Long-COVID in children and their parents: A prospective cohort study.
Iijima, Hiroyuki, Funaki, Takanori, Kubota, Mitsuru · Pediatrics international : official journal of the Japan Pediatric Society · 2025 · DOI
Quick Summary
This study followed Japanese children hospitalized with COVID-19 and their parents to see how many developed long-COVID symptoms. About 45% of children had lingering symptoms one month after infection, dropping to 23% by six months. The most common symptoms were cough, tiredness, and sleep problems, with sleep issues being most strongly linked to a reduced quality of life.
Why It Matters
This study provides longitudinal evidence that post-COVID symptoms in children can persist for months and overlap with ME/CFS diagnostic criteria, particularly regarding fatigue and sleep disturbance. Understanding the prevalence and trajectory of these symptoms in pediatric populations is critical for recognizing and supporting children who may develop ME/CFS-like illness following SARS-CoV-2 infection.
Observed Findings
Long-COVID symptom prevalence was 44.9% at 1 month, 37.8% at 3 months, and 22.8% at 6 months post-infection
Cough, fatigue, and sleep disturbance were the three most commonly reported long-COVID symptoms
Sleep disturbance was consistently associated with significantly lower quality of life scores at all follow-up timepoints (mean differences of 9.25-20.15 points)
ME/CFS-like symptoms were significantly less common in children aged 0-6 years compared to older children (7-17 years) and parents
No specific demographic or clinical risk factors were identified as predictors of developing long-COVID
Inferred Conclusions
A substantial proportion of hospitalized children with COVID-19 experience persistent symptoms, with roughly one in four still symptomatic at 6 months
Sleep disturbance is a key symptom affecting pediatric quality of life in long-COVID and warrants targeted clinical attention
Post-COVID symptoms in older children share phenotypic similarities with ME/CFS, suggesting possible overlap in pathophysiology or symptom expression
Younger children may have different patterns of post-COVID symptom development compared to adolescents and adults
Remaining Questions
What mechanisms explain the age-related differences in ME/CFS-like symptom prevalence between younger and older children?
What This Study Does Not Prove
This study does not establish causation between specific COVID-19 viral mechanisms and ME/CFS development, nor does it determine whether post-COVID symptoms in children are identical to classical ME/CFS. The findings are limited to a Japanese hospitalized cohort, which may not represent all children with COVID-19, particularly those with milder disease managed at home.