The COVID-19 pandemic has brought about many changes for all of us, but children struggling to understand why all of these changes are taking place might be particularly impacted by the stress, demands, and constant adjustments brought on by coronavirus concerns.
Prenatal Impacts:
In fact, the impact of the pandemic may even prove to be harmful for fetal development, thereby affecting children before they are born. High cortisol levels from increased stress in pregnant mothers have been shown to negatively impact the cognitive performance, overall health, and educational attainment of the child [1].
Pregnant women during the pandemic have undoubtedly had to deal with increased levels of stress as they navigate prenatal care through an unprecedented time. Studies show this stress in utero may lead to behavioral problems in the child apparent by age 5 [2], with lasting effects for their health.
For School-Aged Children:
For school age children, more challenges persist. Many students relied on the school setting for consistent and nutritious meals, psychological care, and a safe learning environment. These effects of distanced learning are felt even more deeply by low-income families who may not have the resources to provide a quiet and well-equipped learning environment to children at home [3,4]. Recent studies from early in the pandemic are already indicating negative psychological effects in children who had to quarantine. This isolation brought about symptoms of post-traumatic stress, confusion and anger compared to children who did not quarantine [5].
With many parents also working from home, there has unfortunately been a rise in domestic violence reports as well as childhood exposure to adverse events, which has been linked to long term consequences on health including risk of chronic disease and early mortality into adulthood [6]. Children have also been exposed to the stress felt by adults in their household as they worry about health concerns, employment status, and financial security. This stress can be felt by the children, which may impact their ability to concentrate and function in other realms of their lives, including schoolwork [7]. With parents preoccupied with additional stressors brought on by the pandemic, they also might be less equipped to recognize signs of behavioral issues in their children, leading to undiagnosed, possibly intervenable, mental health disorders [8].
What We Have Learned from Past Epidemics:
Although this is the first time many of us have had to face the challenges of a global pandemic, these impacts on childhood development and mental health outcomes were seen in other pandemics and public health crises throughout history*. For example, mothers who were pregnant during the influenza pandemic of 1918 birthed children who suffered worse health outcomes and even had lower age mortality rates [9].
Children of adults who suffer serious illnesses or have prolonged stays in Intensive Care Units were shown to have increased ratings of loneliness and sadness owing to lack of understanding of their parents’ illnesses and absence. Through the SARS epidemic, children afflicted were shown to have delays in reaching developmental milestones and had lower average body weights. In fact, the methodology employed in this study has proven helpful in working to understanding the long-term effects of the health of children through the pandemic.
With all of this in mind, how do we move forward?
How do we ensure that children are able to learn and grow despite the pandemic? Studies with children who have lived through previous situations similar to COVID-19 have shown that we need to nurture a sense of resilience in children.
Particularly in children, it is important to watch for changes in sleeping and eating patterns. When children are expressing feelings of anxiety, it can be helpful for parents and teachers to maintain a positive outlook…
Though this may be easier said than done, there are key signs to be on the lookout for that might be indicative of some psychological impact or negative mental health outcomes. Particularly in children, it is important to watch for changes in sleeping and eating patterns. When children are expressing feelings of anxiety, it can be helpful for parents and teachers to maintain a positive outlook and help students and children work through these feelings while diverting energy towards productivity, whether that be schoolwork, exercise, or household tasks. Additionally, parents can partner with their pediatricians. Behavioral family intervention training has helped parents be better equipped to recognize childhood behavioral disorders, which allows for earlier intervention [10]. Healthcare providers can utilize verbal advice, written information, teach-back practices, role playing, and multimedia approaches to help parents identify good parenting practices while at well-child visits. Continued support from the school system with regards to providing meals, ensuring adequate resources and technology, and offering telepsychiatry appointments is also crucial in maintaining the overall health and well-being of children. Through concerted efforts from parents, healthcare providers, government agencies, teachers and friends, children will be able to continue with their growth and development through the uncertain and unfortunate circumstances of the COVID-19 pandemic.
Disclaimer: The opinions expressed in this article are my own and do not represent the opinions of any organization with which I am affiliated.
*Photo credit: “Children ready for school during the 1918 flu epidemic in Florida,” courtesy of State Library and Archives of Florida
References:
Aizer A, Stroud L, Buka S. Maternal stress and child outcomes: evidence from siblings. National Bureau of Economic Research Working Paper Series. 2014;18422.
Betts K, Williams G, Najman J, Scott J, Alati R. Exposure to stressful life events during pregnancy predicts psychotic experiences via behavior problems in childhood. Journal of Psychiatric Research.2014;59: 132-139.
Chung G, Lanier P, Wong P. Mediating effects of parental stress on harsh parenting and parent-child relationship during coronavirus (COVID-19) pandemic in Singapore. Nature Public Health Emergency Collection. 2020;1-12.
Fegert JM, Vitilello B, Plener PL, Clemens V. Challenges and burden of the Coronavirus 2019 (COVID-19) Pandemic for child and adolescent mental health: a narrative review to highlight clinical research needs in the acute phase and the long return to normality. Child and Adolescent Psychiatry and Mental Health. 2020;14(20):1-11.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. 2020;395:912-20.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz A, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults – the Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine.1998;14(4).
Liu CH, Doan SN. Psychosocial stress contagion in children and families during the COVID-19 pandemic. Clinical Pediatrics. 2020;1-3.
Dalton L, Rapa E, Stein A. Protecting the psychological health of children through effective communication about COVID-19. The Lancet. 2002;4.
Bengsston T, Helgertz J. The long lasting influenza: the impact of fetal stress during the 1918 influenza pandemic on socioeconomic attainment and health in Sweden 1968-2012. Journal of Economic Literature. 2015;9327.
Bor W, Sanders MR, Markie-Dadds C. The effects of the triple p-positive parenting program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties. Journal of Abnormal Child Psychology. 2002;30(6): 571-587.
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