To the Editor
The coronavirus disease 2019 (COVID-19) pandemic has affected the lives of people across the globe. Although children are less physically affected by the disease, the same cannot be said for their mental health. Children of front-line health care workers (HCW) being taken care of by their grandparents or relatives are subjected to separation anxiety and excessive worrying. Quarantined children suffering from the disease or institutional children away from their family and siblings are likely to have adverse psychological effects.1 Those who have lost their parents to disease and are staying in foster homes, suffer grief, loneliness, adversity, and are quite susceptible to developing posttraumatic stress disorder.
At the same time, children are exposed to social media and gruesome pictures of disease and death may overwhelm them with fear, anxiety, clinginess, inattention, and irritability.2 During adverse childhood events (ACE’s), the body’s natural stress response may become dysregulated (toxic stress) leading to persistent elevation of cortisol and proinflammatory cytokines and predisposing children to negative health outcomes later in adult life.3 This stress can cause delay in cognitive development, somatic complaints, obesity, asthma, diabetes, recurrent infections, sleep disturbance, and even premature death.3
Other pertinent problems during these times are closure of schools, social distancing, lack of physical exercise, and outdoor activities. The electronic media did come to their rescue during home confinement but not without its own drawbacks. A few vulnerable ones may fall prey to the Internet and cell phone addiction and have difficulty readapting after the crisis passes.4
The stress of the parents who have lost their jobs directly affects children. The incidence of child abuse has increased while access to the support system has decreased because of the lockdown.5 The tendency to argue, addiction, self-harming activities, and even suicidal tendency may be seen to an extreme.
Intervention programs to serve children and caregivers in these times should be drawn and implemented by local government agencies. For parents, programs should focus on improving their parenting skills, being responsive, understanding children, protecting them from negative experiences, problem solving, and mentoring them.6 Prolonged exposure therapy, skill-building opportunities, and cognitively-based compassion training for older children help to develop self-esteem, self-efficacy, and goals for the future.6
The need of the times is to listen, understand, reassure children, and make them feel loved and safe. Parents should closely monitor children for any signs of change in behavior and sensitively apprising them of the situation keeping in mind their naivety will lessen the apprehension and help to tide over these tough times. Parents should spend quality time with them, regularize their daily schedule, do fun activities together to take their minds off the crisis, encourage them to do physical activity, and help them in their hobbies. Children should be kept close to their parents and family as much as possible or at least ensuring regular contact in case of adverse circumstances (hospitalization or quarantine of parent or child). Children may need extra love and attention. The future of the world depends on how strong and resilient we raise our next generation to be.
Charu Mahajan, MD, DM
Indu Kapoor, MD
Hemanshu Prabhakar, MD, PhD
Department of Neuroanaesthesiology and Critical Care
All India Institute of Medical Sciences (A.I.I.M.S.)
New Delhi, India
1. Liu JJ, Bao Y, Huang X, Shi J, Lu LMental health considerations for children quarantined because of COVID-19. Lancet Child Adolesc Health. 2020;4:347–349.
2. Jiao WY, Wang LN, Liu J, et al.Behavioral and emotional disorders in children during the COVID-19 epidemic. J Pediatr. 2020;221:264–266.e1.
3. Oh DL, Jerman P, Silvério Marques S, et al.Systematic review of pediatric health outcomes associated with childhood adversity. BMC Pediatr. 2018;18:83.
4. King DL, Delfabbro PH, Billieux J, Potenza MNProblematic online gaming and the COVID-19 pandemic. J Behav Addict. 2020 April 29 [Epub ahead of print].
5. Green PRisks to children and young people during COVID-19 pandemic. BMJ. 2020;369:m1669.
6. Purewal Boparai SK, Au V, Koita K, et al.Ameliorating the biological impacts of childhood adversity: a review of intervention programs. Child Abuse Negl. 2018;81:82–105.