• Dr. Emmanuelle Khoury,PhD

Pandemic responses: supporting children and adolescents

Updated: Mar 25

“Notice that the stiffest tree is most easily cracked, while the bamboo or willow survives by bending with the wind.”  ― Bruce Lee



COVID-19 pandemic response


On Wednesday March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus, often referred to as COVID-19, a pandemic.


According to the WHO a pandemic is “the worldwide spread of a new disease”.


In an attempt to curtail the spread of COVID-19 many countries have entered into different types of lockdown (Spain, Italy) or self-isolation and social distancing (Canada) or shelter in place (USA).

In many places, schools are closed, as are public and cultural venues.


In Montreal, Québec, where I live, all activities, libraries, pools, arenas, dance studios are also closed. To reduce the impact of COVID-19 on our health and social services system, the Quebec government is asking everyone to stay home, not engaged in playdates or dinner parties, and only go out for essentials.


These new restrictions, the new normal as many are calling it, can have an impact on children and adolescents.


They may feel worried, they may feel uncertain, they might miss their friends, and depending on their age they might not understand why they can’t go to school or have a playdate. In a study by Danese et al. (2020), the authors note that children and young people’s well-being and mental health can be disproportionally affected and easily overlooked in the context of emergencies and disasters. One reason for this might be the loss of contact with protective resilience factors, such as schoolteachers, friends, grandparents.


So what do we do now?


How do we support our kids during this pandemic response? If they feel anxious or stressed, or if we feel anxious or stressed, how do we cope?


There are several things that we can do to build resilience and manage stress while staying prepared and responsive to the recommendations by scientists and experts to implement community-based measures (which are to stay home, cough and sneeze in your elbow, social distancing and wash hands frequently).


That being said, preparing with your kids can help them not only understand what is happening and why, but also offer them lifelong skills that they can continue to practice, namely flexibility, resilience, and comfort with uncertainty.



Coping with stress and worry


All of the following suggestions are useful for coping with any potential stress and anxiety from the news that we are reading and from the compassionate and empathic responses we are having to the devastation that COVID-19 is causing.


These suggestions are also useful life skills that can continue to be practiced throughout one’s life.


Tip 1: Remember that anxiety is a normal response

Being anxious or worried is a normal response to what is happening right now. And if your child is expressing this, you can support them by listening to their concerns, accepting their worry, and giving them permission to feel worried or upset. For most children and young people, having the space to express their emotions will be enough for them. For some who are vulnerable to mental health problems stemming from anxiety, the current climate might feel overwhelming. In fact, Danese et al. (2020) suggested that in emergency situations, community needs might overshadow children’s psychological needs. Focusing on connection and affection is a simple and effective way to make your child feel safe. You'll know which ways of demonstrating affection and making connection resonates the most with you and your child.


a. It's also important to remember that mental health professionals are available, many via telehealth, in both the public or private sectors. Your child’s resource teacher or school will also have resources available.


b. It is also important, with very young children, to answer their questions directly and succinctly. That means protecting them from information overload and giving them factual information. Most children, even younger ones, understand the basics of germs and germs making people sick. For older kids that might mean directing them to websites with factual content or a good TedTalk and taking the time to listen to what they are worried about. My older kids were worried about completing their school year and submitting upcoming projects. So we addressed that. My youngest continues to be mostly concerned about playdates and seeing her friends. So we are attending to that.


c. It is also helpful to de-dramatize the current situation with your child or adolescent. Many older children and adolescents will read the news and can handle the facts. For example, Wu and MCGoogan (2020) are reporting a 2.3% death rate from COIVD-19 from the outbreak in China. So the community based, preventative measures mentioned above are important. But information overload can lead to a distortion in the perceived danger. It may seem like there is nothing to read or listen to that isn’t coronavirus related. Yesterday a friend was feeling overwhelmed and I recommended that she limit reading the news to twice a day for 15 minutes at a time. The same applies for anyone, including some of our older children and teenagers, that has access to smartphones and social media.



Tip 2: Manage the uncertainty

The COVID-19 situation is evolving rapidly, almost every hour it seems. This leads to a very high level of uncertainty. How do we plan? What do we tell our kids? Tolerating uncertainty has been shown in many studies, including this one, to be directly related to less anxiety. Anxiety Canada suggests that those who are intolerant to uncertainty require reassurance from others, refuse to delegate tasks, make a lot of lists, double check what they have done. We all do this, but those who are particularly uncomfortable might make several lists a day, or kids might need to ask a parent incessantly if something is ‘ok’ or ‘safe’.

So how do we build tolerance to uncertainty?


a. One way is through mindfulness and kindness to self and others. In another post I wrote on mindfulness, I discuss 5 tips to starting your kids on a mindful journey.


b. A key piece to teaching your kids to be kind to themselves and others, is to help them exercise, socialize, and set healthy boundaries during this period of self-isolation and social distancing. See below for some ideas on that.


Tip 3: Remember that kids are resilient.

When I think of resilience, I often think about the Winnie the Pooh quote


“You are braver than you believe, stronger than you seem, and smarter than you think.”


Remind your kids and yourself that you are brave, strong, smart. That they can be like the reed in Aesop’s fable, not the oak.


In this story, a storm has come upon a reed and an oak. The oak, mighty and strong, stands still, but the wispy, small reed, is bent. The oak makes fun of the reed, and calls it weak. Suddenly, the storm becomes more enraged and the wind increases. The oak, a strong but rigid tree, breaks in half and is blown over. The reed, in its flexible slenderness, was bent, but unbroken. The oak turns to the reed and asks in surprise “How did I, such a strong, tough tree break, yet you are unharmed?”. And the reed says, “We can’t control the wind, but those who can adapt to it will continue to stand after the storm”.


I love this story, and I often relate it to the people I work with who might be experiencing doubt, worry, fear of uncertainty, as it’s a great reminder that we are capable of facing challenges, especially if we can be flexible, humble, and adaptable.



What to do with the kids?


Of course, reducing our anxiety and stress helps to reduce our kids’ anxiety and stress. How do we help our kids and teens practice social distancing ?


It’s a tall order: maintain a healthy lifestyle, work from home, quasi-homeschool our kids, and keep them away from others!


For those of us who are not on the frontlines like our tireless health and social services workers, pharmacy and grocery store staff, and day care educators for health care personnel, we have this unique moment to be at home with our families. Suddently, we no longer have any activities to rush to, school forms to sign, lunches to make.


This is a moment of stillness that is unique.


Also, because of the constantly evolving situation, the uncertainty of what the next few weeks will look like, we have no choice but to be anchored in the present moment.


Remember to give yourself a break and model setting healthy boundaries. If you need to get some work done, or check in on a family member or friend, explain to your child (age dependant) that they need to be involved in an activity and can’t interrupt.


But be realistic.


My 7-year-old can do this for about 15 minutes before she is about to burst, so if I’m on a call for longer than that I ask my 11-year-old to help out. Because my 7-year-old’s tolerance for uncertainty is much lower than her older siblings, she also responds well to having a to-do list. We make one together each day, and I help her make sure that it is realistic and includes items she chooses (watch a show) and items I choose (make your bed).


We can rethink of this moment for ourselves and for our children as an opportunity to learn. You will figure out what that means for you and your family. I see this as an opportunity to learn lifeskills in terms of coping with anxiety and worry, in terms of being connected and kind to oneself and others, but also in terms of learning about the science behind was is happening here. What are epidemiologists? What is public health? Why do scientists know what to do (spoiler: they base decisions on evidence, or facts)? I talk to them about our chief medical and public health officers in our province of Quebec (Dr. Horacio Arruda) and in our country of Canada (Dr. Theresa Tam). My 11 year old is learning a lot from the website www.sciencesnewsforstudents.org (Thanks to her grade 6 teacher, Ms Jessica).



A few more ideas



1. I’ve already talked about the benefits of practicing mindfulness and meditation with kids. Practicing gratitude is also something that has been shown to improve anxiety, depression. In an article for Psychology Today, the author cites a 2003 study that demonstrates how gratitude journals completed by young people, resulted in them experienced increases in determination, attention, enthusiasm, and energy when compared to other groups. Practicing gratitude can include noticing good things, like the shining sun or a soft blanket or even a refreshing glass of water. Help your kids enjoy those moments or those experiences. Also encourage them to express their gratitude – in a private journal or out loud by using their own words to say ‘I liked that’ or ‘thank you’. They can also express gratitude through small acts of kindness and helpfulness that they do for others.


2. Staying connected and helping a friend. Can you or your older kids check in with an older neighbour, or a friend who might need a hand? Maybe together you can drop off groceries at their doorstep, or even drop off a picture or a collage made by your child. Our local elementary school is setting up a buddy program to help members of the community that might be isolated or need a hand in receiving essential items. This is a great initiative to do with your kids. Maybe they can gather pantry foods to drop off at a food bank, or clothes to drop off at a shelter.


3. This might be the time to set up a new family schedule for household chores. With the five of us at home ALL THE TIME now, we have divided up the domestic tasks so that everyone has a chore each day. This keeps the kids busy, and the house tidy.


4. Exercise has multiple benefits, and even in these uncertain times, we can count on a walk or bike ride to be good for the soul. Even for those children or adults with mobility issues, being pushing in a wheelchair or a stroller, or simply sitting on a balcony, can help with mood. For those who can, exercising at home (think jumping jacks and push-ups) are a great way to keep moving


5. Potty training time! For those of you with younger children, this may be the time to finally get rid of diapers. Just this week, my sister, who lives in France and is also in self-isolation, potty trained one of her 3 young children. She has her eyes set on potty training another one.


6. Virtual playdates: my 7-year-old surprised me this week when she asked if she could Face Time her friend. After almost an hour on Face Time, I learned that they had played a game of Battleship and of Guess Who together, virtually! She has since had virtual playdates with two other friends and her cousin.


7. Even arts and crafts can be virtual. If you don’t have any more supplies at home, you can still enjoy art with your kids through these virtual tours: http://www.virtualmuseum.ca/virtual-exhibits/type/virtual-exhibits/ and educart.ca.


A few other resources for talking to kids, teens and adults about their concerns:

https://zerotothrive.org/covid-19/covid-19-parents/

www.virusanxiety.com

https://www.pbs.org/parents/thrive/how-to-talk-to-your-kids-about-coronavirus


Great resources for evidence-based, scientific information:

https://www.mcgill.ca/oss/

https://www.hsph.harvard.edu