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Studies Examine School Challenges and Social Risk Factors for Children with Long COVID

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Long COVID in Children and Adolescents: New Research Highlights Academic and Social Challenges

Two recent studies published in peer-reviewed journals have analyzed factors associated with long COVID in children and adolescents, focusing on academic difficulties and social determinants of health.

Academic Performance and School Support

A study published in Academic Pediatrics examined the association between long COVID and school-related difficulties in children and adolescents. The research drew data from the RECOVER pediatric observational cohort, which included 1,976 participants aged 6–17 years (406 school-age children and 1,570 adolescents).

Key Findings

Approximately 18% of school-age children and 29% of adolescents with long COVID experienced worsened academic grades after the pandemic, compared to 7% and 11% of those without long COVID.

  • Higher proportions of individuals with long COVID reported moderate to severe difficulty paying attention and a lack of enjoyment when interacting with friends.
  • Approximately 35% of school-age children and 27% of adolescents with long COVID were attending or in the process of attending an Individualized Education Program (IEP), compared to 22% and 15% of those without long COVID.

Study Limitations

The study acknowledged several limitations. Data were reported by caregivers, which may introduce bias. Long COVID status was determined using a research index based on reported symptoms rather than a clinical diagnosis. Additionally, the cross-sectional design cannot establish causality, and the association between long COVID and IEP needs may be bidirectional.

Recommendations for Schools

The researchers suggested that students with long COVID may require targeted support, such as:

  • Extended test time
  • Frequent breaks
  • Modified physical education

They recommended that future research include objective neurocognitive assessments and explore mediating factors, including the role of pre-existing health conditions.

Social Risk Factors and Long COVID Risk

A separate study published in JAMA Pediatrics identified associations between social determinants of health and the risk of long COVID in children and adolescents. Researchers from Mass General Brigham analyzed data from 4,584 participants (903 children aged 6–11 years and 3,681 adolescents aged 12–17 years) recruited from 52 sites across the United States as part of the RECOVER initiative.

Participant Demographics

  • 51% identified as male at birth
  • 54% were White non-Hispanic, and 25% were Hispanic, Latino, or Spanish
  • 59% were recruited from existing non-COVID-19 research or clinical cohorts
  • 53% had been infected prior to the widespread appearance of the Omicron variant
  • Caregivers, predominantly mothers (91%), provided data via long COVID symptom surveys
  • 39% of participants were fully vaccinated, and 37% were not eligible for vaccination

Domains of Social Determinants Evaluated

The study evaluated five domains: economic stability, social and community context, caregiver education access and quality, neighborhood and built environment, and health care access and quality.

Key Findings

Economic instability was linked to a 57% higher risk of long COVID (adjusted odds ratio [AOR], 1.57; 95% CI, 1.18-2.09).

Participants with economic instability—defined as difficulty covering expenses, poverty, receipt of government assistance, and food insecurity—showed significantly elevated risk.

A 117% higher risk of long COVID was observed in contexts of high discrimination and low social support (AOR, 2.17; 95% CI, 1.77-2.66).

Food security was associated with a reduced likelihood of developing long COVID. Researchers hypothesized that healthy diets may contribute to a decrease in inflammation.

Study Limitations

The study acknowledged several limitations, including:

  • Potential selection bias
  • Reduced enrollment likelihood by families more affected by social determinants of health
  • Data collection in English and Spanish only
  • Possible symptom miscategorization
  • Absence of objective neighborhood-level data

Conclusions and Future Research

The authors concluded that economic instability and adverse social and community circumstances are associated with an increased probability of developing long COVID in children. They suggested that chronic stress from adverse social conditions may lead to abnormal cortisol responses and immunological dysregulation.

Further research was recommended to investigate whether addressing these adverse social factors can effectively reduce future disease risk.