Taking Care of Kids in COVID-19

COVID-19 is an illness that has symptoms very similar to the common cold or the flu, including headaches, body aches, scratchy throat, cough, fever, and difficulty breathing, along with other symptoms like loss of taste or smell. Since beginning in December 2019, the novel coronavirus infection has spread from one country to the other in a short amount of time to turn into a pandemic. The emergence of the novel coronavirus (COVID-19) pandemic has caused widespread concern, lockdowns, quarantines, and a lot of panic among people all over the world.1

Due to the widespread panic amongst people, it is obvious that parents are also worried about the ramifications of the disease and what it means for their children while trying to figure out what they can do to keep their children safe. While there is still a lot to be learned about how Covid-19 impacts children, but when compared to the adult cases, there have been relatively lesser cases of the infection in children, along with milder symptoms and better prognosis even after getting infected.2

In fact, according to the final report of a joint mission of China and the World Health Organization (WHO) that was formed to study the spread of the coronavirus in China, it was observed that children below 18 years accounted for only 2.4 percent of all reported cases, and most cases were mild. The report also stated that just 2.5 percent of the kids under the age of 19 had developed a severe case of the infection, out of which just 0.2 percent were critical.3

Apart from the actual infection, the lockdown imposed around the world has also had a profound impact on children. Children have been affected by the quarantines, physical distancing, and worldwide school closures. Some children and young people have been feeling more anxious, isolated, uncertain about the future, and bored. They may be feeling grief and fear over the impact of the coronavirus on their families.

When it comes to younger children, especially toddlers and infants, most parents simply assume that these children don’t really understand or notice what is going on around them. Most adults often assume that “They will not remember this, so it doesn’t matter to them.” However, this is not the truth. Even infants notice what is going on around them and can be affected by stress, especially the stress that is impacting their parents and/or caregivers.

While younger children do not have the ability to understand the world around them as much as older children or adults do, but changes in their routines as well as in the routines of people around them can make them worried or anxious. However, they are usually not able to explain or tell us about their anxieties and worries.4

What such young children need the most during this time is to have a sense of safety and security from their parents and caregivers. This they will feel when their parents/caregivers hold them, stay calm with them, reassure them, and listen to them.

How Does COVID-19 Affect Children?

It is important to realize that this is still a relatively new virus, and researchers are still learning every day about how it functions and how it affects different people, including children and pregnant women. While we already know that it is possible for people of any age to become infected and transmit the novel coronavirus, it is being observed that older people and/or people with pre-existing medical conditions like type 2 diabetes, hypertension, heart disease, and others, are more prone to developing serious illness if infected by the new virus.5,6

There is also a rare but serious multisystem inflammatory disease that affects adolescents and children, which is also known to be associated with the novel coronavirus. The clinical symptoms of this syndrome can include, but are not limited to the following:

  • Pink or red eyes
  • Persistent fever
  • Rash
  • Swollen and/or red lips, hands, tongue, feet
  • Low blood pressure
  • Gastrointestinal issues
  • Poor blood flow to the organs
  • Signs of inflammation

Though primarily observed first in the United Kingdom, many children who have had these symptoms have also tested positive for COVID-19. However, it is still not sure whether COVID-19 infection is causing the multisystem inflammatory syndrome. These cases have also been reported from across Europe and in North America.7,8

Children showing any of these symptoms should seek medical attention at the earliest. Early diagnosis and treatment for this condition are critical. Most initial reports have shown that a majority of the cases have responded well to being treated with anti-inflammatory medications.

At the same time, children are likely to be affected by measures that have been taken to control the COVID-19 outbreak, including physical distancing and school closures. Parents/caregivers need to provide special attention to children to prevent and minimize any kind of negative impact on them.

Young Children and their Reaction to Stress

It is important for adults to keep in mind that younger children do not yet have the language or skill to communicate or talk about what is happening around them or upsetting them. However, young children do show certain signs when they are upset and stressed. It is important for adults to pay attention to the behavior of young children and think about how such behaviors may be an indication of how the children are feeling inside. Some of the common reactions to stress that younger children may show include:

  • Sleep problems
  • Increased crying
  • Having problems with going to the toilet
  • Trouble being comforted or soothed
  • Increased worries and crying when being separated from parents at nighttime or otherwise
  • Having bad dreams
  • Throwing temper tantrums
  • Needy or clingy behaviors

What Can Parents Do For Their Kids During Covid-19 Pandemic?

More than older children, it is the younger ones that need to be comforted by their parents. Parents/caregivers need to keep them feeling secure and safe because they are too young to do this for themselves. It is, no doubt, difficult for parents or caregivers to comfort children when they are stressed themselves, so they will need to do the best they can.

Here are some effective ways of helping younger kids when they are worried or stressed during the pandemic:

  • Reassure young children that you are there to keep them safe. This can be done through verbal reassurance for children who understand language and/or through comforting movements and physical closeness, including swaying or rocking while holding.9,10
  • Making the home atmosphere quieter, for example, turning the volume of the TV down, dimming the lights, and playing relaxing music.11
  • Keep patience with them even there is an increase in troublesome or problematic behavior. Keep in mind that problematic behavior in younger children is usually a sign of stress, and not because they are a ‘bad’ kid.
  • Encouraging them to express their feelings through play, stories, and books.
  • Try to maintain a regular routine.
  • Maintain good sleep and eating habits, but be aware that short-term changes in their sleeping arrangements might be necessary. This may include a small child feeling very anxious at night or when separated from their parents. They may also need to or want to spend extra time being physically close with a parent/caregiver.
  • Make sure they are getting enough fresh air and physical exercise or movement.
  • Restricting the exposure of children to TV and media outlets about COVID-19 and also restricting exposure to adult discussions about the related stress to COVID-19, such as job losses and financial difficulties, is a good idea.

For children who can communicated and ask questions about the ongoing pandemic, opt for providing simple and brief information that is also age-appropriate. This should be followed by offering them reassurance that you and social helpers like doctors, teachers, the police force, and others are taking care of them.

Even though the times are difficult, in front of young children, try to remain calm. Remember that children take their cues about the current situation at home from their parents/caregivers, and they also pick up on how they should act and feel. Parents the most important role model for children, and how you behave during this pandemic will determine their stress levels as well.

What To Do If Your Child Develops The Symptoms Of COVID-19?

It is important to seek medical attention if your child develops the symptoms of COVID-19. However, remember that many of the symptoms of COVID-19, like cough or fever are very similar to those of the common cold or the flu, which are more frequent conditions.

Even if your child develops the symptoms, you should continue to follow all hygiene and sanitation practices. Keep Regular handwashing to keep your child safe against viruses and bacteria is necessary.

Even if your child has the flu, seek early medical attention. If you or your child are experiencing the symptoms, it is better to try and avoid going to public places like schools, workplaces, using public transport, and others in order to prevent spreading the infection to others.

Here are some tips to follow if your child develops a fever, cough, and sore throat:

Try to remain calm as your child may become anxious seeing you stressed.

Talk to your doctor. Nowadays, most doctors are doing online consultations. So before heading off to the hospital, it is better to do an online consultation. Your doctor will take a detailed history and make a diagnosis of the severity of your child’s condition. Testing for COVID-19 is usually only recommended if there is a history of your child or any other family member coming in close contact with a CODI-19 patient. There are many other more common causes of children developing a fever, cough, and sore throat that can be managed easily by routine medications. It is, therefore, important that you follow the instructions given and medicate your child as prescribed by your pediatrician.

  • Ensure that your child is getting plenty of rest and keeps drinking lots of liquids.
  • Make sure your child keeps washing their hands often with soap and water for at least 20 seconds.12,13
  • Separate the sick child from the rest of the family as much as possible. This will prevent the illness from spreading to others, especially if there are other children in the house.14
  • If it is not possible to separate the child from the rest of the family, at least ensure that the sick child is wearing a face mask whenever there are others around.
  • The child should be taught to cover his/her face while coughing or sneezing. Teach them to either cough/sneeze into their elbow or use tissues.15
  • Avoid sharing any cups, towels, bedding, and dishes.
  • Clean and disinfect all frequently used surfaces thoroughly and daily till the child is unwell.16,17

Watch out for signs that your child may be in need of more medical help. This can include having trouble breathing, rapid breathing, not being able to eat or drink, sleepiness, or signs of dehydration such as urinating less than usual. In such a case, you should take your child to the emergency room immediately.

Promoting Hygiene Practices in Children

It is important to explain the importance of practicing good hygiene and its role in preventing diseases like the novel coronavirus infection. Here are some tips to help promote hygiene practices amongst children:

  • Teach your children to wash hands with soap and water while ensuring they clean under the fingertips and between the fingers for at least 20 seconds. In case there is no way to wash their hands, they should use an alcohol-based hand sanitizer.
  • Let them know that they should avoid touching their nose, eyes, and mouth repeatedly or without washing their hands, especially when they are out in public.
  • Make sure your children cover their nose and mouth into their elbow or tissue while coughing or sneezing. They should remember to dispose of the used tissue immediately.
  • Use your usual household cleaners or wipes to clean things that are frequently touched, such as toys, doorknobs, light switches, phones, remote controls, etc. Make it a habit to do this every day.

It is important to lead by example during this pandemic situation. After all, children learn when they see what their parents are doing. So follow good hygiene practices yourself and encourage your children also to do the same.

References:

  1. Guan, W.J., Ni, Z.Y., Hu, Y., Liang, W.H., Ou, C.Q., He, J.X., Liu, L., Shan, H., Lei, C.L., Hui, D.S. and Du, B., 2020. Clinical characteristics of 2019 novel coronavirus infection in China. MedRxiv.
  2. Wei, M., Yuan, J., Liu, Y., Fu, T., Yu, X. and Zhang, Z.J., 2020. Novel coronavirus infection in hospitalized infants under 1 year of age in China. Jama, 323(13), pp.1313-1314.
  3. Dong, Y., Mo, X., Hu, Y., Qi, X., Jiang, F., Jiang, Z. and Tong, S., 2020. Epidemiology of COVID-19 among children in China. Pediatrics, 145(6).
  4. Ron, A.G. and Cuéllar-Flores, I., 2020, July. Psychological impact of lockdown (confinement) on young children and how to mitigate its effects: Rapid review of the evidence. In Anales de Pediatria. Elsevier.
  5. Cummings, M.J., Baldwin, M.R., Abrams, D., Jacobson, S.D., Meyer, B.J., Balough, E.M., Aaron, J.G., Claassen, J., Rabbani, L.E., Hastie, J. and Hochman, B.R., 2020.
  6. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. The Lancet, 395(10239), pp.1763-1770.
  7. Wortham, J.M., 2020. Characteristics of persons who died with COVID-19—United States, February 12–May 18, 2020. MMWR. Morbidity and mortality weekly report, 69.
  8. Jiang, L., Tang, K., Levin, M., Irfan, O., Morris, S.K., Wilson, K., Klein, J.D. and Bhutta, Z.A., 2020. COVID-19 and multisystem inflammatory syndrome in children and adolescents. The Lancet Infectious Diseases.
  9. Yasuhara, J., Watanabe, K., Takagi, H., Sumitomo, N. and Kuno, T., 2020. COVID‐19 and multisystem inflammatory syndrome in children: A systematic review and meta‐analysis. Pediatric Pulmonology.
  10. Cahill, T.L., 2003. Reassuring Young Children: The Role of Parents in Helping Children Overcome Adversity (From Shocking Violence II: Violent Disaster, War, and Terrorism
  11. Affecting Our Youth, P 35-51, 2003, Corrinne E. Frantz and Rosemarie Scolaro Moser, eds.–See NCJ-199446).
  12. Sorin, R., 2002. Responding to children’s fears: a partnership approach. Canadian Children, 27(1), pp.30-33.
  13. Saltzman, A., 2014. A still quiet place: A mindfulness program for teaching children and adolescents to ease stress and difficult emotions. New Harbinger Publications.
  14. Beiu, C., Mihai, M., Popa, L., Cima, L. and Popescu, M.N., 2020. Frequent hand washing for COVID-19 prevention can cause hand dermatitis: management tips. Cureus, 12(4).
  15. Alzyood, M., Jackson, D., Aveyard, H. and Brooke, J., 2020. COVID‐19 reinforces the importance of handwashing.
  16. Sacks, E., Sripad, P., Ndwiga, C., Waiswa, P. and Warren, C.E., 2020. Protecting newborn infants during the COVID‐19 pandemic should be based on evidence and equity. Acta Paediatrica, 109(12), pp.2448-2450.
  17. Bender, L., 2020. Interim Guidance for COVID-19 Prevention and Control in Schools. UNICEF.
  18. Chen, T., 2020. Reducing COVID-19 transmission through cleaning and disinfecting household surfaces. Vancouver, BC: National Collaborating Centre for Environmental Health.
  19. World Health Organization, 2020. Cleaning and disinfection of environmental surfaces in the context of COVID-19.

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