In our ongoing series of interviews with McGill experts on COVID-19 issues, Tina Montreuil looks at the impact the COVID-19 pandemic on children’s mental health. She also discusses how to recognize if your children are feeling stress and the steps you can take to help them better cope with the situation.
Tina Montreuil is an Assistant Professor in the Department of Educational and Counselling Psychology and an associate member of the Department of Psychiatry. Her research focuses on investigating the role of emotion regulation, attitudes, and beliefs on the development and intergenerational transmission of psychopathology and how symptoms of mental health problems might interfere with self-regulated learning in a group context and ultimately, educational achievement.
How is COVID-19 impacting our children’s mental health?
Stress is definitely the aftermath of COVID-19, as such, anxiety is very much a normal emotional reaction to current events surrounding the pandemic.
However, stress does not necessarily affect all children or adults in the same way. Some people are more reactive to stress and, more importantly, may react more negatively than others to the stress resulting from much of the uncertainty surrounding COVID-19.
COVID-19 may affect children through several pathways, from routine disruption, unmet educational or academic needs, social isolation, fears, uncertainties or concerns over wellbeing of self and family, as well as by observing their parents not managing their own stress and anxiety in an adaptive and helpful way.
How does stress manifest itself in children and teens? What signs should we be looking for?
Stress can manifest itself in many ways. It can affect a child’s ability to stay focused and concentrated; it can impact their appetite, quality and quantity of sleep and be underlying to a child’s fussiness, irritability and neediness (i.e., clinginess in babies and younger children). In adolescents, it can be associated to a change in mood and affect as well as in greater social isolation and withdrawal.
We are not looking for, or paying attention to, subtle changes in behaviours, which are to be expected. We are more concerned about important changes that disrupt or interfere with normal/usual functioning. More importantly, these difficulties do not solely affect the child/adolescent, but also the entire family unit; such as having to change our routine or usual schedule, or in an increase in conflicts or a change in family climate.
What are the short- and long-term implications of extended periods of anxiety in children and teens?
In the short term, anxiety can appear to be somewhat manageable. However, if left untreated, it can, in some cases, worsen over time. Parents who are not well informed about how to best treat anxiety can sometimes have good intentions, yet reinforce their child/teens’s anxiety by encouraging avoidant behaviours without realizing it. The intent in offering reassurance is well-intended as the parent seeks to comfort and reduce their child/teen’s distress to maintain a certain level of cohesion.
This may appear harmless at first, but over time, whatever used to reassure or appease the psychological and emotional distress tends to fade and is no longer sufficient or as effective in managing anxiety. Reassurance offers immediate comfort, but does not contribute to long-term benefits.
The long-term effect of anxiety is that it may become more chronic, intensify, or generalize to other types of fears or concerns. This can lead to more important individual, interpersonal and familial constraints that were mentioned earlier.
My child has grown increasingly anxious at night and, for the first time, has trouble going to sleep and staying asleep. Is this commonplace during periods of stress and uncertainty?
A change in sleep hygiene can definitely be an area where anxiety’s insidious effect is observed. It is important for the parent to understand what is primarily the source or cause of worry so that this may be addressed. For example, if a child/teen does not want to go outside for fear of contamination, it is important not to reinforce the fear by encouraging avoidance of the feared situation. One way to encourage facing that fear and go out is to help the child/teen reappraise/reevaluate the likelihood of contamination if precaution measures are respected.
It is also important to consider how long the difficulties surrounding sleep have been present in order to determine whether the inability to fall asleep or stay asleep is not itself enmeshed in the anxiety – “becoming anxious about not being able to sleep because I’m anxious.”
One of the main reasons why sleep or difficulty sleeping is often impacted by anxiety and worry lies in the fact that our brain slows down when we are about to fall asleep – giving rise to racing thoughts or rumination.
It is therefore, essential, beyond therapeutic techniques to prepare our children’s brain for sleep and that means limiting visual or auditory stimulation as much as possible minimally for an hour prior to bedtime. This is especially relevant for our teens where as parents we must psychoeducate them on the importance of limiting screen time or gaming before going to bed.
These can be replaced by reading an actual printed book, listening to relaxing music, taking a bath, or spending time talking and connecting with a parent or sibling. For our little ones, having a set or consistent bedtime routine that includes some “self-care” and soothing activities such as bath, cuddles and story time can provide the warmth and security/structure that will reduce uncertainty and have a calming effect on the brain.
How do we help mitigate their overall stress and worry?
“The apple doesn’t fall far from the tree.” This means that a worried parent is more likely to have a worried child/teen. As such, one of the first step in assisting our children in better managing stress is taking care of our own emotional wellbeing as parents.
It is increasingly more important for parents to carve time for things they enjoy, activities that relaxes/calms them and provide a healthy escape – in light of the fact that since COVID-19, our personal life has been “invaded” by the professional domain.
Another way we can help mitigate our children’s stress and worry is by modelling coping skills. The better the parent copes with anxiety, the more likely our children will be able to learn vicariously through those actions.
Another very effective way to teach these skills to our children is to read targeted and age-appropriate books that provide an educational opportunity to explain, normalize and provide tools to manage worry and stress. Additionally, reading with our kids can provide an opportunity to help them ease into their bedtime routine and foster connectedness through shared discussions.
With our adolescents, talking with them about their stress and worry, sharing tips and strategies that work for us and perhaps starting an at-home book club using a self-help book can be a great way to develop essential skills in improving stress tolerance.
Finally, if we have tried all of these strategies and recommendations and your child and family is still struggling, it is very acceptable to seek professional help. Just as if we would not hesitate to consult a pediatrician if our child had a physical condition that was not improving, psychologists specializing in child and adolescent mental health are available and ready to assist you.
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Our radio is on all day long, and there are always updates on the situation. Is this OK or should we limit our child’s exposure to media?
Media exposure in all its forms (printed, digital or radio) should be consumed in moderation. Although the media has the potential to inform and educate us on the most up to date news and sanitary measures to protect us from the pandemic, there is such a thing as “too much of a good thing.” We also know that some news outlet can at times be alarmist and fuel anxiety even in the most resilient person.
On the other end of the spectrum, avoidance of media is also not recommended since, as mentioned earlier, it can maintain anxiety and only offer temporary relief.
Just as with any other activity in our schedule or routine, it is best to determine specific time during the day where these news sources will be accessed in order to keep that balance and maintain a healthy mindset, essential to go about our daily lives.
How much should talk about COVID-19 to our children? What is an appropriate age to talk to my kids about COVID-19? How do we respond to their questions about the situation without increasing their anxiety?
I think it is critical that we do not conceal or deceive our kids by not speaking about COVID-19 truthfully. It is important to adjust the extent of what we share (i.e., death toll, global aspect of the pandemic, etc.) to the age of our children.
Similarly, it is critical to model good emotion regulation and anxiety management to our children in order to avoid shifting our own anxieties and worries unto them. As such, when speaking about the impact of COVID-19 to our children, it is critical, as in with any stress-provoking events, to present a balanced perspective of the situation. In other words, we must make an effort to rely on facts, and speak in a way that is solution-oriented and hopeful.
Living through the COVID-19 pandemic is an “accidental” or “forced” opportunity to model resilience to our children and teach them that uncertainty can be something that we harness and become more tolerant of, if we settle into the right mindset.
How important is routine in a child’s day during this period of uncertainty?
Routine is critical with younger children. With older kids, scheduling and structure is just as important to manage deadlines and avoid unnecessary sources of anxiety. A routine creates a sense of security because it reduces the incidence of unpredictability. A routine also instills a sense of control as we able to react and adjust to our environment by “knowing and being aware” of what is coming or expected.
For children and adolescents alike, including them in establishing and implementing the routine is essential in confidence building and as such empowering them.
In periods of uncertainty such as the current pandemic, it is easier to fall short of our usual routine, but essential in managing stress given that stress reactivity relies heavily on predictability and controllability of events. The less control is perceived and the greater the unpredictability, the more susceptible we are to react negatively.
Establishing a routine helps appease some of the intolerance to uncertainty by controlling what we have the ability to control. Then comes the value of acceptance as being able to admit what we cannot control everything, tolerating uncertainty only makes us more resilient in the face of adversity.
What are some activities that parents can do that will help their children focus on something other than the COVID-19 pandemic?
In our parenting groups, we talk about the importance of connecting with children, and there is no doubt that the importance of warmth and connection is an essential component of coping with the stress related to COVID-19. Families that were already operating on connectedness with their children prior to the pandemic, most likely had a greater ability to ease into COVID-19.
On the other hand, working from home with our children during this time is also providing us with the opportunity to foster this connectedness. It is important during this time to keep a set routine as previously discussed, and not fall into the “holiday break syndrome,” while exercising some level of flexibility given that many of us are working remotely with young children at home. We have to set realistic expectations given that most of us will not be able to keep up the same volume of work as we once did while our children were in school or daycare.
Additionally, it is important to maintain a work-life balance more than ever given that we are now sharing our home with our place of work. As such, making space in our routine for morning or afternoon walks, treasure hunts in our backyard or science experiments in our kitchen sink are very important in helping our children focus on life beyond COVID-19.
More importantly, as we have addressed the topic of self-care earlier, parents have to “put on their own mask” (not in the literal sense), and reserve time to look after their own wellbeing and that of their partner to promote emotional availability; especially when juggling working from home, homeschooling and childcare.
How do I avoid letting the tablet become an ‘electronic babysitter’ while I work from home?
Just as with any other activity, it is essential to try to schedule screen time as part of the child’s routine. As such, over time, the child will make fewer random requests given that we are limiting uncertainty about whether and when the use of the tablet is permitted.
Moreover, it is important to set viewing time using a visual timer for example for younger to children or provide them with sporadic feedback on how much time is left, in an attempt to ease into the transition leading to the end of the tablet session.
Finally, given that we currently have to juggle working from home while caring for young children, we must exercise a certain level of cognitive flexibility and more importantly, adjust our expectations. We cannot expect to be on one hand as productive at home looking after children, and being rigid on-screen time.
There exists a trade-off: spending increased time with children, and having to adjust our expectations that we might not be as productive while they are awake or trying to maintain a similar level of productivity as pre-COVID and being forced into a certain increase in screen time. It comes down to what we value most and what financial / occupational constraints we might be faced with.
Putting aside judgment over whether we are good parents or not, if a reasonable increase in screen time permits us to get work done and be less anxious, this is probably emotionally healthier than a rise in stressful and conflictual interactions.
When it comes to adolescents, we must keep in mind that they find themselves in a developmental period where social connection is increasingly important. As such, screen time becomes their only mean by which to connect with their peers. Again, it is important to psychoeducate, to instill the sense of balance between engagement in various activities, screen time being one amongst many and model as parents, healthy and balanced use of technological devices.
Any tips or tricks to promote handwashing?
Two critical aspects to consider in promoting handwashing are psychoeducation/information on the purpose and benefits of handwashing, and modelling handwashing to our children / teens as parents.
The Health Ministry has created and made available on their website, colourful visual cartoon-like handouts for parents to read with their children on what is COVID-19 and viruses more generally, why it is important to wash our hands and protect ourselves against viruses, and how we can effectively perform handwashing.
Establishing a clear routine early on (i.e., three steps for hygiene when coming back from outdoors), with the support of visual posters and sticker/token charts for the little ones can be quite effective.
With our older kids, the worst thing that we resort to is lecturing our teens when they fail to meet our standards. One way of again increasing their engagement towards such sanitary practices is to share “evidence-based” information with them, engage in a conversation on what is getting in the way of them being observant of these practices and speaking about what could realistically take place, the risks, if good hygiene is not implemented.
Reminding our children that we ask them to wash their hands because we love them and want to keep them safe as opposed to controlling what they do, is essential.
Lastly, I cannot speak enough about the importance of modelling and setting the example for our children. As I keep exercising with my own children, it is not only what you say that matters, but what you do.