In this unprecedented time of history, what guidance do we offer to the parents and caregivers of the children in our care? The first thing we all have to remember is, like in an emergency on an airplane, parents need to put the oxygen mask on themselves first, then their children. One size will not fit all and nobody has a map so we all need to be flexible and do the best we can. Secondly, families need to create a routine that works for the unique needs of their family members, bearing in mind the well-being of the parents as well as the children. This routine planning will inevitably take some improvisational trial and error. Don’t be afraid to adjust as you learn what works and what doesn’t work for your family.
General recommendation for parents:
1. Convey a sense of safety.
Questions of safety are big questions for children and adolescents, especially so for younger children. Reassuring kids that they are safe physically and emotionally, and that their parents and loved ones are safe is essential. This is why it is so important for parents to keep their own emotions in check as much as possible. Emotions can be contagious and creating a calm, safe environment starts with the adults. Although social distancing outside the family is paramount, hugging and touching does not need to stop inside the home. Physical contact between parents and children helps to maintain a safe and supportive environment.
2. Maintain “good enough” child and family routines
Keep routines in place as much as possible and encourage healthy habits. This will contribute to a sense of safety. Good elements of a family routine include getting adequate sleep, eating regular meals together, and making time for exercise. A routine makes the day more predictable. This predictability is helpful for all kids, and crucial for younger or anxious children. Most children will have ongoing school responsibilities and time for these school activities should be scheduled and maintained. Creating written (or pictorial) schedules may be helpful for children and adolescents. Visual prompts, verbal reminders, and timers can be very useful for times of transition for those children who find this challenging.
3. Get outside.
Going outdoors is essential physically and emotionally for parents and children. This can be a good opportunity for talking and listening as well. Ideally, children should get outside every day for at least 30 minutes. Indoor physical activity on rainy days can also be helpful.
4. Sleep is crucial.
Maintain regular bedtime routines and habits. For many children and families this will mean continuing to use the same bedtime as before, while other families may find it helpful to shift bedtimes and wake times to accommodate the needs of the entire family (e.g. to allow parents enough sleep). Total sleep time should remain the same and getting up should be about the same as during the regular school year. Flexibility on the timing for some (e.g. adolescents) may be appropriate but all with the understanding that everyone in the house needs as much (or more sleep) during the COVID crisis.
5. Make “rest time” for kids and adults.
Everyone needs down time and some of this should occur ideally during the day. Designating a time for this (e.g. 3-4 PM) will work for many families. This can also be a time to encourage children to occupy themselves and be more independent.
6. Create opportunities for new shared activities.
This time may be ripe for adding activities to the routine. If family dinners are not already a regular routine this is a great time to start. Family games, arts and crafts, cooking, baking, or yoga are great options to keep your child occupied. These activities can also limit the amount of screen time children are exposed to. Family time can be a time where children can plan for things that they can look forward to and shift their quarantine to a positive mindset while looking forward to new activities each day. Each family member may have a role to play to be sure one individual does not get overwhelmed.
7. Create opportunities for new shared activities.
Information overload is rampant and it is not advisable to keep the news on while children are in earshot as this can provoke anxiety in both parents and children. Social media is also a place requiring parental monitoring as there can be posts that feed anxiety with panic inducing or even false information. Using the provided resources below to control the narrative surrounding the pandemic and to explain what is going on in a developmentally appropriate way is useful so that children know what to expect, but do not expect the worst.
8. Listen and talk with your children and adolescents.
It is especially important during this crisis to remain engaged with your kids and to ask how they are feeling. The National Child Traumatic Stress Network has a helpful chart to identify how different aged children may react to overwhelming feelings amid this pandemic. Project TEACH and the MGH Clay Center for Young Healthy Minds also have good guidance on approaching this with your children.
9. Stay in touch.
Keep in touch with friends, family and loved ones. Facetime, skype, and other similar video chatting apps may be the only way for children and adolescents to keep up with their friends. Staying in touch with grandparents and other extended family in some manner is crucial for children and families, and promotes a sense of safety and continuity.
Project TEACH Child and Adolescent Psychiatrists are available through the Project TEACH warm lines to provide guidance on assessment of a children’s and adolescents’ mental health symptoms and evidence-based treatment during the COVID-19 pandemic.
By David Kaye, MD, Project TEACH Project Director, Regions 1 and 3, and Vice Chair for Academic Affairs and Professor of Psychiatry at the University of Buffalo, and Amber Parden, MD, University of Buffalo