Many families are facing major changes in their day-to-day lives because of COVID-19. With all the unknowns that come with a pandemic, it’s normal to feel anxious about the “what ifs” and the future.
This stress does not just affect adults – children and adolescents are also at risk for anxiety, especially as their daily routines are affected.
Psychiatrist, Dr Magula answers some of your most frequently asked questions about what caregivers should know about anxiety in children during COVID-19.
How is the pandemic affecting children in terms of anxiety – has there been an increase in younger patients at your practice?
Although most children appear to experience less severe physical illness and have much lower mortality rates than other age groups from COVID-19 infection, they remain at substantial risk for negative outcomes given the widespread economic and societal disruption resulting from the pandemic. The consequences of COVID-19 on children are vast in terms of their health, safety and well-being.
According to UNICEF, children might find it challenging to understand what they see online or on TV, and they are vulnerable to anxiety, stress, and sadness. In a study in China, 85.7% of the parents perceived changes in their children’s emotional state and behaviours during the quarantine. The most frequent symptoms were difficulty concentrating (76.6%), boredom (52%), irritability (39%), restlessness (38.8%), nervousness (38%), feelings of loneliness (31.3%), uneasiness (30.4%), and worries (30.1%), these being some of the signs of anxiety that you can pick up in children. Post-traumatic stress is estimated to be four times higher in children in quarantine than those who have not. Their likelihood of presenting acute stress disorder, adjustment disorder, and grief is also higher. In a study conducted in Italy and Spain on children’s anxiety during the pandemic, the prevalence of anxiety among children was 19.4%; which is more than three times higher than the prevalence of anxiety in children in the general population before the pandemic, which was at 6.2.-6.5%, with girls more affected than boys.
What signs do parents need to look out for – what are the symptoms of anxiety in the young?
Anxiety symptoms in the young may vary depending on age and other social and psychological factors that may be present and worsen anxiety feelings. You may suspect your child has anxiety when they feel sad, cry or display anger and frustration. You may notice that they may stop partaking in activities they would usually enjoy at home and school or in the community with their peers. They may withdraw and prefer being alone or just with you only, fearing or refusing to visit extended family members that they would usually visit. You may notice lots of sudden and constant arguing or fighting in the house, even towards you as the adults. Children may refuse their chores and start back chatting or being defiant to rules and instructions or disobey household rules. It is important to keep an eye on the children’s vegetative functions, including their sleep, appetite and weight, energy levels, concentration, and focus even at play.
Play may become limited, especially on the very young and adolescents may have reduced interest in social and peer interaction. However, some may want to break free from the indoor environment and mix more with peers and may be vulnerable as they may start exploring substances and unwanted behaviours. At extreme levels, children may even harm themselves, and some may not want to continue to live due to the stresses of the current situation or even from the fears they may have about the virus or what they may have heard and learnt about someone who may have had the virus.
Anxiety in children is usually accompanied by other mental health issues, including depression, and those with access may self-medicate with substances, so please ensure to seek help from a mental health professional when in doubt or if your child’s symptoms are out of proportion from how you know them.
What are the specific triggers for kids at this time?
A study in Brazil showed that parents who kept their jobs had children who experienced more anxiety. This result highlights children’s insecurity when their parents are not with them during the crisis, and this may be a trigger for developing anxiety in children. The severe implications of this finding and experiences from the COVID-19 pandemic highlight the need for selective strategies to strengthen families and help them protect the children. Parents’ presence is important for children, and children need to feel safe within their families.
Studies in China, Italy and Spain showed that children who were keeping social distance with both their mother and father have lower anxiety scores than those who were isolated with a person other than their parents. This finding confirmed parents’ important role in children’s lives, perhaps, especially in this pandemic.
Another trigger is if children lack emotion-focused conversations with their parents, it can lead to anxiety about their parents’ emotional state, which will influence theirs. Other triggers include limited peer interactions during isolation and quarantine. It is important that children have access to peers to maintain social and cognitive development. One study in Italy showed that staying at home without the chance to go outside may increase responses of anxiety and other related problems such as sleep problems, physical complaints, and worries, and also behavioural problems that involve the family, such arguing with other relatives, maybe because the children need to be more physically active.
During social distancing, the world is relying on technology to learn, live, and stay connected. This may limit this close personal interaction with immediate family within the same household, triggering anxiety from this new form of interaction and potentially harmful information sources they may come across unsupervised. The lack of access to services such as playgrounds, school, parks, and other play and socialisation places can be particularly harmful to vulnerable children or families.
Special attention should be paid to children and adolescents who are separated from their caregivers due to having contracted COVID or suspected of being infected and are in hospitals or care facilities not accessible to children, and those whose caregivers are infected or have died because they are more vulnerable to psychological problems including anxiety.
How can adults help their kids deal with anxiety during the pandemic?
Parents must ask their children open questions about their knowledge and fears around the pandemic, and they must listen to their answers, correcting and educating with the correct information. Other recommendations include that parents be honest and use age-appropriate language, watch their children’s reactions, show sensitivity to their anxiety levels, and have close conversations with care.
Parents and other family members are encouraged to increase their communication with children to address their fears and concerns, play games, engage in physical activity, and use music therapy in the form of singing to reduce the worry, anxiety, fear and stress that children may feel.
The most important thing for children is to have adults around them meet their needs and help them feel secure, calm, and supported in their own sense of control. Children feel better when they can communicate their feelings in a supportive environment. Adults need to be authentic about the pandemic’s uncertainty and psychological challenges without overwhelming children with their fears. This honesty should encompass a coherent explanation of what the children observe and grant permission to safely talk about their feelings. There are now many books, including cartoon illustrations and short videos that parents can watch with their children that best explain the pandemic in a child-friendly manner. There are also increasing materials available online for parents to guide them on how to talk to their children about the pandemic in a manner that will alleviate any existing anxiety about the pandemic.
Please ensure to seek help from a mental health professional when in doubt or if your child’s symptoms are out of proportion from how you know them.