The attention of the world is rightly focused on measures to mitigate the transmission
and economic effect of the 2019 novel coronavirus disease (COVID-19) pandemic. In
this rapidly changing situation, media and social conversations are entirely dominated
by the outbreak, and children are exposed to large amounts of information and high
levels of stress and anxiety in the adults around them. Simultaneously, children are
experiencing substantial changes to their daily routine and social infrastructure,
which ordinarily foster resilience to challenging events.
1
Parents would do anything to protect their children from distress and might avoid
talking about difficult feelings and events. However, research shows that even children
as young as 2 years are aware of the changes around them.
2
Children's understanding evolves throughout childhood and adolescence. Thus, when
adults talk to children, the information provided needs to take into account the child's
age and level of understanding. Sensitive and effective communication about life-threatening
illness has major benefits for children and their family's long-term psychological
wellbeing.
2
Children need honest information about changes within their family; when this information
is absent, children attempt to make sense of the situation on their own.
3
Consideration of the child's developmental stage is crucial to ensure that communication
is effective and neither underestimates or overestimates their understanding.
4
Communicating with younger children should not solely rely on simplification of the
language or concepts used, but must also take into account children's comprehension
of illness and causality. Between the ages of approximately 4 and 7 years, understanding
is substantially influenced by magical thinking, a concept that describes a child's
belief that thoughts, wishes, or unrelated actions can cause external events—eg, an
illness can be caused by a particular thought or behaviour. The emergence of magical
thinking occurs around the same time children are developing a sense of conscience,
while still having a poor understanding of how illness is spread. Adults need to be
vigilant that children are not inappropriately blaming themselves or feeling that
the illness is a punishment for previous bad behaviour.
5
Therefore, listening to what children believe about COVID-19 transmission is essential;
providing children with an accurate explanation that is meaningful to them will ensure
that they do not feel unnecessarily frightened or guilty.
The uncertainty about the personal and global effects of COVID-19 is creating great
concern, in addition to the specific psychological effect of quarantine.
6
Adults' preoccupation with the implications of COVID-19 might compromise their ability
to sensitively recognise and respond to children's cues or distress.
7
Children are well attuned to adults' emotional states; exposure to unexplained and
unpredictable behaviour is perceived by children as a threat, resulting in a state
of anxiety. Even children younger than 2 years will notice the absence of regular
caregivers (eg, grandparents) and become unsettled and upset, seeking their return.
Conversely, children and adolescents' anxiety can also manifest in challenging externalising
behaviours, such as acting out or arguing, rather than more typically assumed tearful,
sad, or worried responses.
Although adults often want to know how children are feeling, adults often do not set
an example by sharing some of their own feelings, and conversations might well be
dominated by the practical aspects of illness.
2
Research has highlighted that parents sometimes specifically use technical or factual
language to try and minimise their children's distress.
8
An absence of emotion-focused conversations might leave children anxious about the
emotional state of the adults around them. This anxiety can inadvertently result in
children's avoidance of sharing their own concerns in an attempt to protect others,
leaving children to cope with these difficult feelings alone.
2
Adults need to be authentic about some of the uncertainty and psychological challenges
of the pandemic, without overwhelming children with their own fears. This honesty
not only offers a coherent explanation for what children are observing, but also grants
permission for children to safely talk about their own feelings. Normalising their
emotional reactions and reassuring children about how the family will look after each
other helps to contain anxiety and provides a shared focus.
Mental health responses to previous emergencies and disasters have included widespread
psychological first aid, focusing on psychoeducation about normative reactions and
coping strategies.
1
Providing information
9
and prioritising communication with children about COVID-19 is an essential component
of any universal, community-led response to the pandemic. Health-care workers are
experiencing unprecedented demands caring for a predominantly adult patient population,
magnifying the invisibility of children's urgent psychological needs. However, ignoring
the immediate and long-term psychological effects of this global situation would be
unconscionable, especially for children and young people, who account for 42% of our
world's population.
10
© 2020 Peter Berglund/iStock
2020
Since January 2020 Elsevier has created a COVID-19 resource centre with free information
in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre
is hosted on Elsevier Connect, the company's public news and information website.
Elsevier hereby grants permission to make all its COVID-19-related research that is
available on the COVID-19 resource centre - including this research content - immediately
available in PubMed Central and other publicly funded repositories, such as the WHO
COVID database with rights for unrestricted research re-use and analyses in any form
or by any means with acknowledgement of the original source. These permissions are
granted for free by Elsevier for as long as the COVID-19 resource centre remains active.