2 years into the COVID-19 pandemic, we are humbled by the tireless work of our clinical and scientific colleagues who have treated and protected the world's children. The clinical profile of SARS-CoV-2 infection in the young is now established: the vast majority of children and adolescents will have a mild illness, with a low risk of hospitalisation or complications. Initial fears over emerging strains being more dangerous appear to be unfounded: reporting the first data from the omicron wave in South Africa, Jeané Cloete and colleagues showed that the observed rapid increases in cases and hospitalisations in children (<13 years) mirrored the high community transmission of SARS-CoV-2, with similar rates of hospital admission or intensive care intervention seen with earlier variants.COVID-19 vaccines, licensed for children older than 4 years, are more than 90% effective at preventing laboratory-confirmed COVID-19 in children. Severe side-effects are rare, with low incidence of myocarditis or multisystem inflammatory syndrome in children (MIS-C). Data from Israel and Hong Kong showed that post-vaccination myocarditis in adolescents occurred in 0·5 per 100 000 after the first dose and 22 per 100 000 after the second dose, with a greater risk in males. On Feb 22, Anna Yousaf and colleagues showed that among 21 million 12–20 year olds in the USA who received at least one dose of COVID-19 vaccine, the reported rate of MIS-C was 1·0 case per million, with none affected having lasting adverse effects. Data on incidence of adverse effects of COVID-19 vaccination in younger children are awaited, alongside crucial licensing decisions for use of vaccines in children under 5 years.Concerns about long-term consequences of SARS-CoV-2 infection in young people are also being challenged. Two large studies of long COVID in adolescents are published in this issue. Terence Stephenson and colleagues report data from 6804 11–17 year olds in England and Selina Kikkenborg Berg and colleagues report data from 28 270 15–18 year olds in Denmark. The studies assessed physical and mental health, school attendance, and health-related quality of life in adolescents at least 2 months after confirmed SARS-CoV-2 infection compared with age-matched SARS-CoV-2-negative controls. They found a high symptom burden in both groups, with a very heterogenous symptom profile indicating that the pandemic has had a profound impact on all adolescents, regardless of infection status.While a minority of children and adolescents do experience lasting effects from SARS-CoV-2 infection, all children have been affected by the pandemic. The very youngest, born just before or during the pandemic, are at risk from effects of maternal stress during pregnancy and developmental delays due to restricted socialisation, limited language interactions, and reduced opportunities for physical and outdoor play. School-age children have missed years of crucial education and peer interactions, with gaps predominantly affecting the most disadvantaged. Adolescents have additionally suffered significant disruption on their journey towards independent adulthood, with millions encountering difficulties in mastering autonomy and independence, maintaining healthy peer relationships and mental wellbeing, and continuing in their education or vocation.Some of the most devastating effects of the pandemic on children have come from losing parents or caregivers; in this issue, Juliette Unwin, Susan Hillis, and colleagues estimate that 5·2 million children have been orphaned by the pandemic. Many more families have been pushed into poverty, where risks of malnutrition, neglect, or abuse of children are heightened. Those young people with a disability or chronic condition have had treatment interrupted or services removed, and millions globally have missed routine childhood vaccinations. These crises can only be addressed through prioritising integrated care for children in national COVID-19 response plans, using evidence-based strategies to minimise adversity and maximise recovery.The pandemic has had wide-ranging and long-lasting effects on young people, but children's developmental plasticity and resilience give us room for optimism. As the world moves into the next phase of pandemic recovery and living with COVID-19, we must grasp this opportunity to support every child to catch up and thrive. The Lancet Child & Adolescent Health will be publishing a Commission to build a roadmap of recovery for this COVID generation. We call for collaborators and research from all aspects of child and adolescent health—particularly from our colleagues in development, social science, and adolescent health—to join us.