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      The COVID-19 pandemic: Technology use to support the wellbeing of children

      , Ph.D. MSN, RN, CNE

      Journal of Pediatric Nursing

      Elsevier Inc.

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          Abstract

          With the publication of this column, hopefully the world emerges from the quarantine of the COVID-19 pandemic. In March of 2020 with the onslaught of the virus, the lives of working adults changed exponentially, and so did the lives of children. COVID-19 disrupted life as we know it, the effects of which we may be only beginning to realize. It would not be unusual if adults and children felt an impact on their sense of wellbeing throughout this time. Lack of support, trauma, unhelpful thinking styles, chronic illness/disability, and substance use compromises wellbeing in adults (Roddick, 2016). Caregivers' wellbeing can have a direct effect on children's wellbeing. Behavioral health experts recommend building five dimensions of wellbeing in children: social, physical, emotional, intellectual, and spiritual (Roddick, 2016). Throughout the COVID-19 pandemic, there was a growing reliance on the use of technology to learn, live, and stay connected. This column will explore how technology became essential during a time of isolation and social distancing and was used to leverage and maintain wellbeing for children. Social wellbeing Play is an essential part of children's physical and social development. Closures of parks and playgrounds were not uncommon throughout the COVID-19 pandemic. The world became more restricted each day. The monkey bars and swings in my neighborhood usually are buzzing with children laughing and playing; now, they have yellow caution tape wrapped around them and signs posted “playground closed.” It just seems unconscionable to see an ordinary, innocent playground condemn as if it were a safety hazard. During the COVID-19 pandemic, the (Center for Disease Control and Prevention [CDC], 2020a) recommended that caregivers avoid setting up playdates for children to practice social distancing from other children. Instead, caregivers were encouraged to set up supervised phone calls and video chats for their child and their friends. The American Academy of Pediatrics [AAP] (2020a) suggested that children play outside while maintaining social distancing so that they had time to move and explore nature. Children who play outdoors experience better motor development and focus, lower obesity rates, reduced attention deficit hyperactivity disorder, less anger, aggression, stress, and depression AAP (2020a). On the positive side, families seem to be spending more time together, walking, biking, and completing school work. Where time is available, caregivers were encouraged to socialize with children through playing games, arts and crafts, and listening to music. Caregivers could also share time with children by co-viewing television programs or using educational apps. “Co-engagement with media and ‘co-viewing’ is optimal for learning and spurring conversations (and thereby helping to develop vocabulary and more in-depth understanding) around new content” (Takeuchi & Stevens, 2011, p. 10). Positive interaction that occurs between caregivers and children is healthy. The fast-paced lifestyle that two working caregiver families are accustomed to seems to have slowed down if only for a short while. Physical wellbeing To date, children are not in the high-risk group of COVID-19 for severe illness or hospitalization (CDC, 2020b). Children are, however, susceptible to illness from the virus with lesser degrees of severity, and are known carriers. Several countries are working on a vaccine; however, it will be months before one is available for use. The AAP (2020b) published guidelines for primary care providers to access during the COVID-19 outbreak. Posted on the AAP website are up to date guidelines and available research. Unlike most adult primary care offices, the AAP (2020b) recommends that newborns, infants, and young children continue to be seen in person by a primary care provider for their routine vaccinations and well visits. Pediatricians are encouraged to monitor community spread of COVID-19 and, if necessary, administer older children's routine vaccinations at a later date. Pediatricians can determine whether or not to separate well and sick visits by rooms and times of appointments. The AAP (2020c) launched a telementoring COVID-19 emergency readiness and response program in March. COVID-19 Project ECHO (Extension for Community Health Care Outcomes) modelTM “is a tele-mentoring platform that uses video conference technology to connect a multidisciplinary team of specialists with primary care providers in local communities” (para. 2). By participating in the program, pediatric primary care providers can stay abreast of policies, procedures, and recommendations for treating children throughout the COVID-19 pandemic and participate in education, case study presentations, and discussions. Telehealth Pediatric health care providers are unable to provide telehealth for all children due to differences in licensing laws by state and gaps in insurance policy coverage (AAP, 2020c). Throughout the COVID-19 pandemic, physician groups have lobbied Federal and State Governments to relax the rules on telehealth to provide care to more children across state lines and in rural areas of the country. The AAP (2020c) is working at the Federal level with the Medicaid/Children's Health Insurance Programs (CHIP) and with other third-party insurers to reduce barriers and increase access to telehealth care. Still, amid the COVID-19 crisis, there is a long way to go to overcome obstacles to telehealth provisions for all children. The AAP (2020d) is keeping a current list of states which are allowing telehealth, the rules, and regulations and publicizes this list for pediatric care providers. The COVID-19 pandemic may cause a paradigm shift that relaxes restrictions imposed by the Health Insurance Portability and Accountability Act (HIPAA), state laws, and insurance reimbursement for telehealth. Emotional wellbeing Caregivers are essential for helping children maintain emotional wellbeing. Throughout the pandemic, caregivers were encouraged to reassure children that adults that they trust (e.g., doctors, nurses, police, teachers) are doing everything they can to learn about the disease to help keep them safe (AAP, 2020e). Also, caregivers can give children a sense of control by letting them know what they can do to help limit the spread of the virus (e.g., washing their hands and coughing and sneezing into their sleeve or a tissue). The CDC (2020b) recommends that caregivers watch children for signs of stress. Children can exhibit stress and anxiety with excessive worry, sleeplessness, inability to concentrate, and unhealthy eating habits. Caregivers can help alleviate stress by remaining calm, creating a daily routine, and talking to children about COVID-19. Reducing children's exposure to COVID-19 television and social media coverage can also help to provide a relaxed and reassuring environment (AAP, 2020e; CDC, 2020b). Food insecurities Families may be more stressed than ever. Today most adult jobs that have survived the pandemic are those that can use computerized technology, are in healthcare, education, or those in food distribution (Carruthers, 2020). To date, over 17 million Americans filed for unemployment benefits, and the unemployment rate is 13% in the US (Long & VanDam, 2020). School lunch programs are funded by the federal government and subsidized at the state level for children whose caregivers meet a certain income level. Schools are required to stay open and provide meals (breakfast and lunch) at a free or reduced rate to those children who qualify. Schools have had to be creative with how they distribute the food, and although the funding for no cost lunches will not increase this school year, the number of students that will qualify for free lunch will rise. Some schools send out a weekly survey to capture all students who will need a free or reduced lunch each week. Intellectual wellbeing Online learning The Tsunami of online learning has occurred. Many schools are offering online (virtual) learning for students (CDC, 2020a) as a means by which to continue education for the remainder of the academic year. Those teachers and administrators who were reluctant to teach online, have had little choice but to embrace this decade-old technology. Some teachers may have experienced fear and trepidation with transferring their classrooms online, but the majority have done so at a rapid pace and in a short period; in the long run, everyone seems to be adapting well. The digital divide is more apparent than ever (Guernsey, Ishmael, & Prescott, 2020). Children who are proficient with using computers are ready for it. Instructors and teaching methods are a bit behind; however, there is hope that new models of education emerge. Change can be useful. We live in a world where Internet access is a now necessity, not a commodity. Access to a computer is as essential for learning in school as is owning paper, pencils, and books. Unfortunately, we still have a disproportionate amount of children in parts of the country that are unable to access the Internet. Some families may share one computer; others may not own a computer at all. We need to find ways through partnerships with government, business, and educational systems to provide computers and Internet access for all learners. During this pandemic, some Internet companies have graciously offered their services for free (e.g., Comcast and Charter Spectrum) for a limited time to low income families (Guernsey et al., 2020). Caregivers may need to work with younger children to show them how to work a computer. School administrators may need to help families to troubleshoot computer and Internet connection issues (CDC, 2020a). Services for children with disabilities In the US, there are over seven million children with disabilities (mental, emotional- behavioral, physical, and more) that require special services in school (Silva, 2020). School districts are required to identify children with special needs and to develop Individual Education Plans [IEPs] (Silva, 2020). Schools are required by law to provide special needs children with free and adequate public education and special services (US Department of Education, 2020). During the COVID-19 pandemic, school districts were continuing to provide special needs children with therapeutic services online. Delivery of specialized therapy online opens the possibilities for services to children with special needs in remote areas who may not have previously had access. IEPs are traditionally complete on reams of paper; because of COVID-19 and school closures, now experts can meet online in synchronous or asynchronous forums with some completing the IEPs in an electronic format (Silva, 2020). Spiritual wellbeing Families struggled with being physically separated from their faith communities during the COVID-19 pandemic, especially during the holy season. Places of worship recognized the spiritual needs of the faithful, and many created access to their communities through social media. Some faith communities made themselves available through Livestream worship on Facebook, communicated with followers on Twitter, and accepted prayer requests on Websites. The Pope had several Livestream services from the Vatican in Rome that were translated, recorded, and posted on YouTube for followers to watch on-demand. Several faith-based educational learning platforms offered subscriptions free of charge for families so that they could continue religious education with their children at home. Summary Technology became essential during the COVID-19 pandemic. During a time of isolation and social distancing, the world relied on technology to learn, live, and stay connected. Technology is best used to leverage and maintain social, physical, emotional, intellectual, and spiritual wellbeing for children, in an environment where children are co-engaged with an adult. The impact of the COVID-19 pandemic will be long-lasting. Hopefully, this time of disruption and loss of lives are not wasted and propels us toward a new way a life improved with technology in a way that enhances wellbeing for all. Uncited reference American Academy of Pediatrics [AAP], 2020f

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          Most cited references 2

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          • Abstract: not found
          • Article: not found

          Eight dimensions of wellbeing

           M. Roddick (2016)
            Bookmark
            • Record: found
            • Abstract: not found
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            Recession-proof jobs that should survive the pandemic

             F. Carruthers (2020)
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              Author and article information

              Contributors
              Journal
              J Pediatr Nurs
              J Pediatr Nurs
              Journal of Pediatric Nursing
              Elsevier Inc.
              0882-5963
              1532-8449
              16 April 2020
              16 April 2020
              Affiliations
              Drexel University, Philadelphia, PA, United States of America
              Article
              S0882-5963(20)30269-4
              10.1016/j.pedn.2020.04.013
              7161478
              32151473
              © 2020 Elsevier Inc. All rights reserved.

              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.

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