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March 11, 2020
With coronavirus disease (COVID-19) reaching epidemic proportions, many US children are growing increasingly anxious about what this means for their own health and safety and that of their friends and family.
The constantly changing numbers of people affected by the virus and the evolving situation mean daily life for many children is affected in some way, with school trips, sports tournaments, and family vacations being postponed or canceled.
All children may have a heightened level of worry, and some who are normally anxious might be obsessing more about handwashing or getting sick.
Experts say there are ways to manage this fear to help children feel safe and appropriately informed.
Clinicians and other adults should provide children with honest and accurate information geared to their age and developmental level, said David Fassler, MD, clinical professor of psychiatry, University of Vermont Larner College of Medicine, Burlington, and member of the Consumer Issues Committee of the American Academy of Child and Adolescent Psychiatry.
That said, it's also acceptable to let children know that some questions can't be answered, said Fassler.
Be Truthful, Calm
"This is partly because the information keeps changing as we learn more about how the virus spreads, how to best protect communities, and how to treat people who get sick," he added.
Clinicians and parents should remind children "that there are a lot of adults who are working very hard to keep them safe," said Eli R. Lebowitz, PhD, associate professor in the Child Study Center, Yale School of Medicine, New Haven, Connecticut, who directs a program for anxiety.
It's important for adults to pay attention not only to what they say to children but also how they say it, said Lebowitz. He highlighted the importance of talking about the virus "in a calm and matter-of-fact way" rather than in an anxious way.
"If you look scared or tense or your voice is conveying that you're really scared, the child is going to absorb that and feel anxious as well," he noted.
This advice also applies when adults are discussing the issue among themselves. They should be aware that "children are listening" and are picking up any anxiety or panic adults are expressing.
Children are soaking up information about this virus from the Internet, the media, friends, teachers, and elsewhere. Lebowitz suggests asking children what they have already heard, which provides an opportunity to correct rumors and inaccurate information.
"A child might have a very inflated sense of what the actual risk is. For example, they may think that anyone who gets the virus dies," he said.
Adults should let children know that not everything they hear from friends or on the Internet "is necessarily correct," he added.
Some children who have experienced serious illness or losses may be particularly vulnerable to experiencing intense reactions to graphic news reports or images of illness or death and may need extra support, said Fassler.
Adults could use the "framework of knowledge" that children already have, said Lebowitz. He noted that all children are aware of sickness.
"They know people get sick, and they themselves have probably been sick, so you can tell them that this is a sickness like a bad flu," he said.
Children should be encouraged to approach adults they trust, such as their pediatrician, a parent, or a teacher, with their questions, said Lebowitz. "Those are the people who are able to give them the most accurate information."
Fassler noted that accurate, up-to-date information is available via fact sheets developed by the Centers for Disease Control and Prevention and the World Health Organization.
Although it's helpful and appropriate to be reassuring, Fassler advises not to make unrealistic promises.
"It's fine to tell kids that you'll deal with whatever happens, even if it means altering travel plans or work schedules, but you can't promise that no one in your state or community will get sick," he said.
Maintain Healthy Habits
Physicians and other adults can tell children "in an age-appropriate way" how the virus is transmitted and what the symptoms are, but it's important to emphasize that most people who are sick don't have COVID-19, said Lebowitz.
"I would emphasize that the people who are the sickest are the elderly who are already sick, rather than healthy younger people," he said.
Lebowitz recommends continuing to follow guidelines on staying healthy, including coughing into a sleeve instead of your hand and regular handwashing.
It's also important at this time for children to maintain healthy habits -- getting enough physical activity and sleep, eating well, and being outside -- because this regime will go a long way toward reducing anxiety, said Lebowitz. Deep breathing and muscle-relaxing exercises can also help, he said.
Lebowitz also suggests maintaining a supportive attitude and showing "some acceptance and validation of what children are feeling, as well as some confidence that they can cope and tolerate feeling uncomfortable sometimes, that they can handle some anxiety."
While accepting that the child could be anxious, it's important not to encourage excessive avoidance or unhealthy coping strategies. Fassler and Lebowitz agree that children who are overly anxious or preoccupied with concerns about the coronavirus should be evaluated by a trained, qualified mental health professional.
Signs that a child may need additional help include ongoing sleep difficulties, intrusive thoughts or worries, obsessive-compulsive behaviors, or reluctance or refusal to go to school, said Fassler.
The good news is that most children are resilient, said Fassler. "They'll adjust, adapt, and go on with their lives."