Protecting the Mental Health of Children during the COVID-19 Pandemic (and beyond). Communication is Key.

Against a backdrop of almost 13 million cases of COVID-19, an urgent global priority must be the mental health of children, who make up 42% of our world’s population.  Children have witnessed the devastating rates of infection and death, restrictions on their day to day life, and preoccupation of their parents and communities about the implications of the pandemic. So while children are relatively unaffected by the virus directly, its psychological impact cannot be underestimated.

How can we take action to protect the psychological wellbeing of children during these turbulent times?

Critically, research shows that the effectiveness of how we communicate about life-threatening illnesses has a long-term impact on parents and children’s psychological and physical wellbeing. In response, a team from the Department of Psychiatry at the University of Oxford have produced a platform of free resources to support parents, teachers, and healthcare professionals in communicating with children about illness, death and COVID-19.

We know that adults will do anything to prevent children from feeling worried, sad or upset. Many may feel uncertain about what children understand about illness or death. This can add to the difficulty of talking to children about COVID-19. However, even the youngest children are aware of changes in adults’ emotions, or the absence of familiar caregivers. Their comprehension of illness and death gradually evolves during childhood, so a good place to start is asking children what they already know and understand. This allows you to adapt information accordingly, and resolve any confusion. This is particularly important between the age of 4 and 7 years, when children are influenced by “magical thinking”. This is when children believe their thoughts, behaviours or wishes cause external events, for example, erroneously thinking that their bad behaviour has caused their parent to become sick. Giving accurate information about COVID-19 using concrete language will make sure that children do not blame themselves or feel unnecessary guilt and anxiety.

We need to be honest about the uncertainty of the pandemic and how it is changing families’ lives, without overwhelming children with our own fears. Talking and sharing feelings helps children understand the changes that they may have noticed in the behaviour of adults around them. It also gives children permission to talk about their own emotions and to share worries or frustrations.

Do schools have a role to play?

Schools also provide children with a safe place to talk about their experiences which may be too difficult to bring up at home. Teachers are important role-models and children can turn to them for support. Questions that children might raise about illness or death may create anxiety for teachers about how to cope with these sensitive topics. The Oxford team have created a guide to support school staff prepare for children’s questions. This can be used in partnership with teachers’ knowledge of their individual students.   

COVID-19 has prompted a sudden shift to telephone or web-based platforms for communication; this is particularly pertinent for healthcare and social care staff, who have simultaneously faced overwhelming patient numbers and elevated death rates.  Additional pressures on staffing levels and the unrelenting task of telling families of a loved one’s death means the outbreak is having an emotional impact on even the most experienced staff. Furthermore, the lack of relatives visiting means that staff have few chances to develop a relationship with families; this is particularly critical as the patient’s role as an important figure for children within the family (e.g. as a parent or grandparent) may become invisible. Given the importance of effective communication for children’s psychological wellbeing, professionals must proactively identify children who are important to patients/residents so that they are not overlooked when communicating with the family.  

So how can we make these impossible conversations possible?

The Oxford team have developed free resources that have been translated into multiple language which include:

• step by step guides and animations for health and social care staff about how to share difficult news by telephone.
• step by step guides and animations for families about how to tell a child about the death of a loved one.

The changes to the world our children currently face might seem almost unspeakable. But, together, we must find words, and ways, to give voice to their experience and prevent millions of children struggling with their fears and uncertainty alone. Empowering and equipping ourselves to communicate with children about illness and death has the potential to mitigate short-term and long-term psychological effects. It is our responsibility to help protect the mental health of our children and we must act now.