Helping children adjust to life after COVID-19 stay at home orders

By Dr. Sheila Modir, pediatric psychologist at CHOC

As communities navigate through re-opening efforts after shelter-in-place orders, it’s natural for adults and children alike to have mixed emotions about what is to come. Children tend to echo the feelings of their parents or caregivers. They will look to the adults in their lives for support and guidance on how to react to this new transition of going outside again, and whether they will continue to remain safe once they are away from the safety of their home. Although parents may not know all the answers to these questions, there are some things you can do to boost your child’s sense of emotional safety in order to help them navigate life as things slowly re-open.

Communicate

Have an age-appropriate, open conversation with your child about what is going on with COVID-19 and why things are beginning to re-open.

• Clarify any misinformation and provide them with the correct facts in a developmentally appropriate manner.
• Limit information to the questions that they ask you, so that you avoid overwhelming them with information that they may not need to be privy to right now.
• For teens, ask them what information they have read online or what their friends have told them about things re-opening
• Ensure that your children understand ways to keep themselves safe in public, as well as the symptoms of COVID-19, so that they can feel a sense of agency in their world as they re-enter

Reassure safety

For children who are prone to higher levels of anxiety, transitions and change are difficult for them. It can be scary to go from staying at home all day — which had been associated with staying safe — to slowly reintegrating back into the world — which had been associated with people getting sick.

Remind your child about ways that everyone is working hard to keep them safe as things slowly re-open. For instance, your family helps keep each other safe by doing things like washing your hands and sneezing into your elbow rather than your hand. Doctors and nurses are working hard to save lives in the hospitals, people wear face masks when they go outside to protect each other, and schools are planning how to handle hygiene and social distancing once they re-open.

If your child is worried about you going back to work, tell them about all the ways that your work is keeping you safe. If your child is worried about getting sick if they go outside, remind them of all the ways you have taken care of them in the past when they have gotten sick. You can let them know that most sick people are recovering, and many children are not getting sick.

Establish routines

If you child’s daycare or school is opening, it is important to remind them of what their daily schedule used to be when they were going to school. If you are going back to work, collaborate with them to create a new schedule of what their days will look like while you are at work. Reviewing their schedule can help them anticipate what to expect and will also provide them with structure and predictability during a period of transition and change.

If your child’s routine at school or daycare will change, review this new change with them often, so that they can mentally prepare for it.

Explain and model emotion regulation

Explain to your child that feelings are normal, and it is OK to feel scared, anxious, worried or excited about things re-opening and people going back to work. Avoid dismissing their fears by saying things like, “Don’t stress about all of this.” Instead, you can model for your child how to express these emotions in a healthy manner. For example, you can tell your child, “I am also worried about going back to work, but whenever I get worried I talk to your aunt because she’s a good listener, then I take three deep breaths, and I think of all the people that are working hard to keep me safe.”

Limit media exposure

Repeated exposure to the news has been found to increase distress and intensify already heightened emotions. It’s also important to be mindful of conversations you have with other adults about COVID-19, as children may listen and misinterpret things said. Here’s more advice on monitoring news and social media intake during COVID-19v.

Be aware of emotional cues

The experience of a pandemic has been traumatic for many children. Being aware of your child’s emotional cues can be helpful in knowing when they are experiencing distress.

Some signs and symptoms of distress are a normal part of adjusting to a transition — such as changes in your child’s sleep or appetite — and will subside as your child adapts. However, when these signs and symptoms begin to interfere with a child’s ability to function, consider contacting a mental health professional.

Here are signs and symptoms of pediatric traumatic stress

Preschool and young child

• Increase in crying and/or screaming
• Difficulty falling asleep on their own and/or increase in nightmares
• Increase in separation anxiety from caregivers
• Engaging in regressive behaviors such as losing their speech, toileting skills, or eating poorly

School-age children

• Feelings of anxiety, sadness and fearfulness
• Constant worries about their safety and safety of others
• Acting clingy
• Somatic complaints such as stomachaches or headaches
• Impaired concentration
• Difficulty sleeping

Adolescents

• Feelings of anxiety, depression and loneliness
• Engagement in risky behaviors such as self-harming, using substances or restrictive eating
• Increase in argumentative behaviors
• Isolation
• Difficulty sleeping or sleeping too much
• On edge much of the time or easily irritable

Resources for parents

• Supporting children during COVID-19 — The National Child Traumatic Stress Network
• Helping children with traumatic separation or traumatic grief during COVID-19 — The National Child Traumatic Stress Network
• Talking to children about COVID-19 — The National Association of School Psychologists & The National Association of School Nurses
• Talking to children about COVID-19 — The Centers for Disease Control
• Helping families cope with COVID-19 — The National Child Traumatic Stress Network

Helpful Books

Children’s books that can be helpful when discussing worries and emotions around transitions and changes.

• “The Kid’s Guide to Staying Awesome and In Control” by Lauren Brukner
• “The Invisible String” by Patrice Karst
• “Wilma Jean the Worry Machine” by Julia Cook
• “What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety” by Dawn Huebner

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