Beyond functional independence: symptom burden and emotional difficulties in pediatric long COVID-a cross-sectional...

Pediatric Long COVID poses significant challenges to daily functioning, yet its real-world impact remains poorly understood. Standard functional independence measures may not fully capture the condition's consequences in developmentally relevant contexts.

A cross-sectional exploratory study was conducted with 27 children and adolescents (mean age 15.48 ± 2.31 years; 70.4% female) meeting WHO criteria for Long COVID. Functional independence was assessed using the WeeFIM and emotional functioning with the SDQ. Contextual functioning variables-school attendance, grade repetition, and withdrawal from recreational activities-were collected as exploratory indicators of real-world impact.

Despite high symptom burden-fatigue (81.5%), difficulty concentrating (63.0%), and malaise (55.6%) among the most prevalent, with 88.9% experiencing symptoms for over 24 months-WeeFIM scores were near-ceiling across all domains (total: 114.56 ± 20.71/126). Contextual data revealed substantial real-world impact: only 18.5% attended school regularly, 11.1% had repeated an academic year, and 85.2% had withdrawn from previously enjoyed activities. SDQ total scores fell within the normal range (12.07 ± 5.04), though emotional symptoms were slightly elevated (5.59 ± 2.34). A significant negative correlation was found between SDQ total score and WeeFIM cognition (rho = -0.570, p = 0.0019), and a coherent brain fog-mood-concentration symptom cluster was identified. These results are preliminary, hypothesis-generating findings from a convenience sample and should be interpreted with caution regarding generalizability.

Children and adolescents with Long COVID may maintain basic functional independence while experiencing significant symptom burden, emotional difficulties, and substantial restrictions in school, recreational, and social domains. These findings highlight the limited sensitivity of standard functional measures and underscore the need for more comprehensive, context-sensitive assessment approaches in pediatric Long COVID practice.