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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Short Summary
In this RECOVER study, researchers wanted to learn how Long COVID affects everyday functioning of children, teenagers, and young adults. Researchers examined the electronic health records (EHRs) of 686 children and young adults under 21 years old, including 651 who got COVID-19 and received care in 21 hospitals in the US. They compared young people who had Long COVID to those who had COVID-19 but did not have Long COVID. They found that young people with Long COVID were more likely to have trouble in school, need extra school support, and develop new or worsening behavioral or mental health issues like anxiety and depression. This study is important because it highlights that doctors should ask about school, daily activities, and emotional well-being when caring for young people who had COVID-19. Long COVID can affect these parts of everyday life and shows that extra support is needed.
This summary was prepared by the RECOVER Initiative.
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