Functional outcomes of children after SARS-CoV-2 infection: An EHR-based cohort study.
Abigail Case, Morgan Botdorf, Nicole Marchesani and 15 others
Children with clinician-confirmed long COVID after SARS-CoV-2 infection were more likely to show school decline, need new school support, and develop new behavioral or mental health symptoms than children without long COVID.
Referral to psychological services did not differ between the two groups.
Key findings
1Children with clinician-adjudicated long COVID had higher odds of receiving school support (OR 2.4, 95% CI 1.2-5.0), school decline (OR 3.5, 95% CI 1.6-7.9), and behavior or mental health symptoms (OR 4.6, 95% CI 2.1-9.2) compared with children without clinician-adjudicated long COVID.
2Children with and without clinician-adjudicated long COVID had similar odds of receiving a referral for psychological or behavioral services (OR 1.2, 95% CI 0.6-2.4).
3Only 6% of children with documented school difficulties or behavioral outcomes had an appropriate ICD-10 code assigned for the healthcare visit.
Still to come
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
All analyses were univariate logistic regressions without adjustment for confounding variables, so the reported odds ratios are crude associations, not independent effects. The comparison group was children with confirmed COVID-19 infection but without long COVID, not uninfected children, so it is impossible to separate the effect of infection from the effect of long COVID specifically. The follow-up window was limited to 28 days through six months post-infection; impairments emerging after six months were not captured. Most children sought care at large tertiary hospitals, which may overrepresent medically complex children and overestimate the proportion with functional impairments. Health-system-level variation across the 21 sites was not modeled, leaving residual heterogeneity unaccounted for. The small sample size (59 with long COVID, 80 without) limited the ability to examine subgroups such as MIS-C or to perform more extensive covariate adjustment. Functional outcomes were extracted from unstructured clinical notes rather than standardized patient-reported measures, and only 6% of relevant visits carried an appropriate ICD-10 code, so the data depend heavily on clinician documentation quality.
Declared interests
Funded by the NIH RECOVER program (Agreement OTA OT2HL161847-01). The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the odds ratios as proof that long COVID causes these impairments. The analyses were univariate, did not adjust for confounding, and the comparison group was children with COVID-19 who did not meet the long-COVID phenotype, not uninfected children. The authors themselves note that the associations are crude, descriptive relationships and may not represent independent effects.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →