Child Mental Health in the COVID-19 Context

Last Updated: July 29, 2020

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The Child Mental Health in the COVID-19 Context tool is revised often and new content is added regularly to guarantee that the latest evidence and regulatory recommendations are included. The CEP is committed to ensuring this information is accurate and up to date.
Last reviewed: September 25, 2020
Last updated: October 21, 2020

Jump to the COVID-19 Resource Centre
Your one-stop shop for all of your COVID-19 related needs, including clinical guidance, maintaining regular primary care practice in the COVID-19 context, social care guidance, local services and more.

Now more than ever it is important for your patients to look after their health and receive care from you as their healthcare provider. It’s essential that patients continue to seek out care that they need.

This tool has has been developed to support primary care providers in navigating and providing patient care in a world where COVID-19 is the ‘new normal’. While how care is delivered has changed, efforts should be made to ensure that the quality has not. As always, when treating your patients, continue to use your clinical judgement and follow standards of care, best practices, evidence and guidelines.

Click on the sections below to get started:

How to talk to children about COVID-19

Parents and caregivers should ensure children receive honest and accurate information during the COVID-19 pandemic (SickKids, March 31, 2020).

Talking tips:

  • Share ‘need to know’ information with children, using age appropriate language.
  • Answer questions directly and honestly, and do not make false promises.
  • It’s okay if you don’t know all the answers. Focus on the short-term plan for the whole family.
  • If children are distressed, let them know that it is ok and understandable to have these feelings.
  • Model healthy coping skills and attend to your own physical and mental health.
  • Consider seeking out additional resources and supports for children with special needs or who are having trouble coping. For a list of local mental health services for families, children and youth, see Local Services > Mental health services.

Answering children’s questions about COVID-19

“We wipe things down to keep them clean.”

You don’t need to explain more than this—young children don’t understand germs or infection transmission yet.

“Sometimes people wear masks to decrease sickness from spreading, when they aren’t feeling well or to help keep them safe from getting sick.”

“Everybody gets sick sometimes. If you get sick, your parents will take care of you until you are all better. I will help you, too.”

“Your child care/school is closed right now. Your teacher and your friends are home too, just like you. When child care is open again, you can go back and see your friends.”

Avoid going into details about illness so toddlers don’t develop fears about attending child care.

“Right now, there is a rule that families need to stay home for a little while and be together. That helps you and your friends stay healthy. I know it can be sad when you can’t see and play with friends, but there are lots of fun things you can do at home!”

Preparing children for reopening

Reopening is presenting kids with a different set of anxieties and challenges. Doing the following, parents and caregivers can help children adapt and prepare for the changes resulting from COVID-19:

Plan, but stress flexibility

Even if only a few weeks at a time, planning ahead will help give kids a sense of safety and security. Children should be included in planning and informed that these plans might have to be reassessed. This can lessen their anxiety over how they’ll be spending the next few months and help them prepare to handle changes.

Agree on ground rules

Establishing clear family rules for socializing will give kids a sense of control. Empathize with their fears, but encourage them to think of ways that your family will work together to help everyone stay safe and healthy.

Take it step-by-step

Emphasizing that reopening is a gradual process can help kids manage their behaviour and feel more confidence. Steps to start with might include maintaining physical distancing or wearing a mask while with friends, or limiting the number of friends your child can see. Discuss what other steps might come down the road so kids know you’re planning ahead even if they can’t do everything they want just yet.

Prepare children by coping ahead

Other families might follow different rules, which could result in uncomfortable moments for kids. Work with kids to anticipate unsafe situations they might encounter so they feel more comfortable and can make better decisions when the time comes.

Validate fears

When a child expresses worry or fear, helping them know their feelings are valid will help manage those feelings. Instead of telling them not to worry, try to find out what they are worried about and answer their questions to correct any misinformation.

Practice bravery

Encourage kids to do various activities in their neighbourhood, such as go on a bike ride or play games outside, and ask them which one they think would be the easiest. Pair this with praise or even a reward for trying one of these activities.

Be alert to signs of something more serious

Look out for signs of mental health distress as discussed in following sections.

Recognizing the signs of mental health distress

Changes in behaviour or emotions can indicate that a child needs more support (CPS, March 2020; SickKids, April 14, 2020; School Mental Health Ontario, 2020; Child Mind Institute, 2020).

Look out for:

  • Changes in behaviour or emotions that seem out of proportion even with the current circumstances (e.g. angry outbursts, depressed mood, sense of panic).
  • Problems sleeping; shifts in sleep patterns.
  • Appetite changes; changes in weight.
  • Headaches, stomach aches/nausea and fatigue.
  • Infantile behaviours that aren’t common anymore for the child (bedwetting, thumb sucking, being afraid of the dark, wanting to be held).
  • Loss of interest in activities they enjoy; reduced feelings of anticipation.
  • Worry and/or fear of leaving the home.
  • Increased rebellion and/or complaining about schoolwork or chores.
  • Increased aggression towards others.
  • More frequent outward expression of emotions.
  • Harsh self-assessment.

If a child expresses thoughts of hurting themself or engages in suicidal behaviour, seek help from a mental health professional immediately. For a list of local mental health services for families, children and youth, see Local Services > Mental health services.

Managing depression

Managing stress and anxiety

Use the CARD System (Comfort, Ask, Relax, Distract) to help children cope:

  • Comfort: help the child accept negative thoughts and feelings.
  • Ask: listen and talk to each other.
  • Relax: model relaxation for the child.
  • Distract: try to keep normal routines and limit the amount of time the child focuses on whatever is making them anxious.

General actions to help support children during the pandemic (WHO, 2020):

  • Support children with at-home learning, and make sure time is set aside for play.
  • Help children find positive ways to express feelings such as fear and sadness. Sometimes engaging in a creative activity, such as playing or drawing, can help with this process.
  • Make sure children have time away from screens every day and spend time doing off-line activities together. Draw a picture, write a poem, build something, bake a cake, sing, dance, or play outside where safe to do so.

Actions to combat disconnectedness:

When a family member is self-isolating

Grief

Children experiencing the death of someone close to them are particularly vulnerable (Canadian Virtual Hospice, 2019). They need time to process their thoughts and feelings and to ask questions. Willingness to discuss difficult topics teaches children that hard conversations can happen safely, and that they can talk with you about difficult things (Canadian Virtual Hospice, 2019).

Talking to a child about the loss of a loved one:

  • Have the conversation in a safe, comfortable place where you won’t be interrupted.
  • Get down to eye level.
  • Tell them that you may be upset or cry while you talk because you’re feeling many emotions, and that this is natural and okay.
  • Explain that they may have strong feelings too and it’s okay to express them.
  • Start with what the child already knows and build from there.
  • Give the information in a straightforward way, using words they can understand.
  • Let them know their questions are welcome. Praise them for asking questions and sharing their thoughts and feelings.
  • Be gentle and sensitive, giving the information they ask for and need.
  • Watch for cues to guide you around pacing the conversation, signs that will help you gauge how much information to provide and when the child is ready to hear it.

Resources New

These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.

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