Impact of the COVID-19 pandemic on children

When a child is infected with COVID-19, they are more likely to have an asymptomatic case, or one that is mild to moderate in severity. The prevalence of long COVID in children is estimated at 1% vs 6-7% in adults. Children are more likely to experience gastrointestinal symptoms than adults. Children are less likely to become hospitalized than adults. Several explanations contributing to the milder COVID-19 symptoms experienced, in the acute phase, by children have been suggested, including: • a lower expression of ACE-2 (the receptor used by SARS-CoV-2 for cell entry) in the respiratory tract in younger children • viral interference (e.g. by other coronaviruses) • cross-reactive immune responses (e.g. antibodies, CD8+ and/or CD4+ T-cells reactive to other viral antigens than of SARS-CoV-2) • some protection offered from an increased Th2-response The most common symptoms among children include fever symptoms, followed by a dry cough. Overall, Children are associated with lower mortality rates than other age groups, when infected with COVID-19. This causes a persistent fever and extreme inflammation. Other symptoms associated with MIS-C include severe abdominal pain and hypotension. Early into the pandemic, dermatologists reported an increase in chilblains-like lesions in children, especially on their feet, fingers, and toes. It has been informally referred to as "COVID toes". This was presumed related to COVID-19 infection, however confirming that a child has been infected can be difficult. == Education ==

|alt=Two donut pie charts illustrating material presented in the text. School closures By the end of March 2020, UNESCO estimated that over 89% of the world's student population was out of school or university due to closures aimed at mitigating the spread of COVID-19. Gender disparity This disproportionately affected girls, with 111 million girls living in areas in which getting an education is already a struggle due to extreme poverty, economic vulnerability steep cultural and legal gender disparities. For instance, closures have forced over 4 million girls out of school in South Sudan, Niger, and Mali, some of the countries with low enrollment and completion rates for girls. At least 1 in 3 of the world's school children – 463 million children globally – were unable to access remote learning when COVID-19 shuttered their schools. In addition, school closures disproportionately affect children from low-income or minority families, children with disabilities, and young women, due to disparities in access to distance education, unequal distribution of increased child-care and domestic responsibilities. Additional concerns surrounded the fact that school subsidized meal programs and vaccinations are cornerstones of child healthcare for many families. The Ofsted report conducted by the UK government stated that some children at every age group had regressed in their skills, but some had thrived. Inspectors found one large difference between children who struggled and children who thrived was that those who did well have good support structures and have benefited from quality time with families and caregivers. The report also found a rise in homeschooling even when schools were opened back up, with families concerned about the virus. Impact on student life globally In a study of 30,383 students from 62 countries, students said overall they were most satisfied with the support provided by teaching staff and their universities' public relations. However, researchers argue that "deficient computer skills and the perception of a higher workload prevented them from perceiving their own improved performance in the new teaching environment." Some students reported feeling boredom, anxiety, and frustration during the first lockdown in 2020. Students also reported higher satisfaction with the role played by hospitals and universities during the epidemic compared to the governments and banks. Socio-demographic (and geographic) factors also played an important role in the students' perception of different aspects of academic work/life. The empirical results suggest that the transition from onsite to online lectures due to the COVID-19 crisis had a stronger effect on males, especially part-time students, undergraduate students, applied sciences students, students with a lower living standard, and students in Africa and Asia when it came to low satisfaction of their academic work and life. A Reuters national survey conducted in the US indicated serious mental health consequences resulting from school shutdowns and the pandemic. This affected both students and their teachers. 90% of school districts surveyed said that their district was experiencing higher "absenteeism or disengagement", and 74% of districts indicated increasing mental stress among students. == Health and development ==

Increased stress for parents and caretakers, risk of infection, and social isolation threaten the health and development of children, and can contribute to adverse childhood experiences. Stressful pressures such as these can negatively impact a child's neurological development, especially in infancy or early childhood, including as a contributor to depression in adulthood. Research published in 2023 has investigated the extent to which education and care for young children has maintained its established positive associations with the development of language and executive functions during the first year of the pandemic. Addressing concerns about 'school readiness', the research found that sustained attendance was positively associated with language development, problem-solving skills and personal-social development of children despite the disruption to early years settings during the pandemic. Children risk losing caregivers to COVID-19. The pandemic and its consequences can cause decreased access to resources such as water, social work or medical care for vulnerable populations. Poverty among children has increased. In 2020, it was projected that approximately 150 million additional children would be living in multidimensional poverty – without access to education, health care, housing, nutrition, sanitation or water – due to the COVID-19 pandemic, according to an analysis jointly carried out by Save the Children and UNICEF. Additional millions of children worldwide are expected by UNICEF to experience food insecurity and malnourishment. An additional 6-7 million children under 5 may have suffered from wasting or acute malnutrition in 2020. Healthcare providers should remain vigilant to diagnose the early ophthalmic signs of this possibly fatal post-COVID-19 inflammatory syndrome. Mental health Children around the world have been affected by the pandemic and lockdown in several ways. Some children count on the right support and resources, making the situation manageable, while others strive to keep up with school activities in this new reality. School closures made children face considerable challenges to learn at home. Children in families that cannot afford resources for home learning activities, where parents have low levels of educational attainment, or where there is inadequate space for effective learning, have definitely fallen behind during this period. Many parents expressed that online learning was difficult for their child, particularly preschoolers and young children, and it was challenging for parents to support children appropriately while juggling work and other childcare demands. A few parents mentioned they were unable to support their child's remote learning since they did not know the information themselves. Studies performed in past epidemics, such as SARS, Ebola virus and MERS have shown a high prevalence of negative psychological effects not only in children, but also in adults. The same is going on with COVID-19 pandemic and while confined in quarantine, according to research, pandemics can have negative effects on children's mental health, but to a lesser extent, both in terms of internal symptoms (e.g., anxiety or depression) and external symptoms (e.g., behavioural disorders, hyperactivity) and the prevalence of anxiety disorders (20.5%) and depression (25.2%) was observed to be twice as high as pre-pandemic estimates. However, some studies suggested mental health improved in children during lockdown, with an overall reduction in anxiety, and an increase in wellbeing in those aged 13–14. Drug and alcohol abuse among minors fell during the pandemic, as did arrests. Mental health visits saw a 24% increase for children ages 5 to 11, and 31% for older minors. Many children became more vulnerable to mental health conditions such as depression and anxiety due to the pandemic and its consequences, among which social isolation has been a contributing factor to a decline in mental health quality. Zanonia Chiu, a psychologist from Hong Kong, said about depressed children: "Now that schools are closed, some lock themselves up inside their rooms for weeks, refusing to take showers, eat, or leave their beds." Apart from psychological problems, there is evidence that the lockdown has also had an impact on children and adolescents' cognition and social abilities. Studies from Europe suggest that the COVID-19 pandemic has impacted families caring for children with intellectual and developmental disabilities (IDDs) even more than the pandemic has impacted the general population. Parents of children with mental and physical disabilities were more likely to report changes in their child's behaviour, such as distractibility, inability to concentrate, irritability and general discomfort. Impact on children and adolescents Many young people who use mental health services are already unable to access essential mental health support. Sessions have been replaced with online or telephone support or even postponed. Some young people may find this less effective or may worry about maintaining privacy if sessions are held remotely with family members close by. Apart from these challenges and difficulties, lockdown and social distancing have also impacted particular populations. In the research "Professionals' perspectives on the effects of COVID-19 on autistic individuals", it is stated that individuals with autism spectrum disorder are at heightened risk of experiencing difficulties coping with the pandemic and resultant measures. Students with autism have to struggle with abrupt changes to course delivery and mentorship programmes due to school closures. Many individuals with autism require support, yet services have been paused temporarily. Some individuals with autism spectrum disorder stated that the lockdown had meant they could engage in hobbies more easily, yet the loss of routines and activities was considered difficult and stressful. Lockdown was deemed to have impacted on individuals with autism spectrum disorder's educations, social lives, activities and health. For some, abrupt changes to education had been unexpectedly beneficial; for example, not attending school was better for their mental health, resulting in less anxiety managing their own school work. Social distancing made them also feel relieved since they have enjoyed not having the pressure to socialize. Lockdown was described as useful as they could choose their day-to-day routines around food and personal hobbies. However, some individuals with autism spectrum disorder have found studying at home problematic, they had difficulties meeting with friends and family as they would wish, some of them have experienced difficulties keeping to a structured routine and filling their daily routines with meaningful activities. They had regressed in their progress due to being unable to leave the house. The marked uncertainty of the pandemic and associated disruptions in routine may be also particularly deleterious for children with IDD, who often benefit from heightened structure, clear expectations and an array of services, and may have difficulty understanding changes necessitated by COVID-19. Children and adolescents may also experience mental health problems due to the COVID-19 pandemic itself, such as increased anxiety, as they might fear that they or their loved ones will get infected or they might worry about the future of the world. Significantly more children reported severe anxiety and severe sleep-related impairment during the COVID-19 lockdown than before COVID-19. The results of this study confirm the suspicions of child and youth care professionals that the COVID-19 lockdown has negative effects on the mental and social health of children and adolescents. In opinion papers, professionals elaborated on the vulnerability of this group and expected more feelings of loneliness, anxiety and depression, as well as a more tense atmosphere at home. Concerns were also expressed that the COVID-19 lockdown would lead to an increase in inequality and that children and families with lower socioeconomic status would be more susceptible to mental health issues. Although this study could not definitely confirm these concerns, children from single-parent families, from families with three or more children, and with parents who had a negative change in work situation reported more mental and social health problems during the COVID-19 lockdown. This study showed that children and adolescents reported poorer mental and social health during the COVID-19 lockdown compared to before and exposed several risk factors for poor mental and social health. Other research highlights the importance of other highly impacted aspects, such as violence, situations of uncertainty, fear or anxiety, the risk of children having physical problems derived from a rise in sedentariness, in time in front of the screens, in unhealthy diets and in the detriment of sleep quality. Those situations can intensify during quarantine and provoke an increase in obesity and a loss of the cardiorespiratory capacity. There is concern over the exclusion of children without digital access and other resources that supported their learning during quarantine. Evidence suggests that there has been a deficit in curriculum coverage and half of parents were engaged with their children's home learning. This represents a concern among teachers since the variability in engagement with the curriculum will potentially have different effects on the development and mental health of students. Relevant findings in different countries There is also evidence that shows some children are having poor speech development as a result of lack of social contact with peers, social distancing and the wearing of face masks. The English Endowment Foundation has collected Data from 50,000 pupils and carried out a survey of schools across England that have shown an increased number of four- and five-year-olds needing help with language. Some of the results were that 96% said pupils starting school in September 2020 needed more support with communication than in previous years. This research is one of the first to also provide evidence about the extent of learning loss as the result of school closures. This study found that the overall performance in both mathematics and reading were significantly lower in comparison to the children's performance on standardisation samples in 2017. These primary findings are part of an ongoing research which plans to collect further data until September 2021. Even though children and adolescents were not highly affected by the pandemic, social isolation measures had an impact on them. A prospective, descriptive and cross sectional study funded by the National University of Comahue in San Carlos de Bariloche, Argentina, which assessed changes in the sleeping habits, screen use, sports-related activities, eating and medical consultation stated that lockdown produced an emotional and behavioural impact on children and adolescents. The emotional and behavioural changes include boredom, irritability, reluctance, anger and changes in sleep pattern. What is more, the use of screens in their leisure time increased by 3 hours on weekdays. The type of physical activities also changed: swimming and team sports changed to biking, walking and skiing. A study carried out in Italy and Spain stated that parents noticed emotional behavioural changes in their children during confinement. However, in Italy 83.8% of parents noticed those changes, while in Spain, 88.9% of parents observed them. This is due to the increased flexibility of lockdown in Italy. As for the changes reported by parents, children and adolescents showed boredom, irritability, reluctance, anger and anxiety, which lead to arguments with the rest of the family, concentration difficulties and frustration. This study is the first one developed to examine the psychological impact of the COVID-19 quarantine on children and adolescents. These two countries are two of the most affected by COVID-19 and this study aimed at examining the emotional well-being of Italian and Spanish adolescents between 3 and 18 in order to provide parents and caregivers with useful advice and guidelines to reduce the impact of the quarantine on the youth. Measures taken to lessen the impact of quarantine on children and adolescents Some authors have reflected on the possible effects of the COVID-19 quarantine on children and adolescents. Wang and colleagues highlight the need for awareness of the quarantine's potential effects on children's mental health, and the importance for governments, non-governmental organizations, the community, schools, and parents to act to reduce the possible effects of this situation. Special attention should be paid to children and adolescents who are separated from their caregivers who are infected or suspected of being infected, and those whose caregivers are infected or have died, because they are more vulnerable to psychological problems. To mitigate this far-reaching and significant negative impact on the psychological wellbeing of children, multifaceted age and developmentally appropriate strategies are required to be adopted by health care authorities. A study carried out by Dialnet in The Basque country analysed the assessment of professionals working with children on the impact of quarantine on the health and health inequalities of the child population, as well as the importance given to the intermediate factors that can modulate the impact of the experience of lockdown on children's health. Health and socio-educational professionals who work with children were surveyed in order to identify and measure the impact on children's health. Furthermore, this multidisciplinar contribution allowed them to determine whether this professional's perspective entailed a different opinion in the face of the health consequences. A review published in 2025 claims that while it is clear many children & adolescents experienced developmental health impacts "it may take decades of research to fully understand as pandemic-era children mature into contributing members of society". Further research is required to determine how well children "bounced back". == Children's experience and understanding ==

Commentators noted that many very young children developed an understanding of reality based largely on the limited world of pandemic life. Taken out of formal childcare and separated from other children they often forgot their old friends. Whilst, previously everyday activities such as visiting a shop or relative's home became exotic. However, even if they couldn't clearly recollect it most young children which were born in the pre COVID-19 world retained some awareness of it. A study of seven to twelve year olds in the UK, Spain, Canada, Sweden, Brazil and Australia understanding of the pandemic found that more than half of children knew a significant amount about COVID-19. They associated the topic with various negative emotions saying it made them feel "worried", "scared", "angry" and "confused". They tended to be aware of the types of people which were most vulnerable to the virus and the restrictions which were enforced in their communities. Many had learned new terms and phrases in relation to the pandemic such as social distancing. They were most commonly informed about COVID-19 by teachers and parents but also learned about the subject from friends, television and the internet. == Impact on most at-risk groups ==

Child safety is at risk during the pandemic. Children who are living in unsanitary and crowded conditions are particularly at risk. Youth – especially young women, indigenous peoples, migrants, and refugees – face heightened socioeconomic and health impacts and an increased risk of gender-based violence due to social isolation, discrimination and increased financial stress. They are also more prone to child marriage as families seek ways to alleviate economic burdens. According to UNICEF, over the next decade, up to 10 million more girls could be at risk of becoming child brides as a result of the pandemic. The Rape, Abuse & Incest National Network reported in April 2020 that for the first time, over half of the victims calling their National Sexual Assault Hotline for help were minors. Impact on young migrants This global crisis is exacerbating existing vulnerabilities and inequalities experienced by young people, amplified in humanitarian contexts where fragility, conflict, and emergencies have undermined institutional capacity and where there is limited access to services. == Vaccines ==

As of 22 September 2020, no vaccine trials were being conducted on children under the age of 18 years. According to the CDC, adolescents ages 16 or 17 are eligible for the Pfizer COVID-19 vaccine, but not the Moderna or Janssen (Johnson & Johnson) vaccines. As of March 2021, Moderna and Pfizer/Biotech had begun conducting vaccine trials for children, and Johnson & Johnson planned to do so as well. On 22 December 2021, the UK Medicines and Healthcare products Regulatory Agency (MHRA) has approved a new paediatric formulation of the Pfizer BioNTech COVID-19 vaccine for children aged 5 to 11 in United Kingdom. On 19 June 2022, the U.S. Food and Drug Administration (FDA) has authorized for emergency use both the Pfizer-BioNTech COVID-19 vaccine and the Moderna vaccine for children 6 months to 5 years old. == References ==