Long COVID in Children: What the Science Shows and How to Protect Them

Authors: Yaneer Bar-Yam, Stephane Bilodeau, Špela Šalamon, Greta Fox, Sunil K Raina, Andrew Ewing

Long COVID in Children: Science, Precautions, and Protection

For years, many parents, doctors, and policymakers were told that children are safe from COVID-19. That belief shaped decisions about schools, masking, and vaccination—and continues to influence public attitudes today. Yet growing scientific evidence makes it clear that this notion is incorrect.

New research is changing what we know. Over the past two years, pediatric studies from the U.S., U.K., and Europe have documented that children and teenagers can experience long-term effects after infection—that can be serious and lasting [1-9]. These findings challenge earlier expectations and call for a rethinking of how we protect children’s health.

What the science shows

Long COVID is a thoroughly and widely documented reality in children and teenagers. Pediatric studies show that 10–15% of children experience long COVID symptoms after infection [2,5], and that multiple infections [3] significantly increase the risk of more severe symptoms (as discussed later).

These symptoms can include fatigue, trouble concentrating, headaches, dizziness, chest pain, and shortness of breath that last for weeks, months, or even years after the initial infection. Children’s lives may be disrupted in ways that affect school attendance and performance, participation in sports, and social development.

Recent pediatric studies reveal that, similar to adults, long COVID in children is often a multi-system condition—affecting brain function, sleep, autonomic regulation, respiratory health, and the gastrointestinal system, as well as specific conditions such as new-onset diabetes [9]. Symptoms often appear in clusters that help doctors identify cases and guide care.

Younger children frequently present with cognitive, behavioral, or sleep-related changes rather than clear physical complaints—making these symptoms less visible and harder for adults to recognize or for children to describe—and therefore more easily missed. This explains why the true burden of long COVID in younger children has been underestimated.

Children recovering from acute-phase COVID-19 show measurable reductions in brain volume and disrupted network connectivity, particularly in the cingulate cortex, hippocampus, and superior temporal regions. Some of these changes partially resolve over time, but others persist, indicating ongoing impairment in cognitive and emotional domains caused by structural, infection-induced damage to the developing brain [6].

Although neurological risks appear less broad in children, some, like cognitive impairment, seizures, and rare psychiatric disorders, can persist for a long time and we do not know yet if they fully resolve [1, Supplement S9]. This is consistent with family reports of “brain fog” and academic struggles over long periods of time. 

Children have limited autonomy to control their environment or daily routines—they may not be able to modify school schedules, rest when fatigued, or reduce cognitive demands—which can make the educational and developmental consequences of illness more severe.

Reinfections

Scientific evidence shows that reinfections double the likelihood of Long COVID and markedly increase related complications, including fatigue, cognitive difficulties, headaches, dysautonomia/POTS, and heart rhythm abnormalities [1,3]. Each additional infection adds cumulative harm—documented in children [4], adolescents [6], and adults [7]. Reducing the number of infections and reinfections is critical to protecting long-term health. Precautions and prevention measures in schools and in family households are essential to avoid these cumulative effects.

Long-Term Public Health Implications

Even if only a small proportion of children experience prolonged symptoms, the impact could be enormous—lost schooling, reduced physical fitness, and increased mental health challenges. Over time, these effects could accumulate, influencing population-level educational outcomes and workforce readiness. Most importantly, the ongoing health consequences of COVID-19 may shape the biological and social development of an entire generation.

Mitigation measures: layered protection for children

Because no proven curative treatments for Long COVID currently exist, reducing infections and reinfections remains the most effective way to protect children.

Schools and families can reduce risk by using multiple proactive measures—in various combinations—including:

• Vaccination for children provides strong protection against acute severe disease in children and adolescents, but only transient, limited protection against infection itself [8]. Recent large pediatric studies also show substantial protection against long COVID, with risk reductions of 30–70% depending on age, and protection lasting 6 months to a year after vaccination [10-12].
• High-quality respirators (such as N95, FFP2, or KN95) in schools and shared indoor spaces reduce airborne exposure.
• Improved ventilation and air filtration—using HEPA filters in classrooms and shared spaces, including lunch rooms, and, where feasible, by upgrading building ventilation and/or opening windows—significantly lowers transmission.
• Avoiding policies that pressure sick children to return too early, which can worsen illness and spread infection to others. This is common sense with all infectious illnesses.
• Safe social connection through outdoor play, virtual hangouts and group activities helps maintain peer interaction.
• Digital options for education—including or combining online classes and recorded lessons—provides safe ongoing education as well as continuity for children who are isolating or recovering, while keeping learning inclusive and adaptable.

Remote Learning

Remote education is one of the well-established approaches for reducing airborne transmission. Although often associated with short-term emergencies, many public school systems offer remote learning as a standard option. Because remote-learning options are less familiar than other mitigation measures and vary across regions, we briefly outline their current availability and use. 

Key practices for successful remote learning include:

• A single, consistent platform for assignments and communication 
• Technology support (loaner laptops, headsets, and internet hotspots)
• Ongoing social connection through virtual clubs or safe outdoor meetups

Many U.S. states operate established remote-learning public schools [13–26]—including large states such as California, Florida, Texas, North Carolina, Georgia, Michigan, Ohio, and Arizona—and home schooling, often incorporating remote components, now accounts for a substantial and growing share of students [27,28]. Similar publicly supported distance-education models exist internationally [29-43]: Canada’s provincial virtual learning systems, Mexico’s national programs such as Prepa en Línea–SEP and Telesecundaria, France’s CNED public distance-education system, Spain’s CIDEAD national distance school, India’s nationwide digital platforms including Diksha and ePathshala, Brazil’s publicly operated Centro de Mídias distance-education networks, and the United Kingdom’s legally recognized home-education framework supported by government-funded online instructional resources. These options—already used for health-related and other needs—can help protect children’s health while safeguarding their learning and development. 

These steps help create layered protection that lowers the likelihood of Long COVID and other post-infection complications in children.

Key considerations

A large number of children are suffering from long COVID—and with many thousands of infections occurring daily, this number is steadily increasing. Some children may require long-term support due to the physical and cognitive effects of the illness, which can impact their ability to learn, pursue careers, and reach their full potential.

Scientific evidence supports the use of layered mitigation such as: vaccination, respirators, ventilation, and flexible remote learning. Protecting children now is an investment in their long-term health, education, and quality of life.

References

1. Taquet M, Sillett R, Zhu L, et al. Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1,284,437 patients. Lancet Psychiatry. 2022;9(10):815-827. https://doi.org/10.1016/S2215-0366(22)00260-7
2. Gross RS, Thaweethai T, Kleinman LC, et al. Characterizing Long COVID in children and adolescents. JAMA.2024;332(14):1174-1188. https://doi.org/10.1001/jama.2024.12747
3. Zhang B, Wu Q, Jhaveri R, et al. Long COVID associated with SARS-CoV-2 reinfection among children and adolescents in the Omicron era (RECOVER-EHR): a retrospective cohort study. Lancet Infect Dis. 2025; published online September 30. https://doi.org/10.1016/S1473-3099(25)00476-1
4. Ertesvåg NU, Haug K, et al. Post COVID-19 condition after Delta infection and Omicron reinfection in children and adolescents. eBioMedicine. 2023;92:104599. https://doi.org/10.1016/j.ebiom.2023.104599
5. Pinto Pereira SM, Buszewicz M, et al. Long COVID in children and young people after infection or reinfection with the Omicron variant: a prospective observational study. J Pediatr. 2023;259:113463. https://doi.org/10.1016/j.jpeds.2023.113463
6. Wang R, Liu J, Li J, et al. Brain microstructural alterations in children post-COVID-19 infection through VBM, SBM, and structural covariance network analysis. Brain Behav. 2025;15:e70905. https://doi.org/10.1002/brb3.70905
7. Su S, Jiang Z, Shi L, et al. Physical, cognitive, and mental health impacts of Omicron reinfection in patients with original SARS-CoV-2 infection: a community-based observational study. BMC Med. 2025;23:526. https://doi.org/10.1186/s12916-025-04322-5
8. Lu W, Zeng S, Yao Y, Luo Y, Ruan T. The effect of COVID-19 vaccine to the Omicron variant in children and adolescents: a systematic review and meta-analysis. Front Public Health. 2024; 12:1338208. https://doi.org/10.3389/fpubh.2024.1338208
9. Miller MG, Terebuh P, Kaelber DC, Xu R, Davis PB. SARS-CoV-2 Infection and New-Onset Type 2 Diabetes Among Pediatric Patients, 2020–2022. JAMA Network Open.2024;7(10):e2439444. https://doi.org/10.1001/jamanetworkopen.2024.39444
10. Razzaghi H, Forrest CB, Hirabayashi K, et al. COVID-19 Vaccine Effectiveness Against Long COVID in Children. Pediatrics. 2024;153(4):e2023064446. https://doi.org/10.1542/peds.2023-064446
11. Wu Q, Zhang B, Tong J, et al. Real-world effectiveness and causal mediation study of BNT162b2 on long COVID risks in children and adolescents. eClinicalMedicine. 2025;79:102962. https://doi.org/10.1016/j.eclinm.2024.102962
12. Yousaf AR, Mak J, Gwynn L, et al. COVID-19 Vaccination and Odds of Post–COVID-19 Condition Symptoms in Children Aged 5 to 17 Years. JAMA Network Open. 2025;8(2):e2459672. https://doi.org/10.1001/jamanetworkopen.2024.59672
13. Littlefield, J. (2025). State-by-State List of Free Online Public Schools, K–12. ThoughtCo. https://www.thoughtco.com/free-online-public-schools-4148138
14. Southern Regional Education Board (SREB). (2024). State Virtual Schools (K–12). https://www.sreb.org/virtual-schools-k-12
15. New York State, Virtual Learning Guidance, https://www.nysed.gov/memo/edtech/virtual-learning-guidance-memo
16. Virtual Innovators Academy (X636), https://www.virtualacademynyc.org/page/enrollment
17. Pennsylvania Department of Education. Cyber Charter Schools. Accessed 2025. https://www.pa.gov/agencies/education/programs-and-services/instruction/elementary-and-secondary-education/charter-schools
18. Massachusetts Department of Elementary and Secondary Education (DESE). (2024). Commonwealth Virtual Schools (CMVS). https://www.doe.mass.edu/cmvs/
19. California Department of Education. California Virtual Academies. https://cava.k12.com
20. Florida Virtual School (FLVS). About Florida Virtual School. https://www.flvs.net
21. Texas Education Agency. Texas Virtual School Network (TXVSN). https://www.txvsn.org
22. North Carolina Department of Public Instruction. North Carolina Virtual Public School. https://www.ncvps.org
23. Georgia Department of Education. Georgia Virtual School. https://gavirtualschool.org
24. Michigan Virtual. Michigan Virtual School. https://michiganvirtual.org
25. Ohio Department of Education. Ohio E-Schools (Virtual Schools). https://education.ohio.gov/Topics/Community-Schools/Types-of-Community-Schools/E-schools
26. Arizona Virtual Academy. About AZVA. https://azva.k12.com
27. National Center for Education Statistics (NCES). Homeschooling in the United States: 2022–23. U.S. Department of Education; September 17, 2024. https://nces.ed.gov/whatsnew/press_releases/9_17_2024.asp
28. Ray, BD, National Home Education Research Institute (NHERI). Research Facts on Homeschooling. 2023–2024 Edition. https://nheri.org/research-facts-on-homeschooling/
29. Canadian eLearning Network. (2024). The State of the Nation: K–12 E-Learning in Canada. Available at: https://k12sotn.ca/
30. Secretaría de Educación Pública (SEP). Prepa en Línea–SEP. https://www.prepaenlinea.sep.gob.mx/
31. Secretaría de Educación Pública (SEP). Telesecundaria. https://www.gob.mx/sep/acciones-y-programas/telesecundaria
32. Secretaría de Educación Pública (SEP). Educación a Distancia. https://www.gob.mx/sep
33. Centre National d’Enseignement à Distance (CNED). https://www.cned.fr/
34. IVIO@School. https://ivio.nl/ivio-at-school/
35. UK Department for Education. Home education: government guidance. GOV.UK. https://www.gov.uk/home-education
36. UK Department for Education. Elective Home Education: Departmental Guidance for Parents and Local Authorities. GOV.UK. https://www.gov.uk/government/publications/elective-home-education
37. Ministerio de Educación y Formación Profesional. CIDEAD – Centro para la Innovación y Desarrollo de la Educación a Distancia. https://www.educacionyfp.gob.es/educacion/mc/cidead.html
38. Ministry of Education (Government of India). Diksha – Digital Infrastructure for Knowledge Sharing. https://diksha.gov.in
39. NCERT. ePathshala. https://epathshala.nic.in
40. Ministry of Education. SWAYAM. https://swayam.gov.in
41. Ministry of Education. PM eVidya. https://www.education.gov.in/pm_evidya
42. Secretaria da Educação do Estado de São Paulo. Centro de Mídias da Educação de São Paulo (CMSP). https://www.educacao.sp.gov.br/centrodemidias
43. Ministério da Educação (MEC). Educação a Distância (EAD). https://www.gov.br/mec/pt-br/assuntos/ead