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Children's normal stress reactions to COVID-19 Coping tips

Prof. R. Delorme, Dr. E. Barron, Dr. A. Hubert, Dr. E. Stantiford - Child and Adolescent Psychiatry Department Robert Debré Hospital - adaptation of SAMSAH Talking With Children: Tips for Caregivers, Parents, and Teachers During Infectious Disease Outbreaks


What you need to know

When children and young people watch on television the news about the COVID-19 epidemic, read the news or hear others talk about it, they may feel scared, confused or anxious - just as much as adults do. Young people do not respond to anxiety and stress in the same way as adults. Some may react immediately; others may show signs later. Adults may not always know when a child needs help.

Possible reactions to an infectious disease outbreak

Many of the reactions listed below are normal when children and youth are coping with stress. If any of these behaviours last longer than 2 to 4 weeks, or if they suddenly appear later, children may need extra help to cope.

# PRESCHOOLERS, 0-5 YEARS OLD

· Very young children may express their anxiety and stress by starting to suck their thumb or wet their bed at night. They may be afraid of illness, strangers, darkness or monsters. It is not uncommon for preschoolers to become clingy with a parent or caregiver, or to want to stay in a place where they feel safe. They may express their understanding of the epidemic repeatedly in their games or tell stories about it. Children's eating and sleeping habits may change. They may also have pain that cannot be explained. Other symptoms to watch for are aggressive or withdrawn behaviour, hyperactivity, speech difficulties and disobedience.

· Infants and children from 0 to 2 years of age cannot understand that something bad is going on in the world, but they know when their caregiver is upset. They may start to show the same emotions as their parents, or they may act differently, such as crying for no reason or staying away from people and not playing with their toys.

· Children between the ages of 3 and 5 may be able to understand the effects of an outbreak. If they are very upset by the news of the epidemic, they may have difficulty adapting to the changes, the possible losses. They depend on adults and their entourage to help them feel better.


# FROM INFANCY TO ADOLESCENCE, 6-19 YEARS OLD

· Children and young people in this age group may have reactions similar to those described above. Young children in this age group often want their parents or caregivers to pay much more attention to them. They may stop doing schoolwork or household chores. Some young people may feel powerless and guilty because they are in a region of France that is less affected by the epidemic.

· Children, aged 6 to 10, may feel sad that they no longer go to school or spend time with their friends. They may find it hard to pay attention. Some may become aggressive for no specific reason. They may engage in regressive behaviour (asking to be fed or clothed by their parent).

· Young people and teens, aged 11 to 19, experience many physical and emotional changes because of their stage of development. This can make it even more difficult for them to cope with the anxiety that may be associated with listening to and reading the news of an epidemic. Older adolescents may deny their reactions to themselves and their parents. They may respond with a routine "I'm fine" or even silence when they are upset. They may also complain of physical pain because they cannot identify what is really bothering them emotionally. They may also experience some physical symptoms because of anxiety about the outbreak. Some may start arguing at home, getting into conflict with authority.

How parents and caregivers can help children manage their reactions during this outbreak to COVID-19

With adequate support from the adults around them, children and young people can manage their stress in response to the COVID-19 epidemic and take steps to maintain good mental and physical health. The most important ways to help are to ensure that children feel considered, loved and cared for.

Be attentive and listen. Parents and other caregivers can help children express their emotions through conversation, writing, drawing, playing or singing. Most children want to talk about things that make them anxious or stressed - so let them. Accept and let them know it's normal to feel sad, upset, or stressed. Crying is often a way to relieve stress and grief.

Allow them to ask questions. Ask your teens what they know about the epidemic. What have they heard at school or seen on television? Try watching the news on TV or the Internet with them. Also limit access to this information so that they are not overexposed to anxiety-provoking messages about the epidemic. Don't let the discussion about the COVID-19 epidemic take precedence over family discussions.

Encourage positive activities. Adults can help children and youth see the positive side that can come out of an epidemic. Examples include heroic actions, families and friends helping or working in response to the epidemic, and people following even simple safety measures (such as social distancing, hand washing, etc.) to prevent the spread of all types of disease. Children can cope better with an epidemic by helping others. They can write letters of affection to those who have been sick or to family members lost to illness.

Adults can teach children and young people how to take care of themselves, such as establishing routines, eating healthy, getting enough sleep, exercising during confinement and taking deep breaths to manage stress. If you are in good physical and mental health, you are more likely to be readily available to support the children in your care. Even if not, don't underestimate your resources. Your children will be able to find energy and reassurance from you, even if you feel helpless.

Tips for talking to your children during COVID-19 infection to help them manage stress

A NOTE OF CAUTION! Be careful not to force children to talk about the COVID-19 epidemic or to participate in self-expression activities. While most children speak easily about the epidemic, some may be afraid. Some may even feel more anxiety and stress if they talk about it, listen to others talk about it, or look at drawings related to the epidemic. Allow children to withdraw from these activities and monitor them for signs of distress.

# PRESCHOOLERS, 0-5 YEARS OLD

§ Give these very young children lots of emotional and verbal support.

§ Stand at eye level and speak in a calm, gentle voice using words they can understand.

§ Tell them that you are always looking after them and that you will continue to do so and keep them safe.

§ Keep a normal routine, such as having dinner together and having a regular bedtime.

# FROM INFANCY TO ADOLESCENCE, 6-19 YEARS OLD

· Ask your child what concerns them and what you can do to help them.

· Comfort them with kind words or simply by being present with them.

· Spend more time with your child than usual, even for a short period of time.

· If your child is very anxious, contact a psychologist for a videoconference. There are many psychologists who are currently available to help you via a phone call or video-conference.

· Encourage children to have quiet times or to express their feelings through writing or art.

For more resources see the fact sheets on opposition and anxiety disorder.


48 Boulevard Serurier, 75019  Paris France

©2020 by Dr. Benjamin Landman. Child Psychiatry, Robert Debre Hospital - Paris