China Medical University Hospital provides integrated traditional Chinese and Western medical care services. Through integrating and exchanging information systems, pediatricians can communicate in real-time to quickly understand the patient's condition, combined with safety reminders for Chinese and Western medicine, to ensure the quality of care for children and adolescents after COVID-19 infection. In addition, they have adopted the "L•O•V•E" four-fold method taught by doctors to guide parents in caring for children and adolescents in the post-pandemic era. (Back row, right one: Vice President Xie Kaisen, Back row, right three: Director Lai Wanyu, Front row, right one: girl - Xiaozhen)

      Nine-year-old Xiao En (alias) had previously been infected with COVID-19. Following the infection, she often experienced chest discomfort and pain, rapid heartbeats during physical activity, and difficulties sleeping due to hearing her own heartbeat. She sought treatment at the Chinese Medicine Pediatrics Department of China Medical University Hospital. After examining her pulse, Director Wan-Yu Lai found that Xiao En exhibited a pulse irregularity known as "Jie Dai Pulse" (indicative of arrhythmia). The integrated Chinese and Western medicine care and consultation with pediatric cardiology yielded no significant abnormalities. The following treatment with Chinese medicine and laser acupuncture saw her symptoms improving, and subsequent heart follow-ups showed no major issues, thus finally putting Xiao En's mother at ease.

Analysis of 15 native symptoms traced in the post-COVID-19 pediatric clinic at the China Medical University Children's Hospital.

      Five-year-old Xiao Zhen (alias), after recovering from COVID-19, began to frequently fall ill. Initially, she had a lengthy period of fever and coughing due to a fungal infection, and soon after recovery, she again started to exhibit symptoms of fever, cough, and runny nose. On average, she would catch a cold and have a fever in less than two weeks, seemingly getting ill from any slight exposure to wind or water. After ruling out structural issues in the nasal and respiratory tracts and diseases like asthma, Dr. Wan-Yu Lai initially treated her with Chinese medicines such as Tsang Ear Powder and Kudzu Root Soup. Later, other prescriptions like Sheng Mai Drink and Guizhi plus Dragon Bone Oyster Soup were used. Xiao Zhen has now recovered health and her illness frequency has significantly reduced.

After infection with the coronavirus, (Left) children often have "Strawberry Tongue", which is a red tongue, a thick white coating, and a tip full of crimson points. It indicates that there is still damp heat remaining in the body. The right picture shows a normal tongue.

      Dr. Wan-Yu Lai, Director of Pediatric Chinese Medicine at China Medical University Hospital, pointed out that, according to statistics published by Taiwan's CDC, about 2.05 million children and adolescents in Taiwan have been infected with COVID-19. After the peak of the epidemic, apart from dealing with the sequelae and Post-Acute Sequelae of COVID-19, we are now facing the "debt tsunami" of immunity, referring to the various clinical sequelae of multi-organ system discomfort repeatedly appearing in infants, toddlers and teenagers. Vice-Superintendent Kai-Sheng Hsieh analyzed that according to the statistical report of the post-COVID-19 pediatric clinic, first established in Taiwan in July 2022 by China Medical University Children's Hospital, the most common symptoms of post-COVID-19 children in Taiwan are cough, fatigue, throat problems, decrease in physical activity, breathlessness, chest pain, and palpitations. These have once again become the clinical symptoms of children and teenagers seeking medical treatment in outpatient clinics in recent times. Parents should pay close attention to various health alerts, such as the decline in children's immunity.

The Shenmen acupoint is located at the end of the wrist crease on the radial side, where the pisiform bone meets the ulna. It is in the depression on the radial side of the flexor carpi ulnaris tendon, which can calm the mind and help with sleep.

      China Medical University Hospital has established a post-COVID-19 integrated care team for children and adolescents. In addition to alleviating symptoms of Post-Acute Sequelae of SARS-CoV-2 infection (PASC) in pediatric patients through specific examinations and regular follow-ups by Western medicine pediatricians, the patients are also evaluated by pediatricians from the Traditional Chinese Medicine (TCM) department. They often observe a white strawberry-like tongue in the patients after infection (as shown in Figure 2), a symptom indicative of a damp-heat coexisting pattern in TCM theory. According to this theory, the "dampness pathogen" has the characteristics of heaviness, turbidity, and stickiness, which lead to prolonged and difficult-to-heal disease processes. In the initial stages, medications to clear damp heat can be used. Subsequent recovery periods may involve prescriptions like Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) and Liu Jun Zi Tang (Six Gentlemen Decoction) for dehumidification and spleen strengthening, or Sheng Mai Yin (Generate the Pulse Drink) and Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) for Qi nourishing and Yin nurturing. In the recovery stage, stewing Four-God Soup (yam, Euryale seed, lotus seed, and Poria cocos) can help, complemented by Job's Tears to further remove dampness and strengthen the spleen. For children unable to take oral TCM, a medicinal bath with TCM herbs such as Fang Feng (Saposhnikoviae Radix), Huang Qi (Astragali Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Gui Zhi (Cinnamomi Ramulus) can be considered for bathing and fumigation, which can help to support righteousness, expel pathogens, enhance Qi, and consolidate the exterior.

The Neiguan acupoint is two inches (three finger-widths) above the middle of the wrist crease, between two tendons. It can calm the mind, regulate the chest and stomach, and help relieve palpitations, nausea, and vomiting.

      Director Wan-Yu Lai of Chinese Medicine Pediatrics: Focusing on Acupressure Massage in Children to Accelerate the Alleviation of Post-COVID-19 Symptoms.

      Dr. Wan-Yu Lai, Director of Pediatric TCM at China Medical University Hospital, suggests that parents can learn to massage key acupoints such as Nei Guan (PC6), Shen Men (HT7), and points along the bladder meridian and the spine (as shown in Figure 3). This can help children regulate their autonomic nerves and intestinal function more quickly, thereby relieving multiple symptoms of pediatric PASC.

According to Xie Kaisen, Vice President of China Medical University Children's Hospital, the fifteen most common symptoms of post-COVID-19 children are fatigue, dyspnea, chest pain, decreased physical strength, and problems affecting memory and concentration. Following the peak of this year's epidemic, these have become clinical symptoms for which children and adolescents have sought outpatient treatment. Parents still need to be very careful about various health warnings, such as children's decreased immunity.

      Furthermore, Dr. Wan-Yu Lai specifically offers the "L•O•V•E" formula for the care of the 2.05 million post-infection children and adolescents. This is aimed at providing guidance for parents in the post-pandemic era and encourages caregivers to spend more time with and listen to the children, to alleviate the negative psychological impact of post-COVID-19 sequelae. Despite the need to wear masks, outdoor activities and sunbathing remain good methods for distraction and mood recovery. To avoid immune debt, regular vaccination is still necessary. For diet, various whole foods should be chosen, and cold, fried, and irritating foods should be avoided to prevent exacerbating damp-heat intertwined symptoms after recovery.

Director Lai Wanyu of the Pediatric TCM Department at China Medical University Hospital explained that for children with post-COVID-19, damp-heat clearing drugs can be used initially. During the recovery period, prescriptions for dampness-removing and spleen-strengthening such as Shenling Baizhu Powder and Liu Junzi Tang can be used, or Qi-nourishing and Yin-nourishing prescriptions such as Shengmai Yin and Zhi Gan Cao Tang can be taken. During recover, Four-God Soup can be stewed and paired with Coix seed to enhance dampness removal and spleen strengthening. Additionally, children who cannot take oral Chinese medicine can also use medicated baths with Chinese medicinal materials like Fangfeng, Huangqi, Baizhu, and Guizhi for bathing and fumigation, which can help to strengthen the body and remove evil, invigorate Qi, and consolidate the exterior.

      How to help 2.05 million children and adolescents to recover their health after being infected with COVID virus. Dr. Wan-yu Lai has shared the "L.O.V.E. " four mnemonic phrases to help parents take care of their children and adolescents in the post-pandemic era. The four steps include spending more time with and listening to children, encouraging outdoor activities, maintaining routine vaccinations, and choosing a healthy diet to avoid exacerbating symptoms of damp-heat after recovery.

1. First step L(Love):

Practice the "Four Ones Love" - At least four days a week, at least one hour each time, spend more time with your children, offer more positive encouragement, and actively listen.

2. Second step O(Out):

Engage in more outdoor activities. The World Health Organization recommends that children and adolescents should have at least one hour of moderate physical activity every day. Outdoor activities allow for sunlight exposure, which aids in Vitamin D absorption and can help slow down myopia. It's a win-win situation.

3. Third step V(Vaccine):

To avoid immunodeficiency, remember to have your child receive regular vaccinations, including the flu vaccine.

4. Fourth step E(Eat):

For one month after the diagnosis, avoid cold drinks, icy foods, and cold-natured foods. Maintain a balanced diet. If the child is prone to recurrent colds, foods rich in vitamins A, C, and D should be consumed more. If experiencing fatigue or brain fog, supplement more foods rich in Vitamin B and Omega-3 fatty acids.

Director Lai Wanyu of the Pediatric TCM Department at China Medical University Hospital suggests that parents can help their children with spine-pinching massage, which can help boost Yang Qi, regulate Yin-Yang balance, help children adjust their autonomic nerves and intestinal function, and help alleviate multiple symptoms of children's post-COVID-19 syndrome.

      China Medical University Hospital offers a comprehensive integrated care service of traditional Chinese and Western medicine. Through the integration and exchange of information systems, pediatricians from both medical practices can communicate in real-time to quickly grasp the patient's condition. By combining reminders about medication safety of Chinese and Western medicines, an additional layer of supervision ensures the quality of care for children and adolescents after a COVID-19 infection. If there are still discomforting symptoms lasting for more than a month after a COVID-19 infection, or if symptoms have severely affected daily life, the patient can be examined at the Post-COVID-19 Pediatric Special Outpatient Clinic. After diagnosis, further recovery can be aided by pediatric TCM doctors to help the child regain health.