As mental health professionals, we are focused these days on supporting all children and parents in coping with the COVID-19 virus health crisis. However, children differ in their characteristics, in the number of adverse experiences while growing up, in the way they are coping with stress and the availability of support they have.

Children who are more vulnerable

In addition to age and developmental status, children’s response to the crisis is also related to their personality traits and their way of experiencing the world around them. Some have more fears, some less, some are prone to worry and anxiety, some not. When children tell us about their internal world, they simply say it is fear, and adults see such children as those who are constantly more concerned than others. Furthermore, children`s reactions in crisis are under influence of the child’s stress and traumatic experiences (e.g. exposure to abuse, domestic and non-domestic violence, frightening events, illness and loss of loved ones…), the stress of those close to them, as well as current stressful life events (e.g. parental divorce, conflicts, change of school or residence, etc.). Because of everything they have experienced or are experiencing, these children most often express anxiety and are more vulnerable to the current crisis, considering the fact they have previously experienced uncertainty and perceived the „world as not a safe place”. Therefore, it is important that adult support is aligned with their increased needs. And let us not forget, children with such experiences are around us at the moment, and they need us.

The difference between anxiety and fear

From the mental health perspective, this is a group of children who most often have anxiety symptoms, who have fears or worries that affect their thoughts and bodily sensations… Anxiety in general is an unspecified and unpleasant feeling of fear or worry, concern that affects both thoughts and experiences in the body. When describing bodily reactions, a child may talk about stomach aches headaches, heart palpitations, pain, without such problems having an organic basis in their physical health. Unlike fear, where the source of the fear is clear, the threat an anxious child experiences is less clear, lasts longer and has a greater impact on the overall condition of the child. This is why they turn to us for help, because children alone cannot overcome such a period.

Anxious children need more elaborated support

In the current coronavirus-related situation, a milder level of anxiety is not only possible, but expected. However, with considerable empathy and responsibility, we want to highlight those children who have a constant tendency to experience unfamiliar situations as dangerous or threatening, and to react more intensely. These are the children we meet in our clinical practice and that is why we think about them these days. Additional support is now very important for parents and family members as well, especially if direct professional support is not available at the moment, due to coronavirus-related restrictions. In addition to the health guidelines that are accessible to everyone, it is important to note that anxious children need more elaborated support, so that their difficulties would not aggravate in this situation. However, if parental or adult support for more intense anxiety difficulties is not sufficient, it is important to seek professional help and an individualized support and/or treatment plan.

On the other hand, we know that family is the most common source of support, but also the most common source of risk. Therefore, in the current crisis, no matter where we are, let us not forget to react if we continue to perceive risks to some children and if protection measures are needed.

What can you do to support children with anxiety reactions?

Whether you are a parent or a caregiver (foster parent, children`s home professional…), what can you do to support children with anxiety reactions that you perceive as their characteristics or as consequences of previous adverse childhood experiences?

1. As a parent/adult, be a role model to children, because your way of communicating and calmness is the clearest message to children. It is important that you are aware of your own reactions. Children are sensible to your anxiety, even when you do not show it openly or think it is not visible. Apply whatever calms you, to be a model of self-calming for children. Anxious children are extremely susceptible to emotional messages. Don’t pretend you are never concerned or distressed, but let the child see how you handle it as calmly (as much as you can) and how good does it feel when you manage it.

2. Maintain some form of routine as much as possible. Help children establish a routine even when they do not go to school, as daily structure reduces anxiety. However, be sure to avoid more intense pressure on children in this situation, that would be greater than in their usual daily life routine. This is important as children with anxiety difficulties are often perfectionists. While maintaining structure, keep in mind healthy habits, exercising, eating, getting enough rest, sleeping, but also leisure and play time, lots of play. You may need to consult with your child’s therapist what is good for your child and develop an individual plan.

3. Listen to the child, his or her concerns, fears and questions related to coronavirus. It is possible that s/he will worry about what may happen to them, family and close people. Even if you are asking questions, try to listen with empathy and show understanding.

4. It is possible that the current situation reminded the child of earlier difficult events, previous separation experiences, as well as fears and losses. Try to be, as much as you can, a source of safety for the child, repeat that you are there for him/ her, show understanding for these reminders, ask the child what would help him/ her. Remind the child of his/ her strength or trait that was of help previously, and of people who were supportive. Anticipate situations that might remind the child of previous experiences or trigger it, and stay close by.

5. Acknowledge the feelings of the child, do not diminish or reject them, do not joke about reactions children might have. You can tell the child that similar feelings and reminders are shared by other children and adults, that it is expected and “normal”. This process is called “normalization” and it helps both children and adults. Adults often think that acknowledging the child’s feelings can reinforce the symptoms. However, on the contrary, it means that we recognize and understand them as part of human experience. When we accept the child’s feelings, children feel that we understand them, they will be calmer and more willing to express themselves. Children whose parents/ caregivers do not show understanding and recognition of feelings, may be confused to understand what they are feeling, have lower self-esteem and, in the long run, it can disrupt relationship with their parents.

6. Do not try to eliminate anxiety – help your child cope with it, like along a wave that will pass. Do not try to change or redirect your child “not to be so anxious.” Help the child to talk about how he or she feels, instead of avoiding it. Expressing in words facilitates processing emotions and experiences. And again, let us remember that normalization helps: “Yes, that is how other children and adults feel in these situations as well.” It helps to support the child in tolerating anxiety as much as he or she can, as it will decrease over time.

7. While talking to the child, focus on facts and knowledge. Children can hear about coronavirus outside the family and in a variety of other situations. Be proactive and explain to the child what you know about the virus, of course, from valid and confirmed sources, in a way adjusted to the child’s age and developmental level. Communicate positive, but realistic expectations. Do not promise the child that something will not happen, but express trust that the child will be able to handle the situation whatever happens and that you are there for the child.

8. Try not to ask questions all the time. Encourage the child to talk about feelings, but avoid constant questioning, e.g. “Are you afraid something is going to happen to your grandmother?” Rather just listen to the child, with open-ended question as „How is it for you, not going to school? “ Make sure you do not reinforce child`s fear and concern. Avoid suggestion by voice, words, body movements, such as “Uh, this is something that might scare you …”

9. Practice relaxing activities. Assist the child with self-calming. These can be some breathing techniques, specific activities that a child has learned during school group activities, training or psychological treatment, but also other activities that might relax the child (listening to music, reading, playing …). Ask the child if you do not know what is relaxing for him or her, help children choose their own calming methods. Some children can do this with words and conversation, others through the activity they love, others through soothing, hugging and comfort.

10. Limit the exposure to the media and constant information about the virus, helping children regulate their anxiety. The younger the child is, the more important this advice is. However, parenting is also important for adolescents, to help them deal with potentially confusing and frightening information.

11. Observe your child to see if your child’s anxiety reactions increase or strengthen, consult with a mental health professional who knows your child.

Be gentle, patient and compassionate with yourself and your child during this period. Show acceptance, give your child warmth and understanding. You need it all as well, it is not just words, it is called support – day by day.

Written by: Assist. prof. Bruna Profaca, PhD, Clinical Psychologist

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