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Long COVID: developing a new online treatment programme to address breathing difficulties and mental health problems in children and young people

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Some estimates suggest up to one in 50 children and young people develop persistent symptoms after COVID-19, while other studies suggest it could be as many as one in seven.[1,2] Many children with long COVID describe experiencing ongoing breathlessness and feelings of anxiety or low mood at least 12 weeks after the infection.[2,3] Dr Samatha Sonnappa of the Royal Brompton Hospital in London is leading a team developing an online programme that aims to help improve breathing patterns and reduce anxiety in affected children. She hopes this new treatment will ultimately help boost the mental health and well-being of young people with long COVID.

How are children’s lives affected now?

Thankfully, most children and young people infected with SARS-CoV-2 (the virus that causes COVID-19) will have a short illness with few or no symptoms. But some will develop long-lasting symptoms that impact their physical, mental or social well-being, interfering with their daily lives.

“Many children and young people with long COVID develop breathlessness – and they may also feel worried, sad, or unhappy,” says Dr Sonnappa. “These problems are often interconnected, can worsen each other, and cause children to miss school and social activities – making them feel disconnected from their education and friends.”

But this picture is complicated because some physical effects of stress and anxiety present as breathing difficulties – including breathlessness and chest pain, at rest or during exercise – which are symptoms commonly experienced by those with long COVID.

“Finding new ways to reduce breathlessness and anxiety associated with long COVID in children and young people is important – particularly as these problems can have a significant impact on their mental health and well-being,” says Dr Sonnappa.

How could this research help?

“Our goal is to develop an online treatment programme that can help improve breathing patterns and reduce anxiety in children with long COVID, enabling them to return to their usual activities,” says Dr Sonnappa.

The researchers will recruit 40 children with long COVID, aged 13 to 18 years, working with them to develop an online treatment programme – which will include breathing and relaxation techniques, and ways to manage anxiety based on mindfulness and cognitive behavioural therapy.

“The programme will also help children to understand the connection between mind and body, for example, how feeling anxious can cause breathlessness – and will provide an option to connect socially with other affected children,” says Dr Sonnappa.

The team will carry out a pilot study to assess whether the online programme provides greater benefits than the current standard treatment alone, by analysing information collected from mental health and quality of life questionnaires, breathing assessments, and participant feedback.

We hope this will ultimately lead to an effective new treatment that can help improve the lives of children with long COVID.

Dr Sonnappa


  1. Molteni, E. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Health. 2021;5(10):708-718. DOI: 10.1016/S2352-4642(21)00198-X
  2. Stephenson T et al. Long COVID – the physical and mental health of children and non-hospitalised young people 3 months after SARS-CoV-2 infection; a national matched cohort study (The CLoCk) Study. Preprint from Research Square 2021; DOI: 10.21203/
  3. Brackel CLH et al. Pediatric long-COVID: An overlooked phenomenon? Pediatr Pulmonol. 2021;56(8):2495-2502. DOI: 10.1002/ppul.25521

Research table

Project details

Project Leader Dr Samatha Sonnappa, MD PhD FRCPCH
Location Paediatric Respiratory Medicine, Royal Brompton Hospital, London
Project Team Dr Terry Y Segal MBChB FRCPCH
Ms Charlotte Wells BSc MRes
Professor Deborah Christie BSc PhD Dip Clin Psych
Dr Liz Whittaker, MB BAO BCh MRCPCH DTMH PhD
Dr Dasha Nicholls MBBS MD FRCPsych
Ms Anna Gregorowski BSc
Dr Deborah Woodman, BA DClin Psych
Other Locations Treatment and Rehabilitation for Adolescents and Children with Complex Conditions (TRACCS) service and Children and Young People’s Psychological Services, University College London Hospitals NHS Foundation Trust
Paediatric Respiratory Physiotherapy, Royal Brompton Hospital, London
Section of Paediatric Infectious Diseases and Department of Child Psychiatry, Imperial College Healthcare NHS Trust Clinical Psychology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Trust
Grant Awarded
Grant Amount £91,064
Start Date
End Date
Duration 24 months
Grant Code (GN number) GN2923


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