Post-COVID-19 health in children: from understanding pathogenesis to effective rehabilitation
DOI:
https://doi.org/10.15574/SP.2025.2(146).119127Keywords:
post-COVID-19 syndrome, children, pathogenesis, rehabilitation, respiratory rehabilitation, physical therapy, psycho-emotional supportAbstract
COVID-19 is a significant challenge for pediatrics, as it negatively affects the health of children, causing the development of post-COVID-19 syndrome. It is important not only to eliminate acute symptoms, but also to develop long-term rehabilitation programs that take into account all aspects of the physical and psycho-emotional recovery of patients.
Aim - to summarize and analyze modern scientific data presented in publications in the PubMed, Scopus, Web of Science databases, as well as in international and domestic clinical guidelines and guidelines over the past 5 years, regarding the pathogenesis of post-COVID-19 syndrome in children and to substantiate effective approaches to rehabilitation aimed at restoring respiratory system functions and improving the overall functional status of pediatric patients.
Analysis of scientific sources and clinical guidelines over recent years allows us to identify key aspects of the pathogenesis of post-COVID-19 syndrome in children. To date, a number of mechanisms have been studied that underlie prolonged symptoms in children after COVID-19. Immune disorders that occur after an infection can contribute to the development of chronic inflammatory processes that cause prolonged symptoms. Given these factors, the development of post-COVID-19 syndrome in children necessitates a comprehensive approach to diagnosis, treatment, and rehabilitation. In particular, an important component is physical therapy, which includes exercises to improve respiratory function, restore endurance and strengthen muscles. In addition, psycho-emotional support is important to overcome anxiety and stress that may arise as a result of the disease and prolonged recovery.
Conclusions. Rehabilitation after COVID-19 is an important stage of recovery for patients with impaired lung function, aimed at improving respiratory function and the patient's overall condition. A multidisciplinary approach and individualization of treatment are key to achieving successful results in restoring body functions. Further research in this area will help improve rehabilitation methods and develop optimal strategies for patients with post-COVID-19 disorders.
The authors declare no conflict of interest.
References
American Association for Respiratory Care. (2014). Quality standards for pulmonary rehabilitation in adults. URL: https://www.aarc.org.
American Thoracic Society. (2020). Guidance for re-opening pulmonary rehabilitation programs. American Thoracic Society. URL: https://www.thoracic.org.
Blank L, Cantrell A, Sworn K, Booth A. (2023). Factors which facilitate or impede patient engagement with pulmonary and cardiac rehabilitation: a rapid evaluation mapping review. Health Soc Care Deliv Res. 11(04). https://doi.org/10.3310/KLWR9463; PMid:37464900
Brackel CLH, Lap CR, Buddingh EP et al. (2021). Pediatric long-COVID: an overlooked phenomenon? Pediatr Pulmonol. 56: 2495-2502. https://doi.org/10.1002/ppul.25521; PMid:34102037 PMCid:PMC8242715
British Thoracic Society. (2013). Guideline on pulmonary rehabilitation in adults. British Thoracic Society. URL: https://www.brit-thoracic.org.uk.
Buonsenso D, Munblit D, De Rose C et al. (2021). Preliminary evidence on long COVID in children. Acta Paediatr. 110: 2208-2211. https://doi.org/10.1111/apa.15870; PMid:33835507 PMCid:PMC8251440
Davis HE, McCorkell L, Vogel JM et al. (2023). Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 21: 133-146. https://doi.org/10.1038/s41579-022-00846-2; PMid:36639608 PMCid:PMC9839201
Foster F, Piggott R, Riley L, Beech R. (2016). Working with primary care clinicians and patients to introduce strategies for increasing referrals for pulmonary rehabilitation. Primary Health Care Research & Development. 17(3): 226-237. https://doi.org/10.1017/S1463423615000286; PMid:26072909
Graves J, Sandrey V, Graves T, Smith DL. (2010). Effectiveness of a group opt-in session on uptake and graduation rates for pulmonary rehabilitation. Chron Respir Dis. 7: 159-164. https://doi.org/10.1177/1479972310379537; PMid:20688893
Harashchenko T, Umanets T, Podolskiy V, Kaminska T, Marushko Y, Podolskiy V et al. (2023). Epidemiological, Clinical, and Laboratory Features of Children with SARS-CoV-2 in Ukraine. Journal of mother and child. 27(1): 33-41. https://doi.org/10.34763/jmotherandchild.20232701.d-23-00012.
Hopkinson NS, Englebretsen C, Cooley N, Kennie K, Lim M, Woodcock T et al. (2012). Designing and implementing a COPD discharge care bundle. Thorax. 67: 90-92. https://doi.org/10.1136/thoraxjnl-2011-200233; PMid:21846790 PMCid:PMC3240777
Howard-Jones AR, Bowen AC, Danchin M, Koirala A, Sharma K, Yeoh DK et al. (2022). COVID-19 in children: I. Epidemiology, prevention and indirect impacts. Journal of paediatrics and child health. 58(1): 39-45. https://doi.org/10.1111/jpc.15791; PMid:34643307 PMCid:PMC8662210
Kumar P, Jat KR. (2023). Post-COVID-19 Sequelae in Children. Indian journal of pediatrics. 90(6): 605-611. https://doi.org/10.1007/s12098-023-04473-4; PMid:36884145 PMCid:PMC9992903
Larsen NW, Stiles LE, Miglis MG. (2021). Preparing for the long-haul: autonomic complications of COVID-19. Auton Neurosci. 235: 102841. https://doi.org/10.1016/j.autneu.2021.102841; PMid:34265539 PMCid:PMC8254396
Lippi G, Sanchis-Gomar F, Henry BM. (2023). COVID-19 and its long-term sequelae: what do we know in 2023?. Polish archives of internal medicine. 133(4): 16402. https://doi.org/10.20452/pamw.16402
Lopez-Leon S, Wegman-Ostrosky T, Ayuzo Del Valle NC et al. (2022). Long-COVID in children and adolescents: a systematic review and meta-analyses. Sci Rep. 12: 9950. https://doi.org/10.1038/s41598-022-13495-5; PMid:35739136 PMCid:PMC9226045
Ludvigsson JF. (2020). Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 109: 1088-1095. https://doi.org/10.1111/apa.15270; PMid:32202343 PMCid:PMC7228328
Ludvigsson JF. (2021). Case report and systematic review suggest that children may experience similar long-term effects to adults after clinical COVID-19. Acta Paediatr. 110: 914-921. https://doi.org/10.1111/apa.15673; PMid:33205450 PMCid:PMC7753397
Malone LA, Morrow A, Chen Y et al. (2022). Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of postacute sequelae of SARS-CoV-2 infection (PASC) in children and adolescents. PM R. 14: 1241-1269. https://doi.org/10.1002/pmrj.12890; PMid:36169159 PMCid:PMC9538628
Marushko Y, Khomych OV. (2023). Assessment of acoustic signal characteristics in children with community-acquired pneumonia according to the prevalence and nature of lung tissue damage using the new device «Trembita-Corona». Modern Pediatrics. Ukraine. 2(130): 79-88. https://doi.org/10.15574/SP.2023.130.79
Marushko Y, Khomych O. (2023). Characterization of the awerage power, frequency and amplitude of acoustic signal peaks over the lungs in children with community-acquired pneumonia using the new device "Trembita-Corona". Medical Science of Ukraine (MSU). 19(1): 53-69. https://doi.org/10.32345/2664-4738.1.2023.08
Marushko Y, Khomych O. (2023). Sensitivity and specificity of the method of acoustic diagnosis of pneumonia using the acoustic monitoring device Trembita-Corona. Child's Health. 18(4): 262-266. https://doi.org/10.22141/2224-0551.18.4.2023.1597
Marushko YuV, Khomych OV. (2024). Peculiarities of acoustic diagnostic methods in pediatric practice (literature review, own research). Modern Pediatrics. Ukraine. 6(142): 88-95. https://doi.org/10.15574/SP.2024.6(142).8895; PMid:26004613
Ministry of Health of Ukraine. (2021, Apr 20). Pro zatverdzhennya Protokolu nadannya reabilitatsiynoyi dopomohy patsiyentam z koronavirusnoyu khvoroboyu (COVID-19) ta rekonvalescentam. Nakaz MOZ Ukrainy vid 20.04.2021 No. 771. URL: https://moz.gov.ua/uk/decrees/nakaz-moz-ukraini-vid-20042021--771-pro-zatverdzhennja-protokolu-nadannja-reabilitacijnoi-dopomogi-pacientam-z-koronavirusnoju-hvoroboju--covid-19-ta-rekonvalescentam.
Noij L, Terheggen-Lagro S, Muselaers E, Whittaker E, Gosling J, Brackel C et al. (2024). A multidisciplinary approach: Management and rehabilitation of children with pediatric post-COVID-19 condition. The Pediatric Infectious Disease Journal. 43(9): 880-884. https://doi.org/10.1097/INF.0000000000004408; PMid:38808972 PMCid:PMC11319073
Pellegrino R, Chiappini E, Licari A et al. (2022). Prevalence and clinical presentation of long COVID in children: a systematic review. Eur J Pediatr. 181: 3995-4009. https://doi.org/10.1007/s00431-022-04600-x; PMid:36107254 PMCid:PMC9476461
Proal AD, VanElzakker MB, Aleman S et al. (2023). SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC). Nat Immunol. 24: 1778. https://doi.org/10.1038/s41590-023-01646-3; PMid:37723351
Roberts CM, Gungor G, Parker M, Craig J, Mountford J. (2015). Impact of a patient-specific co-designed COPD care scorecard on COPD care quality: a quasi-experimental study. NPJ Prim Care Respir Med. 25: 15017. https://doi.org/10.1038/npjpcrm.2015.17; PMid:25811771 PMCid:PMC4532153
Voloshin OM, Marushko YuV, Savchenko II. (2023). А bootstrap analysis of immune status in preschool children suffering from recurrent respiratory infections. Modern Pediatrics. Ukraine. 3(131): 13-21. https://doi.org/10.15574/SP.2023.131.13
Wacks M, Wortley E, Gregorowski A et al. (2023). Fifteen-minute consultation: managing post-COVID-19 syndrome (long COVID) in children and young people. Arch Dis Child Educ Pract Ed. 109: 29-34. https://doi.org/10.1136/archdischild-2022-324950; PMid:37080731
World Health Organization. (2020, Mar 11). WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. World Health Organization. URL: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
World Health Organization (WHO). (2021). A clinical case definition of post COVID-19 condition by A Delphi consensus.
World Health Organization. (2023, May 5). Statement on the end of the COVID-19 global health emergency. World Health Organization. URL: https://www.who.int/news/item/05-05-2023-statement-on-the-end-of-the-covid-19-global-health-emergency.
World Health Organization. (2023). Rehabilitation: self-management of long COVID for adolescents. URL: https://www.who.int/europe/publications/i/item/WHO-EURO-2023-8018-47786-70552.
Yonts A Brugler, Burton J, Jones Herbert L. (2022). A review of current evaluation and management strategies in pediatric postacute sequelae of COVID-19. Pediatr Ann. 51: e421-e4e5. https://doi.org/10.3928/19382359-20220913-08; PMid:36343181
Zhang HP, Sun YL, Wang YF, Yazici D, Azkur D, Ogulur I et al. (2023). Recent developments in the immunopathology of COVID-19. Allergy. 78(2): 369-388. https://doi.org/10.1111/all.15593; PMid:36420736 PMCid:PMC10108124
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Modern pediatrics. Ukraine
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
