Child Trendings.19.March.2020. The following guidance, recommendations, and resources are provided by child trauma experts at Child Trends and the Child Trauma Training Center at the University of Massachusetts. The Center is housed at the University of Massachusetts with Child Trends as the lead evaluating agency, with funding from SAMHSA and the National Child Traumatic Stress Network and additional support from HRSA.
While the Centers for Disease Control and Prevention (CDC) currently reports that the risk of exposure to COVID-19 is low for young Americans, research on natural disasters makes it clear that, compared to adults, children are more vulnerable to the emotional impact of traumatic events that disrupt their daily lives. This resource offers information on supporting and protecting children’s emotional well-being as this public health crisis unfolds.
Amidst the COVID-19 outbreak, everyday life has changed and will continue to change for most people in the United States, often with little notice. Children may struggle with significant adjustments to their routines (e.g., schools and child care closures, social distancing, home confinement), which may interfere with their sense of structure, predictability, and security. Young people—even infants and toddlers—are keen observers of people and environments, and they notice and react to stress in their parents and other caregivers, peers, and community members. They may ask direct questions about what is happening now or what will happen in the future and may behave differently in reaction to strong feelings (e.g., fear, worry, sadness, anger) about the pandemic and related conditions. Children also may worry about their own safety and the safety of their loved ones, how they will get their basic needs met (e.g., food, shelter, clothing), and uncertainties for the future.
In addition to keeping children
physically safe during the COVID-19
pandemic, it is also important to care
for their emotional health.
While most children eventually return to their typical functioning when they receive consistent support from sensitive and responsive caregivers, others are at risk of developing significant mental health problems, including trauma-related stress, anxiety, and depression. Children with prior trauma or pre-existing mental, physical, or developmental problems—and those whose parents struggle with mental health disorders, substance misuse, or economic instability—are at especially high risk for emotional disturbances.
In addition to keeping children physically safe during the COVID-19 pandemic, it is also important to care for their emotional health. Below, we summarize recommendations for promoting the emotional well-being of children in the face of these types of adversities and provide a list of helpful resources. Because broader environments play an important role in supporting an individual’s resilience to childhood adversity, this list supplements resources specifically for children and their families with those intended for educators, communities, and states, territories, and tribes.
Recommendations to support and protect children’s emotional well-being during the pandemic
Understand that reactions to the pandemic may vary.
Children’s responses to stressful events are unique and varied. Some children may be irritable or clingy, and some may regress, demand extra attention, or have difficulty with self-care, sleeping, and eating. New and challenging behaviors are natural responses, and adults can help by showing empathy and patience and by calmly setting limits when needed.
Ensure the presence of a sensitive and responsive caregiver.
The primary factor in recovery from a traumatic event is the presence of a supportive, caring adult in a child’s life. Even when a parent is not available, children can benefit greatly from care provided by other adults (e.g., foster parents, relatives, friends) who can offer them consistent, sensitive care that helps protect them from a pandemic’s harmful effects.
Provide age-appropriate information.
Children tend to rely on their imaginations when they lack adequate information. Adults’ decisions to withhold information are usually more stressful for children than telling the truth in age-appropriate ways. Adults should instead make themselves available for children to ask questions and talk about their concerns. They might, for example, provide opportunities for kids to access books, websites, and other activities on COVID-19 that present information in child-friendly ways. In addition, adults should limit children’s exposure to media coverage, social media, and adult conversations about the pandemic, as these channels may be less age-appropriate. Ongoing access to news and social media about the pandemic and constant conversation about threats to public safety can cause unnecessary stress for children.
Create a safe physical and emotional environment by practicing the 3 R’s: Reassurance, Routines, and Regulation.
First, adults should reassure children about their safety and the safety of loved ones, and tell them that it is adults’ job to ensure their safety. Second, adults should maintain routines to provide children with a sense of safety and predictability (e.g., regular bedtimes and meals, daily schedules for learning and play). And third, adults should support children’s development of regulation. When children are stressed, their bodies respond by activating their stress response systems. To help them manage these reactions, it is important to both validate their feelings (e.g., “I know that this might feel scary or overwhelming”) and encourage them to engage in activities that help them self-regulate (e.g., exercise, deep breathing, mindfulness or meditation activities, regular routines for sleeping and eating). In addition, it is essential to both children’s emotional and physical well-being to ensure that families can meet their basic needs (e.g., food, shelter, clothing).
Keep children busy.
When children are bored, their levels of worry and disruptive behaviors may increase. Adults can provide options for safe activities (e.g., outside play, blocks, modeling clay, art, music, games) and involve children in brainstorming other creative ideas. Children need ample time to engage in play and other joyful or learning experiences without worrying or talking about the pandemic.
Increase children’s self-efficacy.
Self-efficacy is the sense of having agency or control—an especially important trait during times of fear and uncertainty. Children often feel more in control when they can play an active role in helping themselves, their families, and their communities. For example, children can help by following safety guidelines (e.g., washing their hands), preparing for home confinement (e.g., helping to cook and freeze food), or volunteering in the community (e.g., writing letters or creating art for older adults or sick friends, sharing extra supplies with a neighbor).
Create opportunities for caregivers (which may mean yourself!) to take care of themselves.
Children’s well-being depends on the well-being of their parents and other caregivers. Caregivers must take care of themselves so they have the internal resources to care for others. To this end, adult caregivers can engage in self-care by staying connected to social supports, getting enough rest, and taking time for restorative activities (e.g., exercise, meditation, reading, outdoor activities, prayer). Seeking help from a mental health provider is also important when adults struggle with very high levels of stress and other mental health challenges.
Seek professional help if children show signs of trauma that do not resolve relatively quickly.
Emotional and behavioral changes in children are to be expected during a pandemic, as everyone adjusts to a new sense of normal. If children show an ongoing pattern of emotional or behavioral concerns (e.g., nightmares, excessive focus on anxieties, increased aggression, regressive behaviors, or self-harm) that do not resolve with supports, professional help may be needed. Many mental health providers have the capacity to provide services via “telehealth” (i.e., therapy provided by telephone or an online platform) when in-person social contact must be restricted.
Emphasize strengths, hope, and positivity.
Children need to feel safe, secure, and positive about their present and future. Adults can help by focusing children’s attention on stories about how people come together, find creative solutions to difficult problems, and overcome adversity during the epidemic. Talking about these stories can be healing and reassuring to children and adults alike.