On Tuesday, September 11, 2001 the nation was shocked by the news of a terrorist attack on the United States. Two airliners crashed into the World Trade Center and one struck the Pentagon. At the site of the World Trade Center in New York City, 2, 753 people were killed. 

On Monday, January 21, 2020, the first case of COVID-19 was confirmed in the United States. As of April 14, 2020, there were approximately 1,936,700 global cases of COVID-19. Over 459,015 people had recovered from the disease, while there had been 120,568 deaths. In New York City alone, 10,367 people have died from COVID19 related causes, as of April 13, 2020.

Both the World Trade Center terror attack and the World pandemic have left many with emotional distress including shock, horror, post-traumatic stress, depression, suicide, and anxiety. This includes both adults and children. 

In this installment of my daily emotional education series aimed at helping readers live healthier through COVID19, I’m going to focus on younger children, a group that is often left out of our focus. 

This one finding alone from Roberto Olivardia, a lecturer in psychology at Harvard Medical School, is why paying attention to youngsters now is especially important. He reported that as many as 1% of children may suffer from “maskaphobia,” a fear that continues for longer than six months. While usually thought of in relation to costumes and superheroes, in today’s mask-filled streets it is linked to COVID19.

Among the more common questions that I’ve been asked since this stressful outbreak with its consequent school closures and shelter-at-home restrictions, frightening masks, are how should we speak with our children about this event? Should we shield them from dreadful news about COVID19 or talk openly about it? How can we help children make sense of this calamity that we ourselves cannot understand? How will children react?

From balancing self-care, child-care, financial woes, job insecurities, concern for family and friends at a distance, and feeling overwhelmed by it all, this can be a very emotionally toxic time for parents. You are not alone. Some basic information and tools can help provide you, as a parent, with a sense of control and relief.

There is a wide range of emotional and physiological reactions that children display after hearing alarming news. Common indicators of emotional upset are typically based on the age of a child:

Young Children (1-6)

  • Helplessness and passivity; lack of usual responsiveness 
    • Generalized fear 
    • Heightened arousal and confusion 
    • Cognitive confusion 
    • Difficulty talking about event; lack of verbalization 
    • Difficulty identifying feelings 
    • Sleep disturbances, nightmares 
    • Separation fears and clinging to caregivers 
    • Regressive symptoms (e.g. bedwetting, loss of acquired speech and motor skills) 
    • Unable to understand death as permanent 
    • Anxieties about death 
    • Somatic symptoms (e.g. stomach aches, headaches) 
    • Startle response to loud/unusual noises 
    • “Freezing” (sudden immobility of body) 
    • Fussiness, uncharacteristic crying, and neediness 
    • Avoidance of or heightened emotional response to news of death, frightening images

School-aged Children (6-11 years)

  • Responsibility and guilt 
    • Repetitious traumatic play and retelling 
    • Reminders trigger disturbing feelings 
    • Sleep disturbances, nightmares 
    • Safety concerns, preoccupation with danger 
    • Aggressive behavior, angry outbursts 
    • Fear of feelings 
    • Close attention to parents’ anxieties 
    • Avoiding school related activities 
    • Worry and concern for others 
    • Changes in behavior, mood, and personality 
    • Somatic symptoms (Complaints about bodily aches, pains) 
    • Obvious anxiety and fearfulness. 
    • Withdrawal and quieting 
    • Specific, trauma-related fears; general fearfulness. 
    • Regression to behavior of younger child. 
    • Separation anxiety with primary caretakers. 
    • Loss of interest in activities. 
    • Confusion and inadequate understanding of the pandemic evident in play rather than discussion. 
    • Unclear understanding of death and the causes of “bad” events. 
    • Magical explanations to fill in gaps in understanding. 
    • Loss of ability to concentrate and attend to online school activities, with lowering of performance. 
    • “Spacey” or distractible behavior.

What can parents do? 

Two and a Half to Six Years:

  • Listen to and tolerate child’s retelling of what they’re hearing about COVID19 
    • Respect child’s fears; give child time to cope with fears. 
    • Protect child from re-exposure to frightening situations and reminders of harrowing news related to death rates, masks, gloves, handwashing, etc.
    • Accept and help the child to name strong feelings during brief conversations 
    • Expect and understand child’s regression while maintaining basic household rules. 
    • Expect some difficult or uncharacteristic behavior. 
    • Set firm limits on hurtful or scary play and behavior. 
    • Avoid nonessential separations from important caretakers with fearful children. 
    • Maintain household and family routines that comfort child. 
    • Avoid introducing new and challenging experiences for child. 
    • Provide additional nighttime comforts when possible: night-lights, stuffed animals, physical comforting after nightmares. 
    • Explain to child that nightmares come from the fears a child has inside, that they aren’t real, and that they will occur less and less over time. 
    • Use “detective skills” to discover triggers for sudden fearfulness or regression. 

Six to Eleven Years:

  • Listen to and tolerate child’s retelling of event. 
    • Respect child’s fears; give child time to cope with fears. 
    • Increase monitoring and awareness of child’s play, 
    • Permit child to try out new ideas to cope with fearfulness at bedtime; extra reading time or listening to music at bedtime.

Parents with children who have specific fears, such as of masks, can help sensitize youngsters by creating fun masks, playing games with masks, putting them on and off, making up songs about masks, tossing them back and forth and normalizing them as much as possible. There are also numerous free resources for parents that can provide emotional uplift to the 1.5 billion children out of school, sheltered-at-home. One positive book that parents can read to children that’s receiving a great deal of attention right now, “My Hero is You: How Kids Can Fight COVID-19” is available free online.

When should you seek professional help for your child?

Many children and adolescents will display some of the behaviors listed above. These will likely dissipate in a few weeks with social support and with the aid of their families. Many of the above suggestions will help children recover more quickly. For others, however, they may develop post-traumatic stress disorder, depression, or anxiety disorders. Parents of children with prolonged reactions or more severe reactions may want to seek the assistance of a mental health professional. It is important to find a counselor who has experience with childhood trauma. This resource from the Child Mind Institute, is also of genuine help, 

Bottom Line…

1.  Create a safe environment

2.  Provide reassurance of safety to children and extra emotional support

3.  Be honest with children about what the pandemic is—stick to factual information in a most positive manner

4.  Tell children what the government and healthcare professionals are doing to help protect us

5.  Be aware that children will often take on the anxiety of the adults around them—be careful sharing your own anxieties, anger, fear

6. Place the quarantine and illness in perspective

7.  Above all, LISTEN and ENCOURAGE children to express what they are feeling

         We are all in for weeks, months and perhaps longer of continued illness and recovery.  Each bout of this illness may bring with it an exacerbation of emotional distress and turmoil.  Chronic stress will most certainly develop in children – as well as adults.  Learn earlier rather than later how to deal with it and your children will thrive.  Wait, and you will most certainly be dealing with anxiety, depression and PTSD for a long time to come.