Managing children's fear, anxiety in the era of COVID-19

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Editor's Note: Find the latest news and guidance from COVID-19 at the Medscape Coronavirus Resource Center.
With coronavirus disease (COVID-19) reaching epidemic proportions, many American children are increasingly anxious about what this means for their own health and safety and that of their friends and family.

The constant change in the number of people affected by the virus and the evolution of the situation mean that the daily life of many children is affected in some way, with school trips, sports tournaments and family vacations that are postponed or canceled. .
All children may have a higher level of concern, and some who are usually anxious may be more obsessed with hand washing or getting sick.

Experts say there are ways to manage this fear to help children feel safe and properly informed.

Dr. David Fassler

Physicians and other adults should provide children with honest and accurate information geared to their age and level of development, said David Fassler, MD, clinical professor of psychiatry, University of Vermont Larner School of Medicine, Burlington, and Committee member of Consumer Affairs of the American Academy of Child and Adolescent Psychiatry.

That said, it is also acceptable for children to know that some questions cannot be answered, Fassler said.

Be truthful, calm
"This is partly because the information keeps changing as we learn more about how the virus spreads, how to better protect communities and how to treat people who get sick," he added.

Dr. Eli Lebowitz

Doctors and parents should remind children "that there are many adults who are working very hard to keep them safe," said Eli R. Lebowitz, PhD, associate professor at the Child Study Center, Yale School of Medicine, New Haven, Connecticut. , who runs an anxiety program.

It is important that adults pay attention not only to what they say to children, but also to how they say it, Lebowitz said. He stressed the importance of talking about the virus "in a calm and practical way" rather than anxious.

"If you seem scared or tense or your voice conveys that you are really scared, the child will absorb it and also feel anxious," he said.

This advice also applies when adults discuss the issue with each other. They should be aware that "children are listening" and perceive any anxiety or panic that adults express.

Children are absorbing information about this virus from the Internet, the media, friends, teachers and other places. Lebowitz suggests asking the children what they have already heard, which provides the opportunity to correct rumors and inaccurate information.

"A child can have a very inflated sense of what the real risk is. For example, he may think that anyone who gets the virus dies," he said.

Myth that busts
Adults should inform children that not everything they hear from their friends or on the Internet "is necessarily correct," he added.

Some children who have experienced serious illness or loss may be particularly vulnerable to experiencing intense reactions to graphic news reports or images of illness or death and may need additional support, Fassler said.

Adults could use the "knowledge framework" that children already have, Lebowitz said. He noted that all children are aware of the disease.

"They know that people get sick, and they probably have been too, so you can tell them it is a disease like a serious flu," he said.

Children should be encouraged to approach adults they trust, such as their pediatrician, a parent or a teacher, with their questions, Lebowitz said. "Those are the people who can give you the most accurate information."

Fassler said there is accurate and up-to-date information available through fact sheets developed by the Centers for Disease Control and Prevention and the World Health Organization.

Although it is useful and appropriate to be reassuring, Fassler advises not to make unrealistic promises.

"It's okay to tell children that you will deal with what happens, even if that means altering travel plans or work schedules, but you can't promise that anyone in your state or community will get sick," he said.

Maintain healthy habits
Doctors and other adults can tell children "appropriately for their age" how the virus is transmitted and what the symptoms are, but it is important to emphasize that most people who are sick do not have COVID-19, Lebowitz said. .

"I would point out that the people who are sickest are the older people who are already sick, rather than the younger and healthier people," he said.

Lebowitz recommends following the guidelines to stay healthy, including a cough in a sleeve instead of the hand and regular hand washing.

It is also important at this time that children maintain healthy habits, get enough physical activity and sleep, eat well and be outside, because this regimen will greatly contribute to reducing anxiety, Lebowitz said. Deep breathing and muscle relaxation exercises can also help, he said.

Lebowitz also suggests maintaining a supportive attitude and showing "some acceptance and validation of what children feel, as well as some confidence that they can cope with and tolerate feeling uncomfortable at times, that they can handle some anxiety."

While accepting that the child may be anxious, it is important not to encourage excessive avoidance or unhealthy coping strategies. Fassler and Lebowitz agree that children who are too anxious or worried about the coronavirus should be evaluated by a trained and qualified mental health professional.

Signs that a child may need additional help include constant difficulty sleeping, intrusive thoughts or concerns, obsessive compulsive behaviors, or reluctance or refusal to go to school, Fassler said.

The good news is that most children are resilient, Fassler said. "They will adapt, adapt and continue with their lives."

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