As I explained in my first article (Peters, 2022), Long Covid is a physical condition which can affect any part of the body, and can cause different symptoms at different times with varying degrees of severity for each individual child and young person.
In the first article, I looked at just how many children and young people are suffering from Long Covid and the kind of symptoms they face. There is not a one-size-fits-all approach to supporting children and young people in the classroom, but this second article sets out some needs and strategies to help guide you.
The strategies below are for when a child is well enough to be able to begin attending school again. Please do note that initially after a Covid-19 infection some children may be too unwell to attend school. As they return, you can refer to the Pacing Penguins guidelines (Long Covid Kids, 2021).
1, Communication and interaction
What you might see: Reduced ability to find words or express themselves when feeling fatigued or anxious, or if they do not understand a task. Reduced ability to understand and remember verbal information or instructions.
How can you support?
- Use of a “secret signal” which only the student and their teacher/s are aware of to communicate when they feel anxious, fatigued or need help or a break.
- Break instructions down into smaller chunks, repeat instructions, check with the student that they have understood. Ask them to repeat or run through what they have to do and provide a visual breakdown/reminder of steps to complete.
- Use simplified language, shorter sentences and visual supports and prompts to reinforce verbally presented information.
2, Cognition and learning
What you might see: Fatigue and tiredness can be debilitating. Just attending school can use up a huge amount of energy. Add in the energy required to get to school in the first place, then moving around school, then add in the cognitive effort needed for thinking, remembering, learning, talking and socialising.
How can you support?
- Rest breaks during tasks, lessons or exams.
- Provide a quiet place to rest during breaks or lunch-times.
- Use of an exit card to leave the classroom without question when needed.
- A card or signal that they can use to ask for help or to show that they do not understand or need a break.
- Extra time for tasks or exams.
- Flexibility regarding homework or exams.
- Reduced attendance or reduced timetables.
- Opportunities to learn from home or online when physically being “in school” is too difficult.
- Increased differentiation or non-attendance during PE lessons. Liaise with health professionals as needed.
What you might see: Long Covid can cause brain fog, headaches and daily fevers leading to difficulties with concentration, thinking and memory.
How can you support?
- Short tasks broken down into small steps and chunked 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.
- 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.
- Practical activities, physical objects and opportunities for experiential learning to make tasks as concrete as possible.
- Mind-maps or 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.
- Reduce the amount of reading required to obtain information. Use alternatives such as pictures, cartoons and video, paired reading with a work “buddy”, recordings of source material, simplified texts, diagrams, flow charts etc.
- Reduce the amount of writing or copying required from the whiteboard. Use alternatives such as a laptop, note-taking, mind-mapping, etc.
What you might see: Gaps in learning due to reduced attendance or regression in skills.
- Careful monitoring of progress, highlighting gaps in learning and planning individualised support to fill these.
- Continued contact with parents/carers to keep them up-to-date.
3, Social, emotional and mental health
What you might see: Anxiety caused by the duration and severity of difficulties, a lack of understanding, unknown timescales for recovery, missed school or missed opportunities to socialise. A Covid infection can also cause anxiety.
How can you support?
- A keyworker to build a relationship with, to talk to and who will listen, such as an emotional literacy support assistant (ELSA), learning mentor, Thrive practitioner, education mental health practitioner or equivalent.
- Support to work on recognising, naming and expressing feelings and support to cope with strong feelings and to communicate how they are feeling about their situation.
- Emotional literacy resources such as use of role play/mirror games, videos, songs, emotion cards, games, stories and puppets.
- Wellbeing check-ins.
- Social Stories or Therapeutic Stories.
- Evidence-based anxiety interventions.
- Use of Cognitive Behaviour Therapy (CBT) informed approaches to understand the link between thoughts, feelings and actions. Diaries, feelings diaries or rating scales can help the student to express their feelings and to link thoughts and feelings to behaviours.
- Opportunities to express themselves and their feelings through art, drama, dance, sport etc.
- Relaxation, mindfulness, calming activities and breathing exercises.
- A nurturing learning environment with staff that understand the child’s needs will enable them to feel safe and secure and well cared for so that they can focus on getting better (and later to access their learning)
- Understanding that non-attendance due to Long Covid is likely to have different underlying causes to emotionally based school non-attendance.
What you might see: Social isolation (due to not being able to attend school full-time, not being well enough to socialise with peers out of school, attending more medical appointments, or taking part in less extra-curricular activities or sports clubs). Also, a lack of school “belonging” (due to being absent from school for a period of time or not being able to attend full-time).
How can you support?
- Check-ins from a key member of school staff such as a form tutor, teaching assistant, ELSA or key adult with whom the child can establish/maintain supportive trusting relationships.
- Keeping the student in mind (even when they are not in school) and including them in all school activities to ensure a sense of school belonging (include them and their parents in planning if needed). This will also ensure that they have equal opportunities and an equality of access to their education.
- Additional opportunities for making connections, social interaction and developing or maintaining relationships, e.g. social skills groups, friendship groups, circle of friends approaches, or peer-mentoring/buddy systems.
- Use of online platforms to keep in touch with friends and class-mates when physically unable to attend school.
- Be alert to the possibility of stigma and a lack of understanding in other children and young people leading to unkind words, e.g. that the child with Long Covid is “faking it” or doesn’t look ill. Work with peers to understand differences in others and to promote understanding, acceptance and kindness.
- Close and supportive home-school liaision.
What you might see: Loss of identity and changes to sense of self (due to reduced school attendance and not being able take part in social activities, hobbies and sports which previously defined them) and a resultant impact on self-esteem. Reduced self-esteem due to changes in sense of self or awareness of increased difficulties with learning.
How can you support?
- Use principles from Acceptance and Commitment Therapy (ACT) to work on acceptance (accepting a change in self/identity and accepting what is outside of the student’s control), being present, recognising strengths and values and setting goals.
- Opportunities to develop and share strengths and achievements with others. Use of diaries, records of achievements etc.
- Resilience-building activities. Explicitly teach problem-solving skills and self-regulation strategies in response to adversity, e.g. ask questions such as “what would x do?”, “what has worked before?”, “how can we break this big problem into little pieces?”.
- Self-esteem building activities so that the child experiences success and feels a sense of pride in their achievements, for example:
- Use specific praise which emphasises the effort and the approaches they have used as well as the end result.
- Use pre-teaching to increase confidence with learning.
- Design errorless learning tasks or tasks with a reduced level of challenge that the student can attempt independently and experience success with. Challenge can then be gradually increased with success.
- Use self-monitoring charts, record progress visually or keep a diary of achievements which the student can look back at or share with key adults/parents.
4, Sensory and physical needs
What you might see: Sensory sensitivities to noise and light.
How can you support?
- Be aware that busy, noisy spaces such as the lunch hall may feel overwhelming. Provide alternatives.
- Offer access to quiet spaces.
What you might see: Physical symptoms, such as gastrointestinal issues, chest pain, heart palpitations, joint or muscle pain, dizziness, nausea, headaches, fevers, nerve pain etc.
How can you support?
- Exit card so that the student can leave the classroom if needed.
- Have an individual healthcare plan in place in liaison with the school nurse and other professionals (paediatrician, occupational therapist, physio, etc).
5, General ways we can support pupils
- Listen and support children, young people and their families.
- Consider the impact upon families, including siblings.
- Seek the views of children and young people – ask them what would help them and how they would like to be supported.
- Be flexible and consider the individual child’s unique needs, that these may fluctuate over time, and adapt the child’s support plan as and when needed.
- Consider that the student’s focus may need to be on getting better (wellbeing) and that this may need to take priority over attendance and learning for a while.
- Liaise with any involved health professionals and discuss the impact of Long Covid on the child’s learning and wellbeing with your school’s educational psychologist (as appropriate and negotiated).
Supporting guidance for schools
In 2021, Long Covid Kids (LCK) became the first UK-based, international registered charity advocating for and supporting families whose children are living with Long Covid.
The charity aims to achieve recognition, support and recovery for Long Covid and related illnesses. It has already received recognition from the NHS and the US Center for Disease Control (CDC), as well as being a recommended resource in the NICE Long Covid guidelines (2021).
The charity launched a Long Covid Kids support guide – Shining a light on Long Covid in children: A guide to recognition, support and recovery – on April 1.
Created by parents and professionals whose children are living with Long Covid (including educational psychology and occupational therapy input), the support guide aims to be a comprehensive pack containing evidence-based resources and information for parents, families, children, young people, school staff, education, health and social care professionals.
The guide is free to download, print and save as a digital and paper resource for all those supporting children and young people living with Long Covid.
To accompany the guide a dashboard of five padlets will be available containing further useful links to articles, resources and information for:
- Children (up to approximately age 11)
- Young people (from approximately age 11)
- Families
- School staff and education professionals
- Health and social care professionals
We hope that this support pack will help raise awareness of the symptoms of Long Covid and related illnesses in children and young people and in doing so increase understanding, aid early diagnosis and improve response and intervention.
- Dr Sue Peters is an educational psychologist working with the charity Long Covid Kids & Friends, which works to raise awareness of the symptoms of Long Covid and related illnesses in children to increase understanding, aid early diagnosis and improve response and intervention. Visit www.longcovidkids.org
Further information & resources
- Long Covid Kids: Shining a light on Long Covid in children: A guide to recognition, support and recovery, April 2022: www.longcovidkids.org/support-guide
- Long Covid Kids: Supporting children living with Long Covid to manage their energy with Pacing Penguins, December 2021: https://bit.ly/3vUHLT9
- NICE: Covid-19 rapid guideline: Managing the long-term effects of Covid-19, last updated November 2021: https://bit.ly/3I2FsQx
- Peters: Exhausting, painful, lonely: The impact of Long Covid on children, SecEd, March 2022: https://bit.ly/3uFBacW