Incidence and Risk Factors of Long COVID in Children and Adolescents: A Single-Center Cohort Study in Thailand Long COVID in Thai Children: Incidence and Risk Factors
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Abstract
OBJECTIVE: The study aimed to find the incidence of Long COVID in children less than 18 years of age and associated risk factors.
METHODS: This is an observational retrospective and prospective cohort study of children under 18 years of age with evidence of COVID-19 infection from October 2021 to February 2023. Participants were assessed 3, 6, and 9 months after acute infection, with direct evaluation by pediatricians at the first and third visits and by phone call at 6 months. Long COVID was defined as persistent symptoms for at least three months after initial infection. Factors associated with Long COVID were analyzed using univariate and multivariate logistic regression presented using odds ratio (OR) and a 95% confidence interval (CI).
RESULTS: A total of 233 children (mean age 9.95 years; 50.20% female) were included. At 3 months, 83 (35.62%) had persistent symptoms, decreasing to 24 (10.30%) at 6 months; none reported ongoing symptoms at 9 months. Common complaints at 3 months included dyspnea (34.94%), hair loss (33.73%) and sleep disturbances (25.30%). At 6 months, hair loss (37.50%) and sleep problems (25%) remained prominent. Univariate analysis showed that older age (> 10 years), comorbidity, and moderate severity symptom during acute infection were significantly or borderline significantly associated with Long COVID. In the final multivariate model, only the moderate severity symptom remained independently predictive of persistent symptoms at 6 months (adjusted OR 10.56, 95% CI: 1.01–110.33, p = 0.049).
CONCLUSION: More than a third of the children experienced symptoms at 3 months, while persistent cases decreased substantially at 6 months. A moderate-severity symptom during acute illness was a key independent risk factor for Long COVID. These findings underscore the importance of close monitoring, particularly in patients with moderate-severity symptoms, to ensure timely interventions and support for recovery.
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