Things to know about Long COVID in children and adolescents

So far it is not known exactly how many children and adolescents are affected by Long COVID. Further research is still needed on this. However, the illness seems to occur less frequently in this age group than in adults.

Long-term health consequences of other viral illnesses are also known. However, current studies indicate that they occur more frequently and last longer after infection with the SARS-CoV-2 corona virus than, for example, after a seasonal flu (influenza). 

There are various factors influencing the probability of Long COVID. In children and adolescents, Long COVID is more common in:

• Girls and young women
• Adolescents
• Presence of certain pre-existing illnesses
• repeated infections with the corona virus

The probability of Long COVID is also greater if the progression of COVID-19 has been severe. However, it is also possible to develop Long COVID even after a mild or ailment-free progression of COVID-19. 

Within the first 3 months after infection, the frequency of Long COVID ailments decreases significantly, especially in younger children. 

Further general information on the frequency of Long COVID can be found as the answer to the question “How common is Long COVID?”.

Last update: November 2024

Long COVID can lead to various ailments in children and adolescents, with several often occurring simultaneously. These ailments can severely affect daily lives to varying degrees. In many cases, the illness improves within a few months. However, it is also possible for the illness to persist over a longer period.

Common signs of illness in children and adolescents

Prolonged weakness and exhaustion (“fatigue”) are among the most common ailments associated with Long COVID. A person may feel exhausted particularly quickly or need an unusually high amount of rest. However, the ailments may hardly improve at all or only for a short time with breaks or sleep. Fatigue is often accompanied by so-called stress intolerance (“post-exertional malaise”, PEM in short). It is possible that the ailments worsen even after slight mental or physical exertion. 

Circulatory problems can be manifested, for example, by a high pulse rate when straightening up or standing up. Dizziness, light-headedness, palpitations, or a feeling of weakness often occur.

In very rare cases, children and adolescents can also develop the most severe form of Long COVID: ME/CFS (Myalgic encephalitis/Chronic Fatigue Syndrome). The lifestyle of some of those affected is severely restricted. You can find more information on ME/CFS under the question “Do Long Covid and ME/CFS overlap?”.

Last update: November 2024

If parents or other legal guardians suspect that their child has Long COVID, they should first visit the paediatric or GP practice. 

An initial explanation of the ailments can be done in the practice. The ailments are enquired about in a discussion. The child is physically examined and blood is taken for testing, if necessary. This should initially rule out other causes for the ailments.

If necessary, the doctor can also refer you to another specialist practice. There are now also several Long COVID specialist practices for children and adolescents as well as special consultation hours in clinics. The possibility of rehabilitation can also be discussed with the doctor.

You can search for Long COVID outpatient clinics in our service section using the regional clinic search. If you enter “children” in the search function, you will find a list of care services specifically for children and adolescents. You can also find specialised outpatient clinics via the Telephone service.

Last update: November 2024

It is possible that Long COVID can affect the day-to-day school life of children and adolescents. Problems with concentration and memory in particular, as well as tiredness, exhaustion and limited resilience may cause problems. 

Families should therefore seek contact with the school and inform them about the clinical picture. Possibilities can be discussed together, whether and how everyday school life can be adapted to the needs of the child or adolescent. An illness-related special role that goes beyond what is necessary should be avoided wherever possible. In individual cases, however, various adjustments are possible within the framework of compensation for incapacity or special regulations. Such adjustments could include more time for individual tasks and an adapted management of breaks and homework. 

Last update: November 2024

Long COVID can affect all areas of the lives of children and adolescents. Relatives therefore play an important role. They can help adolescents to cope with everyday life with the illness as well as possible.

General strategies in day-to-day life

Parents and other relatives can provide support in learning coping strategies and incorporating them into everyday life. Children and adolescents should concentrate on activities that do them good. These could be listening to audio dramas or playing board games in bed, for example. Learning relaxation techniques can also help. These can be Yoga or mediation exercises such as the body scan, or the “Mindfulness-Based Stress Reduction” (MBSR) programme. In some cases, singing lullabies also relaxes younger children. The melodies are often simple and calming and help in regulating the breath. Targeted breathing and circulatory exercises are helpful in case of shortness of breath or circulatory problems. It is also important to get enough sleep and ensure good sleep hygiene. You can find out more about targeted exercises and good sleep hygiene in the question “What can the affected persons themselves do in case of Long COVID ailments?”.

Pacing

Children and adolescents with Long COVID frequently suffer from fatigue and stress intolerance. In these cases, “Pacing” is an important strategy to conserve one’s own energy. Pacing means listening carefully to your own body and rationing your energy correctly. This includes recognising and adhering to your own stress limits. If these are exceeded, a “Crash” can occur, in which the ailments worsen for a short or longer period of time. Parents or other legal guardians can use the “Spoon theory” to help children and adolescents understand the concept of pacing: only a limited number of “Spoons of energy” are available each day. These spoonfuls of energy should therefore not be used up in the morning, but spread throughout the day. 

A diary can help to consciously observe your own behaviour and its consequences. Thus, activities and regular breaks can be planned in advance over time. For example, you can monitor how much exercise is good for you and then use a pedometer to set an upper exercise limit. Smartwatches enable you to monitor your pulse rate and avoid overexertion. Incorporating targeted relaxation exercises can also be helpful sometimes. Especially in the case of younger children, close relatives should make sure that the child does not exceed its own stress limits.

Aids

Long COVID can manifest itself through various ailments, which can also be of varying degrees. Some affected persons cope with their day-to-day life easier with sunglasses, an eyepatch, or noise-cancelling headphones. If children and adolescents are severely affected, aids such as a shower chair or an electric wheelchair are required. Parents and other legal guardians can seek advice from the paediatrician on such aids and any options of cost reimbursement.

Social and mental support

Long COVID also puts mental strain on children and adolescents in many a cases. It is important that relatives express understanding for the ailments and offer comfort and support. In many cases, the concerns expressed are understandable, such as the fear of losing friends or missing the school year. 

Contact with peers plays an important role at this age. Parents and other legal guardians should try as much as possible to prevent the affected children and adolescents from withdrawing too much. They can help in organising joint activities. However, maintaining friendships while having Long COVID can pose a challenge. In case of fatigue or stress intolerance, it is helpful to plan brief periods of contact and limit these to 15 minutes, for example with the help of a timer. If personal meetings are too strenuous, virtual meetings or chats can be a good alternative. The social network should consist of persons who understand the illness and offer support. Parents and other legal guardians contribute in educating those around them by sharing their knowledge about the illness. An overview of Long COVID can be found in the Flyer on our website. 

In some cases, it is helpful to arrange meetings with other children and adolescents affected by Long COVID and to be able to share experiences. You can find out more about the possibility of networking in self-help groups under the question “Where can affected families find self-help groups or online communities on the topic of Long COVID?”.

In case of problems at school, parents and other legal guardians can provide support, for example, by seeking contact with the teaching staff. You can find out more under the question “What can relatives do if their child can no longer concentrate well at school?”.

If children and adolescents are suffering severely from mental health problems, they should contact the doctor treating them. Thus, psychological support can be provided if necessary.

Last update: November 2024

In some cases, children and adolescents are so severely restricted by Long COVID that they require care. You should then discuss with your doctor whether you can apply for a care degree or a degree of disability. In case of a care degree, you are entitled to care insurance benefits, among other things. 

In the case of Long COVID, various benefits for participation may also be considered. Free information on this topic is provided, for example, by the supplementary independent participation counselling (EUTB ®). Here, the affected families can obtain advice on the possibilities for support in their personal situation. Nearby care counselling centres can be located via Website of the Centre for Quality in Care (ZQP). 

An in-depth article on Support and counselling for children and adolescents in need of care is available on the portal gesund.bund.de of the Federal Ministry of Health.

The affected families can also find support in self-help groups. Read more about this in the answer to the question “Where can affected families find self-help groups or online communities for children and adolescents with Long COVID?”.

Last update: November 2024

The causes of Long COVID have not yet been fully understood. Researchers assume that there are various reasons why someone falls ill with Long COVID. These include persistent inflammation and changes in the immune system and the nervous system. 

The extent to which the mind plays a role in the development of Long COVID is still insufficiently known. Sometimes, the symptoms of Long COVID can resemble the symptoms of mental illness. Palpitations, for example, can occur with both Long COVID as well as anxiety disorder. Prolonged exhaustion can also be a sign of depression. Therefore, the paediatrician must first rule out other illnesses, before Long COVID is diagnosed.

Conversely, physical ailments can put children and adolescents under a great deal of mental strain. Affected adolescents can, for example, express the understandable fear of losing touch with friends or missing out on the school year. If a child or adolescent is under severe mental stress, psychotherapeutic support can be considered. The paediatric practice or GP practice is the first contact point for this. They can refer such support if required. On the website of Deutsche Psychotherapievereinigung, you yourself can also search for psychotherapists for children and adolescents and then make an appointment for an initial consultation. 

You can find information on how relatives can provide support for mental health problems under the question “How can relatives support their child in coping with everyday life?”.

Important to know: Unfortunately, there are still many prejudices against people suffering from Long COVID. Some people, for example, assume that a sick child is not doing something only because he/she does not feel like it. Ignorance about the clinical picture fosters such thinking. It is therefore important that relatives share current knowledge about the illness with their social environment. An overview of Long COVID can be found in the Flyer on our website.

Last update: November 2024

Talking to other families about day-to-day life with Long COVID can prove to be helpful. You are not alone in this challenging situation and may be able to benefit from the experiences of others. 

You can find self-help groups in many places or even online. A list of self-help groups on the topics of COVID-19 and Long COVID is provided by the National Contact and Information Centre for the Encouragement and Support of Self-Help Groups (NAKOS).  You can also search via the Long COVID platform of the Federal Self-Help Working Group (BAG Selbsthilfe). 

Last update: November 2024

Children and adolescents can be affected just like adults by the long-term health consequences following an infection with the SARS-CoV-2 corona virus. However, children and adolescents appear to be less likely to contract Long COVID than adults overall. However, exact estimates of the frequency of Long COVID in this age group are not yet possible due to the limited number of studies in children and adolescents, with partly heterogeneous results. 

Furthermore, in children and adolescents, it is also particularly challenging to differentiate the long-term health consequences, after infection with the corona virus, from other health consequences of the pandemic. Such other consequences can arise, for example, from the fact that children and adolescents had fewer social contacts during the pandemic and that there was temporary distance learning.

The Robert Koch Institute (RKI) on its website provides an overview of the current scientific status of Long COVID. 

Further general information on the frequency of Long COVID can be found in the answer to the question “How common is Long COVID?”.

Last update: November 2024

Long COVID can be associated with a variety of symptoms in children and adolescents. These can severely affect the daily lives of adolescents to varying degrees. 

The following graphic summarises the most common symptoms in children and adolescents: 

Cognitive disorders are often referred to as “Brain Fog” in Long COVID. Children and adolescents that are affected have difficulty concentrating, thinking in a structured manner, understanding contexts, and memorising things, for example.

Another common symptom with Long COVID is prolonged exhaustion (Fatigue). In the majority of affected children and adolescents, it is accompanied with stress intolerance or Post-Exertional Malaise (PEM). These ailments can worsen after even minor everyday efforts such as having a conversation, brushing teeth, or doing household chores (so-called “crash”). In addition to physical, this also applies to cognitive and emotional efforts. This change for the worse usually only sets in after several hours or the next day. It can persist for hours, days or weeks or even lead to permanent deterioration of the condition. 

Circulatory problems in case of Long COVID can take the form of orthostatic dysregulation, for example as part of postural orthostatic tachycardia syndrome (POTS). POTS is characterised by an excessive increase in the pulse rate, while blood pressure drops only imperceptibly. It is often associated with dizziness, light-headedness, palpitations, and weakness, but can also cause a number of other symptoms.

If severe fatigue with stress intolerance and other ailments such as cognitive disorders, sleep disorders, pain, circulatory problems, or flu-like symptoms persist for longer than 3 months, the presence of ME/CFS (Myalgic Encephalitis/Chronic Fatigue Syndrome) should be checked. ME/CFS is a severe chronic multisystem disease, which is often caused by a viral disease. It can be accompanied by considerable physical and cognitive limitations. Severely affected children and adolescents are usually in need of care.

You can find more information on Long Covid and ME/CFS at “Are there overlaps between Long Covid and ME/CFS?”.

Last update: November 2024

Based on current information, various factors increase the risk of Long COVID in children and adolescents. Long COVID is more likely to occur in:

• the female gender
• teenagers
• Presence of certain pre-existing illnesses
• an initial severe bout of COVID-19
• Reinfections with the SARS-CoV-2 corona virus

You can find more general information on risk and protective factors as an answer to the question “What influences the personal risk of contracting Long COVID?”.

Last update: November 2024

According to the WHO definition (2023), children and adolescents are said to have Long COVID if 

• there is a confirmed or suspected infection with the SARS-CoV-2 corona virus and
• ailments occur within 3 months of the infection, which persist for at least 2 months. 

The symptoms can either persist after acute illness of COVID-19 or recur after an initial recovery phase. It is also possible that after an initially mild or asymptomatic infection, new ailments may occur later on. Fluctuating developments and relapses are also possible. 

Basic diagnosis

If Long COVID is suspected, the initial assessment should be carried out in a paediatric practice or a GP (general practitioner) practice. When taking a medical history, it is important to look for typical symptoms. These include fatigue, stress intolerance or post-exertional malaise (PEM), pain, cognitive disorders, depressive symptoms, and anxiety disorders. 

With the help of a physical examination and basic laboratory diagnostics, other causes for the ailments should be ruled out. You can find more information on initial diagnosis in the May 2024 update of the S1 guideline “Long/Post-Covid”.

Symptom-orientated diagnosis

As part of diagnosis, particular attention must be paid to possible existence of stress intolerance or Post-Exertional Malaise (PEM). You can find more information on PEM as an answer to the question: “What are the most common ailments that children and adolescents with Long COVID have?”. As overexertion can lead to permanent deterioration in the condition of affected children and adolescents, it is particularly important to recognise the relevant signs as early as possible. This is the only way to prevent further deterioration in the best possible way using suitable strategies.

If severe fatigue with stress intolerance and other ailments such as cognitive disorders, sleep disorders, pain, circulatory problems, or flu-like symptoms persist for longer than 3 months, the presence of ME/CFS (Myalgic Encephalitis/Chronic Fatigue Syndrome) should be checked. 

To assess an orthostatic intolerance, for example in the form of a postural orthostatic tachycardia syndrome (POTS) or orthostatic hypotension, a 10-minute passive standing test is recommended. Depending on the available options, this can be done leaning against a wall, for example. A tilting table examination can also be carried out, if it is available.

Further diagnosis

Further diagnosis, for example in a specialist practice or a special outpatient clinic, is advisable in the event of abnormal findings in the basic diagnosis and a need for further assessment of the ailments.

In our service section, you can search specifically for clinics and special outpatient clinics for children and adolescents with a focus on Long COVID.

You can find more suggestions for the diagnostic procedure at Consensus paper by the Convent Societies of the German Society for Paediatrics and Adolescent Medicine (DGKJ). The publication of an S2k guideline “Diagnosis and treatment of Long COVID in children and adolescents” is planned for 2025.

Last update: November 2024

Long COVID, as a relatively new clinical picture with many aspects that are still insufficiently researched, poses a challenge for all those treating it. Unlike other diseases, one cannot yet draw on many years of experience in this area. Particularly in the field of paediatrics and adolescent medicine, data is limited and fewer official recommendations are available than for adults. 

Many doctors therefore understandably feel unsure about diagnosing and treating Long COVID. Even affected families often are aware that the clinical picture is still not fully understood. The current limits of knowledge in medicine regarding Long COVID should be addressed transparently. 

The availability of appointments and places in special outpatient clinics and hospitals represents another challenge. Although there are now various contact points for patients with Long COVID ailments, the number of paediatric services is currently still low and the demand is high. Keeping this aspect in mind, it is all the more important that outpatient physicians and other practitioners keep expanding their knowledge of the diagnosis and treatment of Long COVID. The paediatric or GP practice can coordinate any necessary further assessments with specialist practices as well as supportive treatments such as physiotherapy, breathing therapy, occupational therapy or even rehabilitation. Before initiating inpatient, acute, or rehabilitative measures, it is recommended that the resilience of the affected children and adolescents be checked. Furthermore, the extent to which inpatient setting is suitable should be clarified in a personal discussion between the host facility and the families concerned.

Last update: November 2024

At present there is no causal treatment for Long COVID. The focus is on symptom-orientated treatment, in which physical and psychological aspects should be given equal consideration. 

The treatment should improve or at least maintain the quality of life, encourage coping up with everyday life and counteract chronification. Different treatment approaches are important depending on which ailments are present. These include: 

• Physiotherapy (e.g. remedial gymnastics, breathing therapy)
• Logopaedics
• Occupational therapy
• Dietetic treatment
• Psychotherapy/psychosomatic basic care
• Prescription of medical aids

Medicinal therapies can also be used to relieve symptoms. As there are currently no specifically approved medicines for treating Long COVID, experience with other post-infection syndromes can provide orientation. Sometimes, consulting a centre specialising in this area can be useful. Some of these centres offer paediatric or child and adolescent psychiatric advice on medicinal treatment in the form of digital, interdisciplinary case conferences or teleconsultations. 

The respective treatments should be coordinated jointly with the affected children and adolescents, and their relatives. Activating measures can have negative effects in children and adolescents with fatigue and stress intolerance (post-exertional malaise, PEM). You can read more about this in the paragraph “Physical activity, Post-Exertional Malaise (PEM) and Pacing.”.

Regular check-ups are advisable as part of the treatment in order to evaluate the effectiveness of the treatment measures and to adjust them, if necessary. For children and adolescents who are confined to the house or to the bed, these can take the form of telemedical or consulting visits. The paediatric or GP practice should coordinate the treatment, including any necessary appointments with specialists and inpatient or rehabilitation measures. In urgent or even severe cases, referring to a specialist centre may be advisable. Capacities here are limited so far. You can search for suitable centres using the regional clinic search in our service section. If you enter “children” in the search function, specific paediatric care services are displayed.  

Basically, interdisciplinary cooperation between doctors from different specialist disciplines, therapeutic staff, social and care services, and the relevant authorities is essential, especially in complex cases. Medical staff can also contribute towards ensuring that affected children and adolescents receive the best possible support in other areas of their lives. For example, the possibilities of participating in school while having Long COVID can be discussed with teachers. In case of severe, chronic progressions, it sometimes makes sense to apply for a care degree or degree of disability (GdB). In such cases, doctors can advise the families concerned at the appropriate time. You can find more information on support options for affected families at: “How can doctors support the families of children and adolescents with Long COVID?”.

Physical activity, Post-Exertional Malaise (PEM) and Pacing

Physical activity should only be resumed with caution after an infection with the SARS-CoV-2 corona virus. After an infection, children and adolescents can develop fatigue and stress intolerance (post-exertional malaise, or PEM in short). In addition, a stress-induced drop in the oxygen concentration in the blood (oxygen desaturation) and abnormalities of the heart (cardiac anomalies) are described. In case of PEM, overexertion can lead to short-term or even permanent deterioration. However, short-term tiredness after physical activity is normal and should not be confused with PEM. You can find more information on PEM as an answer to the question: “What are the most common ailments that children and adolescents with Long COVID have?”.

If PEM is present, activating therapies are contraindicated, as the negative effects may outweigh. It is then important to align all activities with the individual stress limits. This activity and energy management is also known as “Pacing”. Pacing is intended to prevent the condition of affected children and adolescents from deteriorating. The approach was developed as part of ME/CFS research and is also recommended by the Europe-wide ME/CFS research network, EUROMENE. You can find more information on Pacing as an answer to the question “What is Pacing?”.

More information

You can find more information on the diagnosis and treatment of Long COVID in children and adolescents in the Consensus paper by the Convent Societies of the German Society for Paediatrics and Adolescent Medicine (DGKJ). The publication of an S2k guideline “Diagnosis and treatment of Long COVID in children and adolescents” is planned for 2025. 

Last update: November 2024

You can find detailed information on diagnosis and treatment in various guidelines and consensus papers. These include:

• the consensus paper “Standardised basic care of children and adolescents with Long COVID” of the DGKJ Convent Societies
• the section “Paediatric aspects” of the S1 guideline Long/Post-COVID
• the “Interdisciplinary, collaborative D-A-CH Consensus Statement on the Diagnosis and Treatment of Myalgic encephalomyelitis/Chronic Fatigue Syndrome”

The publication of an S2k guideline “Diagnosis and treatment of Long COVID in children and adolescents” is planned for 2025. 

There are also various advanced specialised training courses. You can find more information on the website of Post-COVID-Netzwerk der Charité.

Last update: November 2024

The causes of Long COVID have not yet been fully researched. Various somatic causes of illness are discussed (See also “Why and how Long COVID develops?”). The extent to which psychosomatic aspects play a role in the development and continuation of Long COVID is still insufficiently clarified. 

In the wake of Long COVID, psychological ailments such as anxiety or depressive symptoms are possible in children and adolescents. As with other serious or chronic illnesses, these can also develop reactively as part of illness-related stresses.

In practice, it may also be difficult to recognise the symptoms of Long COVID as such and to distinguish them from psychosomatic or psychological ailments. One example is palpitations triggered by postural orthostatic tachycardia syndrome (POTS), which can be mistakenly interpreted as a sign of an anxiety disorder in children and adolescents. The same goes for fatigue, which can be interpreted as a symptom of depression.

In this age group, it is also challenging to distinguish psychological stress due to pandemic-related restrictions such as distance learning and social isolation from ailments caused by long COVID. 

For medical practice, it is most important to take the ailments of affected children and adolescents seriously. In this context, it is important to look at adolescents from all angles and treat them accordingly. The basis is formed by careful somatic and psychological diagnosis. If there is psychological stress or uncertainties about the categorisation of the ailments, further differential diagnosis or treatment should be carried out in close interdisciplinary collaboration between paediatricians, psychologists and child and adolescent psychiatrists. If there are no indications of psychological stress during diagnosis, then psychological support should only be provided at the express request of the child or adolescent concerned.

Last update: November 2024

Open and empathetic communication with the affected children, adolescents and their relatives is particularly important. Affected families are sometimes subject to being stigmatised. It therefore helps them a lot if their illness and individual concerns are taken seriously. Basically, it is important to give families hope and to convey good prognosis of the illness in children and adolescents. At the same time, practitioners should not ignore the possibility of a severe progression of the illness.

Children and adolescents with Long COVID are often caught in a conflict between somatic and psychological diagnoses and sometimes experience insufficient care, excess care, or incorrect care. As part of their coordinating function, the doctors in charge should therefore arrange the necessary interdisciplinary examinations and treatments and monitor their progress. When making diagnostic and therapeutic decisions, care must be taken to reach a joint decision with the affected families. For affected families, it often creates trust, when doctors transparently communicate the existing limits of knowledge in medicine regarding this relatively new illness. 

Basically, close co-operation with various institutions such as authorities, schools, health insurance companies and pension insurance providers should be sought. Everyday school life in particular can be a major challenge for affected children and adolescents or, in severe cases, it can be no longer possible as it used to be. Here, medical assessment is important in order to find individualised solutions for school participation together with educators. In addition, doctors can inform affected families about suitable social counselling services. These include the counselling service of the Supplementary, independent participation counselling (EUTB ®).

Children and adolescents have long-term or severe cases of Long COVID in rare cases. A need for care brings with it various challenges for the affected families - also with regard to financial and social law issues. Doctors should then discuss with the concerned families whether and when to apply for a care degree or a degree of disability. The options of care counselling can be pointed out. Nearby care counselling centres can be located via Website of the Centre for Quality in Care. 

Last update: November 2024

Although Long COVID has been the subject of intensive research since the illness became known, there are still many aspects that are not sufficiently known. There is still a lack of evidence, particularly in the paediatric field. The current focus of national and international research on Long COVID is on epidemiological and care research as well as research into pathogenesis, symptoms, diagnosis, and treatment.

The Robert Koch-Institut (RKI) in its Questions and answers provides information on some current research projects, among other things. You will also find information on funded projects on the website of the Federal Ministry of Education and Research (BMBF). 

You will find a selection of scientific publications in our service section. Current publications are added there every month.

Last update: November 2024

In very rare cases, a severe inflammatory reaction can occur in children and adolescents after infection with the SARS-CoV-2 corona virus or illness from COVID-19. This is known as “PIMS” (Paediatric Inflammatory Multisystem Syndrome) or also as “MIS-C” (Multisystem Inflammatory Syndrome in Children). According to the current definition, this clinical picture does not belong to Long COVID due to its acute progression.

PIMS or MIS-C usually occurs around 3 to 4 weeks after infection with the corona virus. Typical symptoms include fever, pain, low blood pressure, vomiting, diarrhoea, rash, and fatigue. In addition, certain inflammatory markers in the blood are elevated. It is also important to rule out possible causes besides COVID-19 for the observed signs of illness.

Some of the affected children and adolescents have to be treated in intensive care. However, the disease can now be treated easily. So far, there have been no deaths reported in Germany, and in less than 10 per cent of cases consequential damage after the acute illness. The risk of contracting PIMS is significantly lower with the Omicron variant than with previously known virus variants.

Last update: November 2024

Long COVID can manifest itself in a variety of ways in children and adolescents just like in adults. In most cases, children and adolescents only have mild ailments, which improve on their own within a few weeks or months. In other cases, the ailments persist for a longer period. 

It is not always easy to recognise the relevant signs in everyday life at school or day-care. However, educators have an important role to play here. If they notice such signs, these should first be discussed with the parents or legal guardians. If Long COVID is diagnosed by a doctor, various treatments and support options can be considered.

Basically, there are no ailments specific to Long COVID. One of the things that can make young children stand out in day-care centres or in child care is that they are increasingly tired or irritable. They may also be more withdrawn than usual. Present evidence indicates that Long COVID occurs less frequently in young children than in adolescents and adults. 

In schoolchildren, the illness can become apparent when the following signs appear again over a longer period of time:

• prolonged exhaustion (“fatigue”)
• Problems with concentration and memory
• Drop in performance
• Tiredness, falling asleep in class
• Sensitivity to light and noise
• Circulatory issues
• Headache
• Muscle and joint pain
• Shortness of breath, breathlessness

Prolonged weakness and exhaustion (“fatigue”) are among the most common ailments associated with Long COVID. Affected children or adolescents may feel exhausted particularly quickly or need an unusually high amount of rest. However, the ailments hardly improve or only improve for a short time after a rest period. Fatigue is often accompanied by so-called stress intolerance (“post-exertional malaise”, PEM in short). The ailments can worsen even after slight mental or physical exertion. An affected pupil may then complain of increasing pain and exhaustion after sports. Or a pupil reports a feeling of emptinessor increasing fog in their head (so-called “brain fog”) after carrying out several tasks. Repeated overexertion can even lead to permanent deterioration in children and adolescents with stress intolerance. It is therefore particularly important for these adolescents to know their stress limits and not to exceed them. 

In particularly severe cases, the illness ME/CFS (Myalgic Encephalitis/Chronic Fatigue Syndrome) can occur after infection with the SARS-CoV-2 corona virus. This chronic illness often severely impairs the day-to-day life and the ability to participate of those affected. Sometimes, attending school is no longer possible with ME/CFS. Information for teachers and parents of children and adolescents with ME/CFS is provided by the Socio-educational centre of the University clinic of Würzburg and the Elterninitiative ME/CFS-kranke Kinder & Jugendliche München e. V.

Last update: November 2024

Long COVID can lead to various ailments in children and adolescents. Problems with concentration and memory in particular, but also prolonged tiredness, exhaustion and limited resilience can impair physical and mental performance. Some children and adolescents have so-called “stress intolerance”. The ailments can worsen even after slight mental or physical exertion. This can also be reading a text or having a short conversation. 

In addition, just as with other chronic illnesses, the ailments and challenges associated with Long COVID can put psychological strain on affected children and adolescents. Fear of missing out on the school year or losing touch with friends can have a negative impact on learning success. Absenteeism caused by illness can sometimes make it difficult for affected adolescents to catch up with studies and keep up with the others. 

The extent to which learning and academic performance are affected by Long COVID is different for different people. While some children and adolescents perform as usual, others may stand out due to a drop in performance a few weeks after contracting COVID-19 illness. You can find further signs of Long COVID as an answer to the question “What can be the indications of a possible illness of Long COVID?”.

If Long COVID ailments persist, it is important to adapt everyday school life to the needs and stress limits of the pupil as far as possible.

Just like other chronic or serious illnesses, Long COVID can also have an impact on social interaction. Affected children and adolescents may find it difficult to participate in social activities due to prolonged fatigue or concentration problems, for example. Some sick children and adolescents react very sensitively to stimuli such as light and noise. Social situations such as group conversations or joint activities can then overstrain and exacerbate the ailments. 

It is possible that affected children and adolescents may withdraw because of the ailments. An informed and vigilant environment is therefore particularly important to prevent social isolation. Educational and social professionals can encourage social interactions through adapted activities. Such activities should take into account the energy level and individual resilience of the child or adolescent concerned. In addition to adapting group activities, alternative forms of participation may also be possible in individual cases. 

Last update: November 2024

In the wake of Long COVID, children and adolescents may experience mental ailments such as anxiety or depression. Worry about missing out on the school year or losing touch with friends are also understandable. The situation itself can also make children and adolescents frustrated and sad. 

Educational and social professionals can provide a safe space in which the child or adolescent can talk about their own feelings. It helps to validate these feelings. This can be done by signalling that such feelings are completely normal given the illness and the associated challenges. It is important to believe that the ailments are genuine and accept the stress limits described. Specialists can offer support and comfort. If possible, school psychologists or counselling services can also be consulted. If there is a suspicion of mental disorder requiring treatment, educational and social professionals should seek dialogue with the parents or legal guardians, so that appropriate treatment can be arranged if necessary.

Last but not least, participation in lessons is also important in order to mentally strengthen children and adolescents affected by Long COVID. 

Last update: November 2024

In addition to the illness-related stress, affected children, adolescents and their families are sometimes confronted with additional challenges. Some affected persons feel isolated because they are not understood by their environment or even face stigma. This is abetted by a lack of knowledge about Long COVID. 

Education can help prevent stigmatisation. Educational and social professionals should therefore actively share their knowledge with their colleagues wherever possible. For example, they can pass on reliable sources of information and organise collective case discussions or informational events. If this is not possible, a conversation in the staff room can also be helpful. The more colleagues have up-to-date knowledge about Long COVID, the more likely it is that standardised and appropriate care can be provided for affected children and adolescents.

The social environment plays an important role for children and adolescents in coping with the illness. Depending on the type and extent of the ailments, it can therefore make sense to educate classmates about the clinical picture in an age-appropriate manner. This promotes commensurate understanding and can favour a supportive and strengthening social network. An overview of Long COVID can be found in the age-appropriate Flyer on our website.

Last update: November 2024

Social services can play an important role in the coordination of support services. For example, they can establish connections between affected families and therapeutic services or forward official handouts to the respective institutions. 

Employees in youth welfare offices should also have knowledge of Long COVID. This is important, for example, if a pupil is only able to take limited part in lessons because of the illness. To ensure that the participation of the children and adolescents concerned takes centre stage, flexibility and individual decision-making are sometimes required.

Last update: November 2024

Long COVID is a complex illness, which is not yet fully understood. It can be accompanied by many different ailments and affect different areas of life. Close cooperation between all parties involved is therefore crucial in order to provide the best possible support for affected children and adolescents. Open and empathetic communication with parents or other legal guardians is particularly important. Affected families are sometimes subject to stigma. It therefore helps them a lot if their illness and individual concerns are taken seriously.   

Educational and social professionals can regularly talk to parents or other legal guardians about the health of the adolescent and ask about learning experiences at home. Specialists can also ask whether contact with the treating doctor is possible or even desired. This means that any necessary adjustments can be agreed upon with the treating doctors. This usually requires a release from doctor-patient confidentiality.

Open dialogue between affected families, teachers, school management, the school’s psychology service and treating doctors helps to find individual solutions for school participation. Support is available from the EUTB centres operating across Germany (Supplementary independent participation counselling). 

Last update: November 2024

So far, there are only limited online resources or specialised articles on Long COVID, which are specifically aimed at educational and social professionals. Information material on the topic of “Education and Long COVID” can be found at the “Bildung Aber Sicher” initiative. The initiative is a consortium of educational professionals, parents, pupils and committed citizens. Information on the topic of “Long COVID and School” is also available on the “Inclusion and school” website of the State Institute for School Quality and Educational Research Munich (ISB).

Information and tips for teachers and parents of children and adolescents with ME/CFS is also provided by the Social Paediatric Centre (SPZ) of the University clinic of Würzburg and the Elterninitiative ME/CFS-kranke Kinder & Jugendliche München e. V..

The SPC of the University Clinic of Würzburg also offers digital group training sessions for children and adolescents with Long COVID as well as their legal guardians and interested teachers. These training sessions provide comprehensive information about the symptoms and how to deal with Long COVID. 

Last update: November 2024