As the Covid-19 pandemic rages on, the world continues to focus on the economic impact and the mortality and transmission rates of the coronavirus. Thankfully, the impact of the current lockdown on the mental health of adults has gained significant attention, but very little has been said about the impact it has had on the mental health of children. The Covid-19 pandemic is seriously disrupting the development of children in many aspects of their lives—their learning, behaviour, physical and mental health.
As with adults, children are prone to suffering a wide variety of mental health issues during the pandemic, particularly anxiety and stress. The pandemic will cause most individuals to feel helpless, lonely and socially excluded; in children, the social isolation, boredom, stress and the lack of outdoor play may lead to increased levels of anxiety and depression that may last for years after the pandemic is over. Children are exposed to a plethora of information about the virus from different sources—television, internet, social media, friends and family. With schools being closed and social distancing being practiced, the normal routines and social interactions children are used to have changed drastically. Across the world, children are struggling to cope with the lack of daily structure and routine, having difficulties with sleeping patterns, and are more likely to suffer separation anxiety once the lockdown is lifted.
The current pandemic is an overwhelming, anxiety-provoking and stressful time for parents themselves, and this may make it difficult for them to recognise and address their children's mental health needs adequately. Seeing a caregiver suffer a labile mood and be constantly in stress can cause anxiety in children and make them believe their safety is at threat from the outside world. In some cases, the absence of regular caregivers, such as grandparents, may further fuel their anxiety levels. Children express anxiety and stress in different ways; rather than being tearful and being upset, their anxiety is often expressed through challenging and disruptive behaviour, such as acting out or becoming argumentative with others. They may complain of headaches and nonspecific body pain, appear drowsy and sleepy more than normal, show apathy to everything around them, and their appetite may be poor.
Children will suffer a wide range of anxious thoughts during the pandemic. Will they be able to meet their friends ever again? Will they fall behind in class? Will they have to repeat a school year again? Will the family have enough financial security to make it through the pandemic? What if a loved one falls sick and/or dies? For many children, the pandemic will make them reflect on the concept of death for the very first time.
Many adults avoid talking to their children about the pandemic as they assume this will cause distress and parents may hesitate to talk openly about their own difficult feelings with their children during this period of lockdown and uncertainty. However, communicating with children openly is absolutely essential. Research shows that children as young as two become aware of changes that occur around them, and benefit psychologically when they are communicated to and informed about things going around them in a caring, sensitive manner.
What parents and caregivers need to understand is that if children are not spoken to about things that have changed around them during this pandemic, they will try to make sense of the situation on their own. Between the ages of four and seven, children's interpretation about the outside world is often informed by "magical thinking", whereby they believe a thought they have had or an action they have carried out is directly attributable to a specific life event. During this pandemic, children are highly vulnerable because such thinking may lead them to believe they are somehow responsible for the negative events occurring around them, and start blaming themselves for the events. This emphasises the importance of parents exploring their child's understanding and beliefs about the coronavirus pandemic and providing them with an accurate explanation that is meaningful and allays their fears and guilt.
An easy error that many parents make when speaking to their children about the pandemic is to talk in a concrete and practical manner about the illness, rather than focusing on the feelings and emotions they experience, and not exploring the same in their children. When parents don't allow their children to have access to their emotional state, children are left confused and distressed. If parents are not open about their own thoughts with their child, the child will avoid sharing their thoughts and anxieties with the parent, leaving the child to cope with difficult emotional feelings on his/her own.
When talking about the pandemic, parents need to be honest about the psychological challenges of the pandemic without being overwhelming; this will encourage a child to open up about his/her own feelings in a safe space. Explaining to children that their worries and stresses during this pandemic are a normal reaction, and reassuring them with hope that things will gradually improve will help allay their anxieties. Children feed off the energy their parents radiate, so instead of being negative and appearing irritable, parents should model confidence when speaking to their children.
An important part of the government's public health campaign during the pandemic should include psychoeducation that equips parents and caregivers with information on communicating with and relaying information to children about the pandemic in a safe, contained manner.
One important question to ponder on is the impact of the pandemic on the mental health of children in the long term. A recent review conducted by the University of Bath, Somerset, United Kingdom, suggests that long periods of social distancing can cause depression and anxiety in children, even after lockdown restrictions are lifted, with the impact on mental health lasting for up to 9 years.
A group of children will be significantly affected during this pandemic more than others due to their existing vulnerabilities. These include children who face physical and sexual abuse at home, those with special needs and those with pre-existing mental health difficulties. Children growing up in challenging home environments, such as those who witness domestic violence or face poverty, are also at a higher risk of suffering mental health difficulties in the long term.
Good communication and providing accurate information to children in a safe, comforting manner is essential to avoid an adolescent mental health pandemic over the next decade. The current mental health provisions during the pandemic appear to be geared towards adults, and the urgent psychological needs of children during this time should be given equal importance. Ignoring the long-term psychological effects of the pandemic, especially in children and young adults, will lead to a mental health tsunami that the world will reel under for years to come if not dealt with appropriately.
Dr Mehtab Ghazi Rahman is a Consultant Psychiatrist working for the National Health Service of the United Kingdom.