The psychological toll of COVID19 on kids
Our lives changed immeasurably when school closures and quarantine for nonessential workers began in many parts of the world in the early spring of 2020. My family had just returned from international travel, so we had no choice but to hunker down for 2 weeks with our girls who were 4 years and 14 months old at the time. Although as a physician I understood the full significance of the pandemic, at the time, a couple of weeks of later bedtimes, relaxed screen time rules, at-home meals and family movie nights actually sounded like a break from the craziness of everyday life.
However, as the weeks stretched to months and parents (ourselves included) began to resume many of our regular work responsibilities, so many were left wondering about the psychological impact on our kids. When the days of baking banana bread, creative craft-making and family walks progressively morph into hours of Disney+ and parents who are increasingly stressed as they juggle completing responsibilities, what effect does this have on the kids? Will they suffer in the long term? The truth is, there is very little data on the long-terms effects of large-scale disease outbreaks on children. Here’s what we do know:
The psychological impact on children can be attributed to 2 different types of potential sources of psychological distress:
Fear of infection or a loved one becoming infected and/or dying
Distress related to frustration and boredom, lack of routine, parental anxiety/depression, and lack of social interaction with same-aged friends
Today we’ll focus on the 2nd element – a future post will talk more about how to speak to kids about illness or illness/death of a loved one.
First, the not-so-great news. Research has shown that children and teens are experiencing mental health issues related to the disruptions of school closures, cancelled activities, and maintaining social and physical distancing. We know that, in general, when children are out of school (weekends and summer holidays) they tend to be less physically active, have more screen time, irregular sleep patterns and less healthy diets. During the pandemic, these negative effects were likely compounded by the lack of outdoor activities and interactions with same-aged friends at the beginning of the outbreak, as well as anxiety about an uncertain future.
There are a few studies that looked a the short-term impact of the pandemic on children. A study of youth aged 3 to 18 years from Italy and Spain (Orgiles et al, 2020) showed that children had more difficulty concentrating, and feelings of irritability, loneliness, and worry. A Chinese study showed that the following factors were associated with increased levels of depressive symptoms: smartphone or internet addiction, having a family member or friend infected with the virus, levels of separation anxiety and tendency to adopt an emotion-focused coping style (Duan et al., 2020).
Children with specific mental health needs have been particularly impacted – this includes children with autism spectrum disorder, for whom maintaining a consistent routine is extremely important. The suspension or cancellation of speech therapy and social skills training has stalled progress and even contributed to regression in kids who need these services to thrive. In my clinical practice, I’ve seen teenagers who have suffered greatly from feelings of isolation and lack of access mental health services. Many of them have replaced in-person social contact with increased time online, exposing them to other potential sources distress including online bullying or online predators.
Here’s the good news: children have an enormous capacity for strength and resilience and, as parents, there’s a lot you can do to mitigate the risk factors mentioned above. There is so much you can’t control right now, so it’s important to focus on what you can control. Children have a fundamental need to feel safe and loved. If you keep these two needs at the core of your daily interaction with your children, your behaviour and actions can be a source of stability and reassurance.
Try to maintain structure and routine as much as possible, but allow for flexibility. That might sound contradictory but here’s what I mean: children thrive with consistency and routine, so it’s important to have some structure built into your day. However, rigid schedules will probably leave children stressed and parents feeling disappointed when they inevitably don’t work out, so have room for flexibility built in! Have a “general” schedule to your day, but if you plan a 45 minute online dance class in the morning, and your child is not having it after 10 minutes– don’t force it! It’s perfectly fine to move on to something else or just take some time to rest and regroup. ;/’
As a parent, be aware of your own feelings. Take the time you need to mourn what has been lost. It’s OK to be sad about that cancelled ballet recital and soccer season that isn’t happening. It’s OK to be angry that you had to cancel the family trip you spent a year planning and looking forward to. It’s OK to be disappointed that the first day of school won’t look how you expected it to. Instead of fighting these feelings –let them come, acknowledge that it’s normal to feel them, and then try to find productive ways to move forward. Dr Pooja Lakshmin, a perinatal psychiatrist, talks about distinguishing between productive and unproductive worries. “Ruminating about the social distancing precautions each family in your kid’s school is taking is less productive, for you don’t have any control there. Especially in times of uncertainty, it’s seductive to believe that if you worry about something for long enough, you can affect the outcome, but this is a fallacy.” When these unproductive worries arise, we want so badly to find information that will refute the worries or reassure us. This can lead to compulsive researching/online scrolling, which will likely just exacerbate the problem. Rather than “doomscrolling”, she suggests just letting the feelings be and focusing on what you can control.
Talk to children about what’s going on in a way that is appropriate for their age and developmental level. Children are more perceptive than we give them credit for and if they are hearing the news and sensing your anxiety, they might already be creating worst-case scenarios in their minds and imaging things as worse than they actually are. It’s important to start a conversation with them about their worries – be honest and reassuring. For children who are less inclined to express themselves verbally, help them find ways to express themselves through creative activities – art, music, or writing can be very helpful. I’ll have more tips for concrete things you can say depending on your child’s age/developmental level in a future post.
Model good behaviour – if you are online all day, it’s hard to tell your kid to put down the tablet and get outside. Put aside a bit of time each day to do something with them. This applies to preschoolers and teenagers! If teenagers are not particularly interested in spending time with you, it’s still important to check in every day to see how they’re feeling (even if they roll their eyes at you, trust me). Also, children are perceptive and will model how to respond from their caregivers. Although you can’t control what’s going on, you can control how you respond to it.
Filter the news! In March, I was watching every single press conference on COVID19 because I needed to know the daily numbers of hospitalizations, ICU admissions and deaths. As a physician, it was important for me to have this info. The thing is, my 5 year old probably didn’t need to have all these details. If your kids and seeing/hearing things on the news or from others, it’s important to sit down and talk with them about it. Avoiding the conversation might make things worse (as in point 3).
If you notice a change in your child’s mood or behaviour, speak to a health care professional about it. I was surprised how many parents thought that doctors were no longer seeing patients these past few months. Although some did have to shift to virtual visits, in-person visits are being offered more and more by many family doctors, pediatricians, psychologists and social workers. Don’t hesitate to reach out!
When you don’t know what to say or do, you can’t go wrong if you say these simple words to your child (and this works for any age): You are safe. You are loved.