Balancing the medical and social needs of children during the COVID‐19 pandemic

Keith Grimwood and Anne B Chang
Med J Aust 2023; 218 (3): 140-140. || doi: 10.5694/mja2.51804
Published online: 20 February 2023

In reply: We thank Hyde1 for the interest in our Editorial, and for highlighting long COVID in children and adolescents.2 However, we contest the claim that our statement concerning symptoms in children and adolescents recovering from coronavirus disease 2019 (COVID‐19) inaccurately reflects the long COVID review.3 In that review, only two studies complied with the consensus research definition for long COVID, aligned with the World Health Organization, of symptoms persisting for more than 12 weeks.4 The difference in persistent symptoms between COVID‐19 cases and controls in one of these studies was 1.4% (95% confidence interval [CI], ‐2.2 to 5.0), and in the other it was 13.2% (95% CI, 10.9–15.5), but the low (13.4%) response rate risked sample bias. Indeed, even after including five additional case–control studies with symptoms persisting for more than 4 weeks, the median difference in symptoms was only 3.0%, leading the authors to state that “nearly all symptoms reported by children and adolescents infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) are also reported in similar frequencies in those without evidence of infection”.3

Systematic reviews and meta‐analyses have also concluded that frequencies of most reported persistent symptoms were similar between SARS‐CoV‐2 cases and uninfected controls, and difficult to differentiate from symptoms following pandemic‐enforced school closures and lockdowns.5,6 Overall, the studies were of poor quality, retrospective and subject to bias, and many lacked controls.3,5,6 Absence of an agreed case definition precluded prevalence estimates of long COVID in children and adolescents. Nevertheless, a meta‐analysis of five case–control studies found that persistent anosmia, headaches, cognitive impairment, and throat and eye discomfort were 2–8% more common following SARS‐CoV‐2 infection than in those without infection, but not fatigue, abdominal pain or myalgia.5

Prospective, longitudinal studies involving various age groups are needed to better characterise long COVID in children and adolescents. This includes recruiting suitable controls, employing a uniform case definition and individualised objective assessments. Finding controls who have never been infected will be challenging. Alternatives could be vaccinated individuals without prior proven infections or those with another proven viral infection. Detailed multidisciplinary pheno‐endotyping studies could then be performed to identify precision medicine‐based therapies.

Meanwhile, SARS‐CoV‐2 will continue to circulate. Vaccination and measures limiting airborne transmission, such as improving school indoor ventilation, will help reduce COVID‐19 and long COVID in children and adolescents.


  • Keith Grimwood1,2
  • Anne B Chang3,4,5

  • 1 Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
  • 2 Gold Coast Health, Gold Coast, QLD
  • 3 Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
  • 4 Queensland Children's Hospital, Brisbane, QLD
  • 5 Charles Darwin University, Darwin, NT


Open access

Open access publishing facilitated by Griffith University, as part of the Wiley ‐ Griffith University agreement via the Council of Australian University Librarians.


Anne Chang is supported by a National Health and Medical Research Council Senior Practitioner Fellowship (APP1154302).

Competing interests:

No relevant disclosures.

  • 1. Grimwood K, Chang AB. Balancing the medical and social needs of children during the COVID‐19 pandemic. Med J Aust 2022; 217: 299‐300.‐medical‐and‐social‐needs‐children‐during‐covid‐19‐pandemic
  • 2. Hyde Z. Balancing the medical and social needs of children during the COVID‐19 pandemic [letter]. Med J Aust 2023; 218: 140.
  • 3. Zimmermann P, Pittet LF, Curtis N. The challenge of studying long COVID: an updated review. Pediatr Infect Dis J 2022; 41: 424‐426.
  • 4. Stephenson T, Allin B, Nugawela MD, et al. Long COVID (post‐COVID‐19 condition) in children: a modified Delphi process. Arch Dis Child 2022; 107: 674‐680.
  • 5. Behnood SA, Shafran R, Bennet SD, et al. Persistent symptoms following SARS‐CoV‐2 infection amongst children and young people: a meta‐analysis of controlled and uncontrolled studies. J Infection 2022; 84: 158‐170.
  • 6. Pellegrino R, Chiappini E, Licari A, et al. Prevalence and clinical presentation of long COVID in children: a systematic review. Eur J Pediatr 2022; 181: 3995‐4009.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.