Children with post-COVID syndrome carry socio-educational burden

Paediatric post-COVID syndrome (pPCS) brings a substantial socio-educational burden that must be included in medical, social, and educational care, suggests a study.

“[T]he biopsychosocial and educational impact of pPCS is major among affected adolescents, and these elements should be systematically characterized using appropriate scales and need to be taken into account by professionals in medical, social, and educational care,” the researchers said.

This prospective, single-centre study examined data of pPCS patients presenting to an institution between May 2021 and November 2022. Researchers evaluated functional impact by assessing school absenteeism and by using the Adolescent Depression Rating Scale (ADRS), Pediatric Quality of Life Inventory (PedsQL), and Fatigue Severity Scale (FSS).

Fifty patients (median age 14.0 years, 70 percent female) were included in the analysis. Extreme fatigue (84 percent) and exertion intolerance (82 percent) were the most common symptoms, followed by orthostatism (66 percent), dyspnoea (66 percent), and headache (66 percent). One in four patients (25 percent) had an abnormal Schellong test. [Pediatr Infec Dis J 2025;44:228-233]

The median ADRS, PedsQL, and FSS scores were 3.0, 56 percent, and 45.0, respectively. Of the patients, 60 percent experienced partial (34 percent) or complete (26 percent) school absenteeism. Child psychiatry (48 percent) was the most common referral to a specialized consultation, followed by pulmonology (46 percent), physiotherapy (36 percent), and an ear-nose-throat specialist (24 percent).

Most of the patients (80 percent) presented with a typical form of pPCS, while the rest (20 percent) had a clinical presentation indicating a functional disorder triggered by COVID-19. The latter had more frequent thoracic pain (p=0.012) and more referrals to paediatric neurology (p=0.01), gastroenterology (p=0.011), ophthalmology (p=0.037), and child psychiatry (p=0.035), but less to pulmonology (p=0.014).

In addition, patients in the latter group had more school absenteeism and social withdrawal, with more severe PedsQL and ADRS scores.

“Larger studies are needed to confirm the two different pPCS phenotypes, including their management and outcome,” the researchers said.

Educational component

In further analysis of the PedsQL scale, the researchers found that the educational component of the children’s lives was more heavily affected than the social component. They also observed difficulties with memorization, attention, and absenteeism. [Med Care 2001;39:800-812]

“Reassuringly, despite the potential reduced in-person interaction and the temporary shift to online learning, the quality of social life remained largely unaffected,” the researchers said. “It raises the question of whether social networks may have participated in keeping social life more active. [J Adolesc Health 2020;67:179-185]

Additionally, nearly a third of patients met the ADRS criteria for a depressive state. While the risk of depression is generally high among adolescents than adults, this was further exacerbated by the pandemic that brought significant changes to the environment. [Br J Clin Psychol 2022;61:287-305; Lancet 2021;398:1700-1712; J Affect Disord 2022;296:567-576]

PCS may have caused the impacts on quality of life and depression in children, but it is possible that the environment in which patients evolved during the pandemic (eg, lockdown, social distancing) played a significant role.

“Indeed, during this period, the quality of life and mental health in adolescents were altered, with an increased reporting of anxiety and depression,” the researchers said. “Therefore, it is difficult to discriminate between the relative contributions of PCS and the general environment to the children’s quality of life at that time.” [Psychiatry Res 2020;293:113429; JAMA Netw Open 2023;6:e2349613]