Long-term trajectories of social adjustment and emotional/behavioral problems in pediatric post-acute COVID-19

COVID-19 has been associated with adverse mental health outcomes in children. However, evidence regarding the long-term trajectories of post-acute symptoms remains limited. We examined long-term emotional and behavioral trajectories in children following COVID-19 infection. Eighty-four children (aged 6–16) with a confirmed COVID-19 were initially enrolled. Of these, 69 completed the three-year follow-up assessment and were included in the present analyses. Parents completed assessments approximately three months post-infection, retrospectively rating their child’s behavior preceding infection and during the two weeks prior to the post-COVID assessment. An age- and sex-matched control group ( n = 94) completed identical assessments. The COVID-19 group was reassessed approximately three years post-infection. Results showed that the COVID group showed significant impairments in school functions, internalizing problems, conduct problems, irritability and focus in post-COVID conditions compared to pre-COVID baseline. At three-year follow-up, most impairments resolved to pre-COVID levels. However, prosocial functioning among females remained impaired. Additionally, longer time since infection correlated with fewer school function problems ( r = -0.26, p = 0.041) and lower levels of internalizing symptoms ( r = -0.26, p = 0.038). In conclusion, post-COVID-19 children exhibited marked post-acute impairments in school functioning, increased emotional and behavioral problems followed by heterogeneous recovery trajectories.