Functional outcomes of children after SARS-CoV-2 infection: An EHR-based cohort study
Case, A; Botdorf, M; Marchesani, N; et al., Journal of Pediatric Rehabilitation Medicine, July 2026
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Publication Details
DOI: 10.1177/18758894261460624
Abstract
Background: Clinical manifestations of the post-acute sequelae of SARS-CoV-2, or Long COVID, have been well-described. However, few pediatric studies explore the impact on everyday function. The objective was to describe functional outcomes for children and youth with Long COVID.
Methods: A retrospective cohort study of individuals < 21 years of age with COVID-19 infection seeking care at 21 children's hospitals across the United States was conducted. Using a systematic chart review, children with confirmed Long COVID were identified by clinician adjudication between March 2020 and December 2022. Outcomes were compared to children with COVID-19 infection without confirmed Long COVID. Functional impairments included difficulty participating in school and extracurricular activities, new referrals to rehabilitative therapies, newly modified education plans, and new or worsening mental health symptoms. Descriptive statistics and logistic regression were used to evaluate these outcomes among children with and without Long COVID.
Results: Among 686 children with completed chart review, 651 (95%) had a COVID-19 diagnosis. Functional impairment was documented in 139 (21%) children, of which 59 had clinician-adjudicated Long COVID. Compared to infected children without Long COVID, children with Long COVID had higher odds of school decline (OR 3.5, 95% CI 1.6-7.9, p = 0.002), school support (OR 2.4, 95% CI 1.2-5.0, p = 0.014), and new or worsening behavioral or mental health symptoms (OR 4.6, 95% CI 2.1-9.2, p < 0.001).
Conclusions: Significant functional impairments exist among children and youth following SARS-CoV-2 infection and serve as a reminder to clinicians evaluating children with Long COVID to explore everyday function. Future prospective studies with longer follow-up are underway.
Authors
Abigail Case, Morgan Botdorf, Nicole Marchesani, John E Leikauf, Rebecca Letts, Christine Maughan, Megan L Fitzgerald, Miranda Higginbotham, Aparna C Swaminathan, David Liebovitz, Deepika Thacker, Dima Dandachi, Jennifer A Muszynski, Kari Wellnitz, Nathan M Pajor, Ravi Jhaveri, Sandy L Gonzalez, Suchitra Rao
Keywords
functional outcomes; neurocognitive outcomes; pediatric long COVID; post-acute sequelae of SARS-CoV-2 infection; retrospective cohort study