Supporting children and young people identified as having Long Covid in education settings
This document has been developed to provide a brief overview of what is currently known regarding the impact of Long Covid on children and young people’s education.
It focuses on advice and guidance for schools and educational settings to ensure this group is supported as effectively as possible in education.
Long covid is a new condition and understanding is developing quickly, so data and guidance in this document are subject to change.
Click on the link below to watch the guidance webinar
Somerset EPS Long Covid Training Webinar for Education Settings.mp4
Click HERE to download this guidance page
What is Long Covid?
Long Covid is a working definition, there is no formally agreed definition for young people:
New symptoms that arise after a probable covid infection that last for more than 12 weeks and for which there is no alternative cause.
How common is Long Covid in children and young people?
This is hard to determine accurately as there is no objective test. Many of the symptoms described cross over with other conditions such as Chronic Fatigue Syndrome, Medically Unexplained Symptoms and Chronic Pain. All of these conditions tend to be treated and supported in similar ways and can result in challenges including difficulty with school attendance.
What are the common symptoms?
There are more than 300 symptoms reported with Long Covid. The medical team use the symptoms to work out what medical illnesses may need to be excluded and then rehabilitation is planned by considering the challenges and impairments that arise as a result of the symptoms. Fatigue is the most frequent feature of children and young people suffering with Long Covid.
Impact of Long Covid on individuals (from University of Sheffield, School of Education, with quotes from Long Covid Kids)
Mental health and wellbeing: Children and young people with Long Covid are likely to feel anxiety from a lack of understanding of their condition, and an unknown timescale for recovery. Some have described their experiences as leaving them feeling “sad, depressed, angry, helpless and broken”. They said that it is “horrible, scary, boring, and stressful and that they hate it.” Children and young people may have limited access to psychological resources. They may explore mortality and plans for the future. There can be an ongoing strain and psychological burden. Pain management and treatment adherence can cause anxiety and require ongoing effort.
Cognition and learning: Children and young people report feeling “dizzy, foggy and that their minds can go blank. They said that they can have constant headaches, that they find it hard to focus or concentrate and are more forgetful. They said that their mind feels like treacle and they find it hard to understand.” Children and young people may miss school and face increased risk of becoming NEET (not in education, employment or training). School staff may lack confidence and knowledge of how to support with Long Covid. Children and young people face reduced educational and vocational outcomes. The school support they can access from teachers, pastoral staff, and medical professionals can reduce. Children and young people may experience inconsistent support.
Social difficulties and changes to identity: Children and young people can experience social thinning: when a person’s social contact and connections to other people, family and friends gradually erode. Also, decreased school belonging, loss of identity and changes to sense of self, impacting self-esteem, and a sense of being different. “Feeling left behind, alone or lonely, isolated, stuck and trapped.”
Supporting children and young people with Long Covid: strategies and approaches
Themes of good support (University of Sheffield, School of Education)
-
Understanding needs
-
Person-centred practice
-
Communication
-
Collaborative working
-
Putting the individual in control of their symptoms, rather than the symptoms in control of them.
General approaches
-
Listen to children and young people and families, including siblings, get their views on support
-
Be flexible as needs fluctuate over time
-
Recovery may take priority over learning and attendance - DfE guidance (Working together to improve school attendance (publishing.service.gov.uk) states schools should be mindful of barriers faced by children and young people with medical conditions and may consider phased-returns or part-time timetables but these MUST be temporary, in place for the shortest time possible, formally reviewed with the student and parents, with the expectation that the student will return to full time attendance.
-
Work with the multi-disciplinary team (MDT) around the children and young people, e.g. health professionals and Educational Psychologists
-
Goal setting
-
Facebook group, Zoom hangouts; online chat forum: Support Services | Long Covid Kids
-
Age-appropriate books on coping with illness (e.g. Sticky McStickstick by Michael Rosen)
-
Also consider forming Collaborative Care Teams of parents, teachers, Dr, EP who work together with one as a central communicator, and front load adjustments and gradually withdraw when the child or young person is ready (The Conversation).
-
Pacing: Most people tend to do a lot when they are feeling good and not very much when they feel unwell. This can lead to big swings in activity, overdoing it one day and crashing the next, which can then exacerbate any other symptoms. This is called the boom-bust situation, with the recovery period known as “payback”. We need to avoid this. Pacing energy management (by attending school every day for 1-2 hours for instance, rather than attending Mon/Wed/Fri) helps avoid swings and keep progress to recovery sustained. This can then be reviewed and increased as you feel better.
The following suggested support strategies are adapted from the Somerset Graduated Response Tool and Long Covid Kids Support Guide.
Communication and interaction
-
Asking for help: secret signals / “time out” card for when they feel anxious, confused and need a break.
-
Understanding verbal instruction: chunking; repeating instructions; ask them to repeat instructions; simplified language; check in during activity to see if they still understand
Cognition and learning
-
Fatigue and tiredness: breaks; quiet place; time out card; help card; extra time; flexibility on homework and exams; reduced attendance / timetable learning from home; differentiation in PE; Organise transport door to door; Avoid child needing to queue or line up; Warm room at break/lunch; Can another child carry bags? Consider that mornings can be more challenging.
-
Concentration / brain fog: Many of these strategies relate to supporting executive function; Short tasks broken down into small steps and chunked up into sections that can be worked through in a logical order and can be ticked-off; Simplified task prompt sheets that are reinforced with visual prompts; Recording part of a lesson, so that it can be referred back to; Clear instructions and support to start a task; Clear task expectations; Clear end point for each task (with clarity on what the finished task will look like or a specified end-time); Visual prompts, structures, checklists, timetables or reminders; Colour coded key info; Sentence starters; Allow thinking time; Practical activities, physical objects and opportunities for experiential learning to make tasks as concrete as possible; Mind maps/flow diagrams to record ideas visually; Increased differentiation of tasks; Rest or brain breaks; Reduce distractions in the environment to facilitate concentration, e.g. sit nearer to the teacher or away from windows or doors; Opportunities for pre-teaching, repetition, reinforcement and overlearning to support retention of knowledge and generalisation of skills; Banks of key words, especially for topic work or specific subject vocabulary; less reading and writing; Abridged versions of more challenging texts, drama and role play to support understanding of text; Allow them to talk through their learning and thinking; Identify and draw on their strengths, preferences, and interests.
-
Missed learning: Monitor and track progress; Regular contact with home to share upcoming topics and homework; Develop a catch up plan including a learning content map with the children and young people and their family so that it is realistic and there is joint ownership, Boosting motivation; Support them to understand this plan and where they are in it and celebrate progress; Be flexible with expectations of how much work needs doing.
Social and emotional mental health
-
Anxiety: Key worker (including regular scheduled meet and greet and end of day check ins); Emotional literacy (recognising and naming, communicating emotions); Check-ins; Social stories; Anxiety interventions; Cognitive behavioural therapy (CBT); opportunities for expression (drama, art, sport); Nurturing environment; distinguish between Long Covid and emotionally-based school avoidance (EBSA); Teach calming strategies (e.g. finger breathing); Visual timetable.
-
Social thinning: Key worker check ins; Including them in activities; Additional opportunities to make connections; online platforms for keeping in touch; Address stigma and understanding in peers; Show child that home and school are working together.
-
Loss of identity: Share strengths and achievements (diaries); Resilience building (problem solving, self-regulation); Families and school can support children and young people to connect past and future by sharing and reminding them of memories, e.g., using photo albums, letters; Acceptance and Commitment Therapy (ACT)
-
Self-esteem: Specific praise; Self-esteem building activities; Pre-teaching; Reduced challenge; Records of progress; Growth mindset (focus on effort, especially around catching up on missed work)
-
Staff: Training on adverse childhood experiences (ACEs), SEMH awareness and relational approaches
Sensory and physical
-
Noise and light, smell and taste: Access to quiet space; Alternative spaces at lunch time; Be aware of any changes to or distortions of smell and taste; Reduce sensory stimuli in the classroom.
-
Physical symptoms (pain, dizziness, nausea): Time out card; Individual health care plan; Occupational and physical therapy; Leaving lessons earlier and / or later; Personal Emergency Evacuation Plan (PEEP); Alternative routes around school; consider location of locker etc. to reduce movement.
For more detailed descriptions of Universal and SEND support, see the Somerset Graduated Response Tool
If you are concerned that a child or young person has an immediate risk of injury or death, call 999
References
Developed by Michael Wild (Assistant EP, Somerset EPS) in collaboration with Somerset NHS colleagues: Dr Sarah Bridges (Consultant Paediatrician), Dr Kate Staveley (Associate Clinical Director - Women’s and Children’s Health), Joanne Leek (Health Promotion Manager Emotional Health & Wellbeing), Dr Anna Kyle (Consultant Paediatrician)
