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  • Clinical Research Article
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Postacute COVID-19 fatigue, dyspnea and reduced activity in children and adolescents

Abstract

Background

This study aimed to quantify fatigue, dyspnea, and physical activity and identify associated factors in children and adolescents with postacute COVID-19 syndrome.

Methods

A prospective cohort study included 74 participants aged 6–18 years with postacute COVID-19 symptoms and 120 age- and sex-matched controls without SARS-CoV-2 antibodies. Participants completed questionnaires assessing fatigue, dyspnea, and physical activity and underwent pulmonary function tests.

Results

Children with postacute COVID-19 syndrome reported significantly greater fatigue (parent-rated scores: mean 67.9 vs. 82.4, p < 0.001; child-rated scores: 73.7 vs. 83.0, p < 0.001), increased dyspnea (mMRC grades 3–4: 10.9% vs. 4.1%, p = 0.001), and lower physical activity (median 787.8 vs. 1658.5 MET*min/week, p < 0.001) than controls. They also had a higher prevalence of mixed (8.1% vs. 1.7%, p = 0.029) and restrictive lung disease (29.7% vs. 10.8%, p = 0.001). Older age and COVID-19 were identified as risk factors for fatigue and reduced activity. Fatigue correlated with reduced physical activity but not with pulmonary function.

Conclusion

Children and adolescents with postacute COVID-19 syndrome, particularly older individuals, experience greater fatigue and reduced physical activity than controls. These findings highlight the importance of quantifying postacute COVID-19 symptoms and their associations with physiological assessments.

Impact

  • This prospective, age- and sex-matched cohort study revealed that children and adolescents with postacute COVID-19 syndrome perceived higher fatigue levels, had higher dyspnea scores, had a greater prevalence of mixed lung and restrictive lung disease, and exhibited less physical activity than their control counterparts.

  • Fatigue correlated with reduced physical activity but was not consistently correlated with pulmonary function test results.

  • This study highlights the importance of quantifying postacute COVID-19 symptoms and exploring the associations between individual symptoms and the impact of coronavirus infection on various systems, including the neurological, musculoskeletal, cardiopulmonary, and immune systems.

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Fig. 1: Flow chart of the study design.
Fig. 2: Comparison of fatigue, dyspnea, physical activity, and pulmonary function test results between patients with postacute COVID-19 syndrome and age- and sex-matched controls.

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Data availability

The data supporting this study’s findings are available in the supplementary file (PostAcuteCOVID data.cvs).

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Acknowledgements

We would like to express our sincere gratitude and respect to all the staff and patients at the post-COVID multidisciplinary integrated clinics of National Taiwan University Children Hospital for their continuous efforts, technical support, and patience. Without their help, this study could not have been conducted. This study was supported by the National Science and Technology Council (NSTC 111-2321-B-002-017 and NSTC 112-2321-B-002-013) and National Taiwan University Hospital (NTUH 112-W001 and NTUH 113-W001). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors

Contributions

C.W.L., L., Y.C., and S.F.G. contributed to the conception and design of the study, interpretation of the data, drafting of the article, and critical visualization of the article. C.W.L., K.Y.C., Y.C.L., J.H.W., T.Y.Y., C.Y.L., Y.M.L., and Y.C.C. collected and analyzed the data. L.M.H. provided suggestions for improving the manuscript. All authors contributed to and approved the final manuscript.

Corresponding authors

Correspondence to Susan Shur-Fen Gau or Luan-Yin Chang.

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The authors declare no competing interests.

Ethical approval and consent statement

This study was approved by the Research Ethics Committee of the National Taiwan University Hospital (202206053RINC). Written informed consent was obtained from all participants or their guardians before study implementation.

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Lin, CW., Chen, KY., Wu, JH. et al. Postacute COVID-19 fatigue, dyspnea and reduced activity in children and adolescents. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-03897-2

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