COVID-19 Curbside Consults

Helping children cope with the COVID-19 pandemic

Jason V. Lambrese, MD
Cleveland Clinic Journal of Medicine August 2020, DOI: https://doi.org/10.3949/ccjm.87a.ccc010

ABSTRACT

Numerous societal changes in response to the COVID-19 pandemic, such as school closings and event cancellations, have caused anxiety and fear for children and young people. There are ways to help young people cope with the current situation including establishing an open dialogue, creating a structured daily routine with a schedule with assigned roles, and using social media and video conferencing to remain socially connected.

INTRODUCTION

During the past month, our society has been forced to change in innumerable ways in response to the COVID-19 pandemic. Schools have closed, events have been cancelled, families have been quarantined, and medical visits have become virtual. The continuous onslaught of news via television and the internet may be more than many people can comfortably process, particularly youth. As a child and adolescent psychiatrist, I have recently conducted many virtual visits with children and adolescents and their families, all of whom are adjusting to our new normal. Anxiety and fear are common responses to our ever-changing landscape, but there are ways in which we can support young people in coping with the current situation.

MEET CHILDREN WHERE THEY ARE AT

Our goal is to create an open dialogue with youth where they can share their fears and questions. It is important to be honest in a developmentally appropriate way, using language that the child will under-stand. Providing more information or detail than children can comprehend or process may overwhelm them. On the other hand, being unnecessarily vague and avoidant will do little to address their fears.

Emphasize that the child’s family is doing everything they can do to stay safe, which entails washing hands and spending less time with outside family and friends. As the stream of information about the pandemic is ongoing, so may be the child’s questions and need for reassurance. Validate the child’s feelings, and let them know that there are people working to keep them safe. Look for ways that the child can engage in helpful activities—using chalk to draw or leave inspirational messages on the sidewalk and placing a teddy bear or sign in a window, for example.

CHILDREN MAY STRUGGLE WITH UNCERTAINTY AND CHANGE

Many children, particularly those with underlying mental health concerns such as autism spectrum disorder or an anxiety disorder, may be responding negatively to the recent changes to their daily lives. With very little time to mentally prepare, we have suddenly changed what would normally be a predictable pattern in their lives. Staying home from school has led to a loss of routine, structure, academic support, and social contacts. At the same time, it is not clear when this situation will end.

Parents can respond to this uncertainty by developing some routine and structure in the child’s day. Fostering a sense of predictability at home can go a long ways in helping children cope with an uncertain world. This includes attempting to keep a consistent sleep routine for their child but also recognizing that kids often stay up and wake up later when not attending school. It is also important to set aside time each school day for children to complete schoolwork and to take appropriate breaks. Parents can plan activities for the child or family to do during these breaks such as reading, playing games, doing physical activity, and getting fresh air while maintaining social distancing.

PARENTS CANNOT BE PARENTS, TEACHERS, AND WORKERS SIMULTANEOUSLY

Parents are in a predicament where we are asking them to take on the role of teacher while still being parents and perhaps still working in or outside the home. This rapid role change can be jolting for family systems, with immense pressure being placed on parents to successfully fulfill each of these roles. Unfortunately, this often sets parents up for failure, as it is difficult to simultaneously teach and parent their child while also completing their day’s work.

Creating a daily schedule can help parents better divide their time among their various roles. Reassure them that the school day at home will probably look different than the school day at school. Parents should avoid placing undue pressure on themselves to maintain fidelity to a regular school-day schedule while at home and instead craft one that balances educational, social, familial, and recreational needs.

SOCIAL DISTANCING IS PHYSICAL DISTANCING

Many people are struggling with the need to socially distance themselves from family, friends, and coworkers. For youth, the need to remain separated from their extended family, teachers, classmates, teammates, and friends can feel devastating and confusing, especially if the child does not feel sick. Parents should remind the child that these measures are designed to keep them and their loved ones from getting sick, but reframe the concept of social distancing into physical distancing. Just because we cannot be physically close to others does not mean we need to socially isolate ourselves. Take advantage of social media and video conferencing platforms (eg, Skype, FaceTime, Duo, Zoom) to maintain contact with loved ones virtually. Parents can arrange for a group of their children’s friends to all watch a movie at the same time while also on a video chat so that they can share the experience with one another. Maintaining remote contact while sheltering in place will help buffer against feelings of loneliness.

RETURNING TO SCHOOL

As the summer winds down, parents, children, and schools are considering the options for safely returning to school. There are many factors to consider—the best environment for learning, ability to remain at home with the children, social distancing ability in the school setting, and each district’s COVID-19 infection rates. Unfortunately, this is a dynamic situation and recommendations may change at the last minute.

The American Academy of Pediatrics (AAP) has released a statement that “strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school”. This recommendation comes with the understanding that being physically in school not only provides educational instruction, but also is relevant for social/emotional connectedness and development, physical activity, safety, and reliable nutrition. The AAP statement provides detailed considerations for each level of school with regards to physical distancing, cleaning protocols, screening for COVID-19, masks/personal protective equipment, and physical/mental health of the pupils; this detailed document is valuable for educators and parents.

In addition, the American Psychiatric Association (APA) and the American Academy of Child and Adolescent Psychiatry (AACAP) have released a joint statement that details school reopening recommendations, including the need for flexibility, importance of safety, role of social interactions, and potential for inequity across school districts and families. It also recognizes the particular consideration for students with special learning needs or mental health concerns.

THERE IS HELP FOR YOUTH AND FAMILIES

For some children, adolescents, and families, the COVID-19 pandemic is too much to bear. Those with a history of medical or mental health concerns may have a more difficult time coping with the stressors brought on by the response to the pandemic. Some may benefit from speaking with a mental health professional. In addition, here are some helpful resources:

Substance Abuse and Mental Health Services Administration

Taking Care of Your Behavioral Health

www.samhsa.gov/sites/default/files/tips-social-distancing-quarantine-isolation-031620.pdf

For Immediate Assistance

Disaster Distress Helpline - Call 1-800-985-5990 or text TalkWithUs to 66746

National Suicide Prevention Lifeline - Call 800-273-8255

Crisis Text Line - Text TALK to 741741

Footnotes

  • The statements and opinions expressed in COVID-19 Curbside Consults are based on experience and the available literature as of the date posted. While we try to regularly update this content, any offered recommendations can-not be substituted for the clinical judgment of clinicians caring for individual patients.

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