Covid-19 is causing anxiety in both children and adults. Whereas adults may reach out to partners, friends and close family members to express their distress over travel restrictions, cancellation of gatherings, and social distancing among other measures, anxiety in children and adolescents is overlooked.
How anxiety manifests in children
Children and adolescents may present with:
· Clingy behaviour
· Startling easily
· Crying over small upsets or temper tantrums
· Sleeping poorly
· Reduced appetite and
· Headaches or stomach-aches.
Older children may seek reassurance from parents but the need to stay home for long periods may result in:
· Frequent sibling fights and
· Missing their school friends
Some children are more vulnerable than others
This can be due to several reasons including; biological factors caused by genes and brain wiring, psychological factors such as temperament and coping strategies, and environmental factors such as anxious parenting.
Children who are born in families with a history of anxiety are likely to be exposed to behaviours such as withdrawal, acting out, emotional and physical violence.
As they get older, they may experience severe anxiety as a result of their genetic make-up.
Depending on socialisation and upbringing, some children may develop resilience and learn how to better cope with stress, anxiety, and adversity.
However, others cannot cope well and Covid-19 fears may trigger anxiety.
Adverse childhood experiences
An environment where children and adolescents are exposed to verbal abuse, emotional neglect and physical violence contributes to the development of anxiety. These exposures are collectively termed as adverse childhood experiences.
Adverse childhood experiences contribute to poor health outcomes in adulthood, increase the occurrence of depression in pregnancy, and also contribute to a vicious cycle of poor health outcomes across generations.
Anxious, overprotective, or overly critical parenting behaviours can contribute to the development of pathological anxiety in children.
What can families do to prevent or manage anxiety in children?
Model good behaviour
Adults should display kindness and understanding towards one another as children tend to model adult behaviour. In the current uncertain economic times, some parents may place excessive or unreasonable demands on each other and this may cause anxiety in children.
Predictability in the family routine
Creating a structure and predictability in the family routine is reassuring for children.
Ensure the children continue eating a balanced diet. Involve them in meal planning.
Pay attention to their dental and general body hygiene while maintaining a tidy home. This makes it easier for all to endure the stay-at-home orders.
Teach them a new skill
This is a good time to teach or enhance children's skills including managing their living space and laundry.
Teach them how to cook and other life skills beyond what is taught in school. Create a schedule with age-appropriate activities as it creates a sense of predictability.
Use of drawings and journals
Active exploration of children's thoughts and feelings through gentle questioning and the use of drawings are other ways for parents to reassure children and adolescents.
School-age children easily express themselves through drawings and engaging in art activities which in itself has also been described as therapeutic.
Journaling among adolescents not only creates a reference that they can revisit in the future regarding what Covid-19 was like for them. It can also help them deal with feelings of anxiety and fear of abandonment by friends or separation of the family due to illness.
Set aside time to allow children to express their distress
Even though it seems to be over trivial matters, they may have reasonable fears over future school achievements as well as future work or training prospects under the current circumstances.
Unexpressed distress may express itself through unusual behaviour such as bedwetting, withdrawal, excessive sleeping, and body aches.
Connect to family and friends through technology
Let them talk to their grandparents and other favourite members of the family. Where smartphones or computers are available, let them use video calls to talk to stay connected to their friend or cousin.
Seek professional help
If anxiety interferes with normal functioning in a child or adolescent, seek professional help from a psychologist.
A physical doctor consultations where possible can be followed by tele-consult strategies to deliver continued counselling support while reducing the chances of infection with Covid 19.
Dr Samia is a consultant paediatric neurologist and the chair of the Department of Paediatrics and Child Health at Aga Khan University Hospital, Nairobi.
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