centre for Disease Control (CDC), U.S., is the first to find an increased risk for both types of diabetes in children after the pandemic.

77.2% increase

In January, the CDC reported a 77.2% increase in new cases of diabetes (Type 2 and Type 1 ) in children during 2020-21, in comparison to the two previous years. Researchers at Johns Hopkins Children’s Center too have now reported a similar spike in Type 2 diabetes in the same period in the 8-21 years age group.

Doctors are not sure if these new diagnoses will be a temporary or chronic phenomenon because children will have to be followed up for a longer time to determine that.

“In SAT Hospital, we had 54 new Type 1 cases in 2020, 74 in 2021 and 51 cases (till September) in 2022, showing a slight increase in incidence. In the case of Type 2, usually we do not see more than two or three cases in an entire year in children less than 15 years. But in 2021, we had nine Type 2 cases in this age group,” says Dr. Riaz.

Even before COVID

“Globally, the burden of Type 1 cases was on the rise even before COVID-19 came along. Hence, establishing a causal link to COVID-19 might not be easy,” says Sheeja Madhavan, paediatric endocrinologist, KIMSHEALTH.

Doctors say it is fairly well-established that the lack of physical activity, increased screen time, and unhealthy eating during the pandemic period has led to a significant increase in childhood obesity, which could be manifesting now as a rise in Type 2 disease.

Many theories have been proposed on the possible association of COVID-19 and Type 1 disease, that the virus can directly induce the disease by destroying the beta cells or that the virus can induce or accelerate the autoimmune process.

One significant issue of pandemic lifestyle and metabolic disorders in children has been the unusual increase in early onset of puberty (precocious puberty) in girls, something that is well-documented, says Dr. Madhavan

Precocious puberty

She says that she now sees at least 2 or 3 cases of precocious puberty every week, in girls as young as six or seven years of age. Early menstruation can be quite unsettling for young children and apart from the psychological stress, these girls also end up with a shorter height because growth slows down once puberty is attained.

Parents need to be aware of the signs of diabetes in children because early intervention and proper lifestyle management can reverse the condition.

Clinicians advocate large-scale awareness creation at the community-level about the spike in lifestyle diseases amongst the young so that the general sluggishness and the increased eating-out culture in the post-pandemic period are tempered by sound interventions to promote healthy and active lifestyle habits.