Many children are now heading back to school, and some might have already started. This is typically an exciting time, but since the Delta variant rages and vaccination rates remain low in many countries, children are becoming ill in increasing numbers. This is a scenario that can cause anxiety for many parents and children. As parents of young children ourselves – and as psychologists – we know how challenging this situation can be for families.
While the internet is awash with advice (and sadly, with misinformation) on how to handle the emotional turmoil that comes with Covid, it’s vital that these tips are hinged not only on latest empirical data, but are also backed by modern psychology.
Here are some research-based, yet practical tips for parents on how to talk with Covid-positive children:
Take a step back
It’s important to remember that many children have been exposed to messages and media emphasising fear and personal responsibility developed for adults. In the UK, the widely-distributed guidance is: ‘Stay at home. Protect the NHS. Save lives’ and ‘If you go out, you can spread it. People will die’. While in the US, a slightly similar messaging was delivered: ‘Say it with me, America: Coronavirus stops with me.’
Children were never the intended audience for these messages, and may blame themselves unnecessarily when they find out they are sick. Parents should be prepared to hear that children and young people feel that they have failed – and been failed.
Set the stage
Talking with children about what a positive result will mean in terms of treatment, isolation, and outcome can help set their expectations before they take their test. Children often want to know what comes next so making space for them to ask questions prior to taking the test can help keep things calm and help parents anticipate what concerns their children might have in advance of the test result.
Listen for practical concerns
A child with a positive diagnosis may have concerns about getting very sick and dying, or hurting others by transmitting (or having transmitted) the virus. They can be reassured that they will be cared for, that most children do not even know they have it, and that most children recover well.
Consider a gentle approach
To help prevent anxiety, stress and guilt, parents can consider a non-blaming approach, and not anthropomorphise the virus with violent intent. For example, instead of saying the virus is an ‘invader’ or ‘attacker’ that their body is going to ‘fight’ or ‘destroy’, alternative phrasing can include framing the virus like a tiny ‘printer’ that the body will ‘breakdown’, ‘remove’, or ‘flush out’.
Be prepared for strong emotions
Special care may be needed for children who are experiencing a lot of anger, fear, confusion, and guilt about their Covid diagnosis. Those who were following hand hygiene, masking and social distancing guidelines, may need reminding that although these measures reduce the transmission, they do not eliminate risk. This may be frustrating for children, but parents can listen and validate these feelings.
Keep it positive
Parents can emphasise positive messages of staying home to promote self-care and ‘building up the body’. Take care to avoid a central focus on the young person being a danger to others. Focusing only on being a danger to others can increase anxiety, especially for young children. If a young person has been non-compliant with Covid precautions prior to testing positive, a focus on danger to others can also lead to increased guilt and anxiety. Instead, re-orientating children to focus on the present and immediate future may be more helpful, such as taking care of themselves and being a good friend to others by staying home.
When it is more than just Covid
For some children, their Covid diagnosis will complicate care and recovery for other serious conditions that are urgent, painful, and threatening that have brought them to the hospital. Stress associated with hospitalisation is normal and most will manage by utilising existing strategies and resources. However, young people admitted with Covid may have carers who are also Covid-positive and are therefore advised to isolate and not visit.
Lack of face-to-face contact can be stressful for families. Depending on the situation, parents can ask their children’s doctor for emotional and psychological support and for help staying in touch.
When things start to feel very stressful
Children, or parents, may have early posttraumatic stress symptoms associated with a Covid diagnosis. The severity of the disease, a history of prior trauma, other stressors (such as family separation), or repeated exposure to frightening media coverage may exacerbate the likelihood of traumatic stress symptoms. Parents can reach out to their children’s doctor with questions about signs and symptoms of stress to proactively get support for their child or for themselves.
Here are some common questions that children have and examples of messages that parents can use for children with a positive Covid diagnosis:
Child has no symptoms or mild symptoms
|How did I get sick? Is it my fault?||Millions of people have got it because it is very contagious. It is not your fault. It doesn’t matter how you got Covid. We are going to focus on helping your body feel better.|
|Am I going to die?||No, it is very unlikely that will happen. Millions of people have got Covid and recover well.|
|Is someone going to sick because of me and die?||The virus is no one’s fault. Our family is going to focus on taking care of ourselves and building our bodies up, by resting and doing activities we enjoy at home.|
|Will I ever get better?||Most young people that get Covid feel better quickly. Our family is going to rest to help our bodies feel better.|
|What kinds of treatments am I going to get?||We will stay at home and rest. If you don’t feel good, you can have some medicines to help you feel better. If you start to feel very bad, we will take you back to the doctor for more help.|
|Are you worried about me?||Note for parents: If your child knows you are worried, show them how you are dealing with your worries. For example: ‘I am feeling a little worried right now, so I am going to call grandma,’ or ‘As a parent, it is normal for me to worry about you. I feel worried now, so let’s play a game together, so I can think about having fun.’|
|Why do I need to stay home if I feel fine?||Your body is still working on getting rid of the virus, while it is doing that you can give it to other people. This virus causes some people to get very sick and while others, mostly young people, have none or very few symptoms.|
Child has symptoms requiring hospitalisation
|Am I going to die?||Almost all children get better from this virus. There are lots of doctors and nurses taking care of you to help you feel better. You can ask me questions any time. If I don’t know the answer, I will ask your doctor.|
|Am I going to kill someone? What if I got someone else sick already and don’t know?||The virus is no one’s fault. We are going to focus on resting and doing what the doctors tell us to do to help your body feel better.|
|Will I ever get better?||Almost all young people get better from this virus. There are lots of doctors and nurses taking care of you to help you feel better. You can ask me questions any time. If I don’t know the answer, I will ask your doctor.|
|What is going to happen to me in the hospital?||At the hospital, there will be lots of doctors and nurses to help take care of you. They will give you medicines to help your body.|
|What kinds of treatments am I going to get?||We will talk to the doctors and nurses and ask them all of our questions. We can ask them questions every day. They will give you medicines to help your body feel better.|
Clear communication with children is a skill, the importance of which is especially made evident by the pandemic. We need to prioritise effective communication with children, since this is an essential aspect of a global, community-led response to the pandemic. Doing this can safeguard the intermediate and long-term psychological well-being of children.
As parents and psychologists, we can’t overemphasise the importance of clear communication with children about Covid. This can help you and your children come together to make sense of how the virus is impacting on your family.
Jessica Hafetz Mirman, PhD is a lecturer in applied psychology and public health at the University of Edinburgh. She tweets @hafetzj.
Meghan Marsac, PhD is a paediatric psychologist at the University of Kentucky, and is the author of Afraid of the Doctor. She tweets @MeghanMarsac.
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