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SWICK TIPS

Swick

Brought to you by Dr. Susan Swick, Physician in Chief, Ohana Center for Child and Adolescent Behavioral Health

The current public health emergency is one without much precedent in most people’s lives or in our national experience. Disruption always creates stress, and extended school cancellations, financial disruptions, and fear of contagion have brought anxiety, uncertainty, and confusion. These feelings can be profound for children, as their school routines have been upended and parents may be stressed. Here are some strategies for parents:

Offer clear, open, regular, and child-centered communication

Accurate information calmly delivered is the antidote to anxiety or panic in a stressful situation. Most children will have noticed people wearing face masks, or dramatic scenes on the news with hospital workers in full protective gear, breathlessly reporting growing numbers of the infected and the deceased. At a minimum, they are being commanded to wash hands and not touch their faces (which is challenging enough for adults!), and probably overhearing conversations about quarantines and contagion. Many children are managing extended school closures and some are even managing the quarantine or serious illness of a loved one. When children overhear frightening news from distressed adults, they are going to become anxious and afraid themselves. Parents should remember to find out what their children have seen, heard, or understand about what is going on, and they should correct misinformation or misunderstandings with clear explanations. They should also find out what their children are curious about. “What has you wondering about that?” is a great response when children have questions, to make sure you get at the matter they are really worried about.

It is also fine to not have an answer to every question or worry. “That’s a great question. Let’s look together at the CDC website…” Offering to look for answers or information together can be a powerful way to model how to handle uncertainty. And always couch your answers with appropriate (not false) reassurance: “Children and young adults appear to be very safe from this illness, but we want to take care to protect those that are older or already sick.”

Part of being child-centered in your communication includes offering information in an age-appropriate manner. Preschool aged children (up to 5) still have magical thinking. They are prone to finding masks and gowns scary, and to assuming that school stopping may be because they did something wrong. Tell them about the new illness and the doctors and officials working hard to keep people safe. Their sense of time is less logical, so you may have to tell them more than once. Reassure them that children do not get very sick from this illness, but they can carry and spread it, like having paint on their hands, so they need to wash their hands often to take good care of other people.

School-age children (roughly from 5-12 years old) are better equipped cognitively to understand the seriousness of this outbreak. They are built to master new situations, but are prone to anxiety as they don’t yet have the emotional maturity to tolerate uncertainty or unfairness. Explain what is known without euphemisms, be truly curious about what their questions are and look for answers together. Often what they need is to see you being calm in the face of uncertainty, bearing the strong feelings that may come, and preserving curiosity and compassion for others. Adolescents will need all of this support, and can also be curious about more abstract implications (political, ethical, financial). Do not be surprised when they ask sophisticated questions, but are still focused on the personal disruptions or sacrifices (a canceled dance or sports event, concerns about academic performance). Adolescence is a time of intense preoccupation with their emerging identity and relationships; it is normal for them to experience events in a way that may seem selfish, especially if it disrupts their time with friends. Offer compassion and validation, while acknowledging that shared sacrifice and discomfort are a part of every individual’s experience when a society must respond to such a large challenge.

Be mindful of your children’s vulnerabilities

Being child-centered goes beyond thinking about their age and developmental stage. You are the experts on your children, and will know about any particular vulnerabilities to the stresses of this serious outbreak. Children who are prone to anxiety or suffer from anxiety disorders may be more prone to silent worry. It is especially important to check in with them often, find out what they know, what they are worried about, and remind them to “never worry alone.” It is also important to continue with any recommended treatment, avoiding accommodation of their anxieties, except when it is required by public health protocols (i.e., staying home from school). Children with developmental disabilities may require additional support to change behaviors (hand washing) and may be more sensitive to changes in routine. And children with learning disabilities or special services in school may require additional support or structure during a prolonged period at home.

Preserve routines and structure

Routines and predictability are important to the sense of stability and well-being of most children (and adults). While disruptions are unavoidable, preserve what routines you can, and establish some new ones. For children who are out of school for several weeks, set up a consistent home routine, with a similar wake-up time and bedtime and “school schedule.” Be sure to preserve time for physical activity and social connections within this new framework. Social time does not require physical proximity, and can happen by screen or phone. Physical activity should be outside if at all possible. Predictability, preserved expectations (academic and otherwise), physical exercise, social connection, and consistent sleep will go a long way in protecting everyone’s ability to manage the disruptions of this epidemic.

Find opportunity in the disruption

Include family time in your new schedule. This disruption is also a rare opportunity to slow down, spend time together, listen, learn more about one another, and even to have fun. You could play board games, card games, watch movies together, or even read aloud. You might discover it is the time to try new hobbies (knitting, a new language, or instrument), or to teach each other new skills. You might learn something new, or something new about your children. You will also offer a model of finding the opportunity in adversity, and even offer them some wonderful memories from a difficult time.

Take care of the vulnerable and ease others’ hardships

Without a doubt, this will be a difficult time for many. One powerful strategy to build resilience in our children and to strengthen our communities is to think with them about ways to help those who are more at-risk or burdened by this challenge. Perhaps they want to make cards or FaceTime calls to older relatives who may be otherwise isolated. They may want to consider ways to support the work of first responders, even just with appreciation. They may want to reach out to elderly neighbors and offer to get groceries or other needed supplies for them. Focusing on the needs of those who are more vulnerable or burdened than ourselves is a powerful way to show our children how communities pull together in a challenging time, to enhance their feeling of connectedness, and to build resilience in them, in our families, and in our communities.

Community Hospital COVID-19 tests

Date: May 25, 2020
Patients tested to date: 965
Positive cases to date: 21
Current positive inpatients: 0

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