By Danielle Hamilton BScN, RN
COVID-19 has rattled our world, with devastating impacts on children and families across the globe. From job loss to supply shortages, parents and children have been faced with new and evolving sources of stress. Parents are concerned about not only the physical health of children and protecting them from the virus, but 
their emotional and mental health as well. Children were quickly removed from their schools and daycares to reduce their risk and transmission, and later parents were faced with the difficult decision to have them return or not. Childcare support became unstable, and the previous routines and structure were no longer attainable. As parents engage in the balancing act of working from home (if you were fortunate enough to have the option) while ensuring children were participating in their education, they also worry about providing children with stimulation and activity while maintaining safety.
International data indicate that the numbers of children who are symptomatic, test positive for, or die from the virus is very small compared to older age groups (Our World in Data, 2020). Since the numbers of children affected are relatively low, they may appear to be a small or insignificant, but if we were to ask the parents of these young adults and children, would they agree? Many children with COVID experience mild cases, which are still a cause for worry for parents and families as they track potential older, vulnerable people who have been in contact with their children Some children experience more severe symptoms. Foster et al. (2020) conducted research involving 57 pediatric patients with COVID-19 during the initial phase of the outbreak. Of these patients, 83% presented with a fever or cough, and all who required admission to hospital had secondary diagnoses including diabetic ketoacidosis, vaso-occlusive crisis, acute chest syndrome, asthma exacerbation, altered mental status from hypernatremia, reactive arthritis, or appendicitis (Foster et al., 2020).
It is not to say that children who have not been officially diagnosed with the virus have not been affected. Children are vulnerable and at an increased risk of abuse during school closures (Cluver et al., 2020). COVID-19 has also presented some challenges related to food security for some children (Pérez‐Escamilla, Cunningham & Moran, 2020). They are at risk of increased stress and reduction of supportive resources secondary to this pandemic which may impact their mental health (Clemens., et al., 2020). Children are also susceptible to related posttraumatic distress (Zhou, 2020). It has also been observed that there is a reluctance to seeking medical attention due to fear of contracting COVID-19 which has resulted in decreased admissions but increased severity when care is obtained (Ciacchini et al., 2020).
How do we as health care professionals support children and families through COVID-19? It has been recommended that psychological services that include social, school, and family systems be provided (Zhou, 2020). By providing direct or indirect services and resources that support children, parents, and schools/teachers we can encourage sustainable recovery (Zhou, 2020). Although the pandemic has resulted in limited access to services in many areas, we also need to be innovative with delivery and improve access. We have already seen drastic changes in the delivery of care through virtual means and deployment of resources as required (Price & Campbell, 2020). We must continue to adapt and support policy and program development and change to best suit the needs of children and families.
References
Ciacchini, B., Tonioli, F., Marciano, C., Faticato, M. G., Borali, E., Pini Prato, A., & Felici, E. (2020). Reluctance to seek pediatric care during the COVID-19 pandemic and the risks of delayed diagnosis. Italian Journal of Pediatrics, 46(1), 87. https://doi.org/10.1186/s13052-020-00849-w
Clemens, V., Deschamps, P., Fegert, J. M., Anagnostopoulos, D., Bailey, S., Doyle, M., Eliez, S., Hansen, A. S., Hebebrand, J., Hillegers, M., Jacobs, B., Karwautz, A., Kiss, E., Kotsis, K., Kumperscak, H. G., Pejovic-Milovancevic, M., Christensen, A. M. R., Raynaud, J.-P., Westerinen, H., & Visnapuu-Bernadt, P. (2020). Potential effects of “social” distancing measures and school lockdown on child and adolescent mental health. European Child & Adolescent Psychiatry, 29(6), 739–742. https://doi.org/10.1007/s00787-020-01549-w
Cluver, L., Lachman, J. M., Sherr, L., Wessels, I., Krug, E., Rakotomalala, S., Blight, S., Hillis, S., Bachman, G., Green, O., Butchart, A., Tomlinson, M., Ward, C. L., Doubt, J., & McDonald, K. (2020). Parenting in a time of COVID-19. The Lancet, 395(10231), e64. https://doi.org/10.1016/S0140-6736(20)30736-4
Foster, C. E., Moulton, E. A., Munoz, F. M., Hulten, K. G., Versalovic, J., Dunn, J., Revell, P., Koy, T. H., Arrington, A. S., Marquez, L., & Campbell, J. (2020). Coronavirus Disease 2019 in Children Cared for at Texas Children’s Hospital: Initial Clinical Characteristics and Outcomes. Journal of the Pediatric Infectious Diseases Society, 9(3), 373–377. https://doi.org/10.1093/jpids/piaa072
Our World in Data. (2020). Mortality Risk of COVID 19. https://ourworldindata.org/mortality-risk-covid#case-fatality-rate-of-covid-19-by-age
Pérez‐Escamilla, R., Cunningham, K., & Moran, V. H. (2020). COVID-19 and maternal and child food and nutrition insecurity: A complex syndemic. Maternal & Child Nutrition, 16(3), e13036. https://doi.org/10.1111/mcn.13036
Price, D. W., & Campbell, C. M. (2020). Rapid Retooling, Acquiring New Skills, and Competencies in the Pandemic Era: Implications and Expectations for Physician Continuing Professional Development. Journal of Continuing Education in the Health Professions, 40(2), 74–75. https://doi.org/10.1097/CEH.0000000000000297
Zhou, X. (2020). Managing Psychological Distress in Children and Adolescents Following the COVID-19 Epidemic: A Cooperative Approach. Psychological Trauma: Theory, Research, Practice & Policy, 12, S76–S78. https://doi.org/10.1037/tra0000754