By Patrick Tennant, Ph.D.
Project Manger, Child Mental Health, Baker Institute
Director of Program Implementation for Child and Family Policy, Meadows Mental Health Policy Institute
Quianta Moore, M.D., J.D.
Fellow in Child Health Policy, Baker Institute
Parenting young children, which can be complicated during the best of times, has become even more challenging as families deal with concerns related to the Covid-19 pandemic and the resulting societal changes. Fortunately, research from a variety of fields, including developmental and clinical psychology, can shed light on the ways that young children experience crises like this one and the most adaptive ways for caregivers to respond.
Behavioral Manifestations of Children’s Distress
Caregivers need to be aware that children’s distress about the pandemic can manifest in a wide variety of ways, some of which will not appear to be related to the pandemic at all. Young children may not have the vocabulary, or even the cognitive capability, to describe their distress. Yet, if a parent knows what behaviors to look for, they can ascertain their child’s distress just as clearly. For example, distressed children’s appetite and sleep patterns may significantly increase or decrease, or they may experience a regression of their behaviors. Preschool age children (2 to 5 years old) may become “clingy” or “whiny,” report fear of being alone or have non-characteristic tantrums or outbursts. Young school age children (5 to 8 years old) may exhibit irritability, decreased interest in or engagement with typically enjoyed behaviors, and physical symptoms such as stomachaches or headaches.
Even though children may experience the stressors of this pandemic differently than adults, caregivers need to understand that it is important to tune in to their children’s experience. For example, in the aftermath of Hurricane Katrina, one study found that in cases where mothers perceived their child’s experience of a disaster to be less stressful than the child’s actual experience, those children exhibited more symptoms related to post-traumatic stress.
What Children Need During a Crisis
The CDC developed the Essentials for Childhood framework as a guide for individuals and communities attempting to create environments for positive child development. Safety, stability and nurturing are the pillars of the framework:
- Safety: The extent to which a child is free from fear and secure from physical or psychological harm within their social and physical environment.
- Stability: The degree of predictability and consistency in a child’s social, emotional, and physical environment.
- Nurturing: The extent to which children’s physical, emotional, and developmental needs are sensitively and consistently met.
Though originally developed with community-led child abuse and violence prevention efforts in mind, the Essentials for Childhood framework also has significant utility during this or any crisis. It provides a minimum standard of what children need for positive and healthy development and a way for caregivers to structure their thinking about how to provide for and interact with their kids during a crisis.
Caregiver support has been identified as a key protective factor for children experiencing stress and adverse life events. Protective factors are the individual or environmental characteristics, conditions or behaviors that reduce the effects of stressful life events.
What Caregivers Can Do
Specific recommendations for caregivers can be filtered through the safety, stability and nurturing framework. Under the domain of safety, recommendations include communicating to young children that adults are working together to protect everyone from the virus and that the child’s caregivers are also taking steps, like social distancing and hand washing, to keep everyone safe and healthy. Omnipresent reminders of the pandemic through television and social media may threaten a child’s sense of safety, so caregivers should minimize their children’s exposure to media. It is also important, however, that caregivers are honest and factual about the situation, while also providing reassurance.
Providing stability for young children can include keeping a regular daily schedule and maintaining routines and family traditions as much as possible during the pandemic. Predictability and a sense of control are key. Thus, setting expectations for children so they can anticipate what will happen before it does, when feasible, and allowing them to plan some family activities, can be helpful.
Nurturing will require that caregivers practice self-care and compassion. Taking care of one’s self allows caregivers to be emotionally available to their children. Self-care may include cultivating an awareness of one’s own thoughts and feelings, accepting that some or all aspects of the pandemic may be challenging and appropriately leveling expectations for oneself and others. In addition to the basic fact that stressed caregivers are not well-prepared to nurture others, it is important to remember that children pay attention to their caregivers for cues about how to respond. Therefore, unhealthy responses from caregivers may be directly mirrored in their children. Finally, play can be communicative, connecting and even therapeutic for children, so caregivers should nurture their child through ample, engaged play time.
Beyond those basic steps, caregivers should be on the lookout for signs of acute distress or trauma in their children. Though there are a wide range of developmentally appropriate responses to crises and each child’s idiosyncratic baseline needs to be considered, there are also responses that indicate a need for focused attention from a caregiver and, potentially, professional intervention. Such signs include incessant, repetitive play with themes associated with the pandemic, especially illness or death, or an increase in the frequency or severity of nightmares (which may include themes unrelated to the pandemic too). Additionally, persistent preoccupation with or extreme avoidance of the virus may indicate that a child’s experience of this crisis is traumatic. Newly developed sleep problems may also indicate distress. Therefore, ensuring children have a bedtime routine and appropriate sleep hygiene are important to support quality sleep. Given their developmentally appropriate, egocentric view of the world, children may also feel personally responsible for the crisis or related challenges and could develop feelings of guilt about “their role” in it, so caregivers should be attuned to signs of shame or guilt.
If a child is exhibiting severe versions of the behaviors described above or other concerning signs, consultation with a mental health professional or pediatrician is warranted. Fortunately, successful treatments for children suffering from post-traumatic stress exist. Trauma-focused cognitive behavioral therapy is a well-supported, evidence-based treatment for addressing children’s trauma. Trauma systems therapy, a more contextual approach, also has some empirical support, as do certain psychopharmacological medications.
This pandemic has impacted the world, and families everywhere are adjusting to a new way of life. Young children do not express their concerns, anxieties and fears the same way as adults, and understanding how to interpret the signs of their distress and respond appropriately is important for infant and child mental health.