Children’s Emotional Well-Being and COVID-19

Months of uncertainty regarding schooling, separation from friends and family, loss of extra-mural activities, lack of supervision and the ‘new normal’ (i.e. masks and social distancing) resulting from Covid19 and lockdown may be taking their toll on children’s coping mechanisms and sense of resilience. Children of front-line workers may be particularly affected because fear for their own or the lives of their loved ones may be more frightening to them than any real risk they face. The good news is that the vast majority of children will adapt, cope and thrive if their parents/caregivers are able to provide them with appropriate support. Life – even without a pandemic – is full of changes, dramas and traumas. Our children are learning this invaluable life lesson through this experience.

What is the impact?

As the global pandemic is still ongoing, the level of impact is unknown, although we can use other large-scale crises to understand what this might be. What we do know is that children differ from adults in that they largely lack the experience, skills and resources to be able to meet their developmental, social/emotional, mental and behavioural needs without adult input. Children’s adjustment and resiliency depend on inherent (their experiences, developmental level and social influences) as well as event-related factors (extent, intensity and duration).

Are younger children aware of the stressors?

Given the length of time that we’ve been living in lockdown as well as the pervasiveness of the pandemic, it is inevitable that even if your child does not know exactly what is going on they are aware that something stressful is affecting their family. This is particularly true for the children of front-line workers. In addition, intentionally or unintentionally, children may be privy to conversations where anxieties are discussed. They may be exposed to confusing or inappropriate amounts of information via the media and social media. Children’s well-being is not only impacted by the awareness of the virus, but younger children may blame themselves if someone they are close to becomes sick. Feelings of guilt and self-blame may also occur in older children for having survived or for being unable to protect their loved ones.

How do I know my child is in distress?

During times of great stress and uncertainty, it is easy to underestimate the level of a child’s distress especially when one is only relying on the child’s outward behaviours. Many children who experience adjustment difficulties after or during a crisis may have no observable distress behaviours. Children might try to avoid revealing concerns as they might think they will be considered weird or that they’re alone in their emotions. They may also not want to further burden their parents/caregivers who are having difficulty coping or they may feel that their distress is insignificant in comparison to what others are experiencing.

Conversely, some children and adolescents may have emotional outbursts and disruptive behaviour. Adolescents may turn to new or increased substance use and alcohol consumption. Insomnia, refusal to go to sleep, frequent waking, nightmares, night terrors and fears of sleeping alone are very common in younger children. These behaviours are related to a child’s sense of security. Maintaining a bedtime routine, spending more time together near bedtime, having a favourite doll or stuffed animal nearby, leaving a light on and staying with them until they are asleep may help.

Regressive behaviour is common, especially among younger children. They become more dependent on adults, are clingy, and separation anxiety or school refusal may occur. They may regress to thumb-sucking, develop speech difficulties, fear the dark or have toileting difficulties.

Another way children indicate they are in emotional distress is through somatic symptoms. The most common include headaches, stomach-aches, chest pain, and nausea. These symptoms typically improve when children are given the chance to express their feelings through play, drawing or talking.

There is a strong link between caregivers who are feeling overwhelmed and children in emotional distress. Adults often hide their own distress to protect their children or provide them with false reassurance which may communicate to children that they should not or cannot be upset. If parents are not able to manage their own distress, they could become impatient and be less able to recognise and react to their child’s emotional needs. They may rely on their child for their own comfort. This will negatively affect the child’s sense of safety and security. Parents in this state may overreact to somatic symptoms or excuse disruptive behaviour. Continuing to provide consistent limits and opportunities to discuss your child’s fears, anger, sadness and other emotions leads to better outcomes. If children and adults receive sufficient and sustained support and have the internal resources to adapt, they can emerge with new skills that they can use to cope with future adversity.

Is medication an option?

Medications are generally avoided in the management of children’s distress after a disaster. Children need to develop an understanding of the event and learn to express and cope with their reactions. Medication should, therefore, not be used to suppress reactions such as crying or feelings such as sadness and should not be used to blunt children’s awareness of the event. There are exceptions if the child has a history of medication use for preexisting anxiety or depressive conditions. In addition, the drawn-out effect of the pandemic may result in higher medication prescription than is typically found as internal coping resources get worn down.

What do I do?

Communicating with children during a crisis may help them begin to make sense of all that has occurred. Reminding them of previous challenges they have overcome may increase their self-confidence because they have already coped with an event that once appeared overwhelming. Telling a child who is worried that they should not be is usually ineffective and sends the child the message that their emotions are not valid. Avoiding discussion is rarely helpful and often isolates children at a time when they are most in need of support and assistance. Helping children develop a range of coping skills they can use when experiencing distress and troubling feelings can also assist them in future times of crises. A discussion about the parent’s own distress and what strategies they used to cope is often useful as it provides the child with coping strategies they can apply as well as having these roles modelled. The initial mental health goals are to restore stability, improve social networks, decrease hyperarousal and support recovery. Many symptoms are a normal response and recommending, modelling or teaching ways to help the child adapt and return to previous functioning is often enough intervention.

Listen Provide opportunities for your child to express their feelings of worry, anxiety, fear and concern. Acknowledge what is happening/happened and let them know that it is okay for them to share their experiences and that you understand that they are concerned.

Protect Try to re-establish feelings of emotional safety by having a calm routine and providing your child with information about what is being done, what they can do to keep themselves safe as well as what your community and workplace is doing to keep everyone safe.

Connect Re-establish normal social relationships and stay connected with others in order to have social support even if only in an online environment. Social support promotes stability, recovery and predictability in people’s lives.

Model Even though you may not know how to process your own experiences, you can acknowledge the disruption that it has had on your life. Acknowledge your and your child’s need to ‘get back to normal’, highlight and look for the positive aspects of the ‘new normal’. By doing so you are demonstrating that it is possible to have an optimistic view to the future and that stress can be effectively coped with even in situations of fear and uncertainty.

Adapted from the “Listen Protect Connect Model and Teach During the World-Wide Pandemic” ©2020 North American Center for Threat Assessment and Trauma Response™

To conclude Building resilience is essential for good emotional outcomes. Among the most important protective factors for supporting the emotional well-being of children are secure attachment relationships, self-determination, self-regulation skills and being part of a supportive social system such as school. A loving and caring family system is a fundamental protective factor in strengthening a child’s resilience and supports healthy development in spite of crisis and hardship. Equally important is that children have access to education, health services and opportunities for play and social interaction. If you and your child are struggling to cope, seek professional assistance .

Click for more about Lianna Morrison – Educational Psychologist – MEd Psych (US) MECI (UP)

References

Chung, S., Foltin, G., Schonfeld, DJ., (2019) American Academy of Pediatrics: Pediatric disaster preparedness and response topical collection (chapter 4, Mental Health Issues)

Schonfeld, Dj., & Demaria, T (2015) Providing Psychosocial Support To Children And Families In

The Aftermath Of Disasters And Crises. Disaster Preparedness Advisory Council And Committee On Psychosocial Aspects Of Child And Family Health Pediatrics

Stafford, B., Schonfel, D., Keselman L., Ventvogel P., Stewart, C.L., (2006) The Emotional Impact of Disaster on Children and Families from the Practical guide of mental health in disaster situations

The National Child Traumatic Stress Network: Parent/Caregiver Guide to Helping Families Cope With the Coronavirus Disease 2019 (COVID-19)

Wong, M. (April 2020) Psychological First Aid for Schools, Teachers and Students, North American

Centre for Threat Assessment and Trauma Response www.aap.org/disasters/adjustment www.ispcan.org/covid19resourcepage (Talking with children: tips for caregivers, parents, and teachers during infectious disease outbreaks)

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