Study examines children's emotional wellbeing throughout COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was the stimulus for a slew of progressive restrictions on social movement and interactions to break the chain of viral transmission. In the UK, this included closing all preschool children's facilities.

A new study, released as a preprint on the medRxiv* server, reports the effects of such limited interactions on the emotional health of very young children, as reported by closely involved parents.

Background

During the first wave of COVID-19 in England, only about 5% of children attended either school or childcare, with the number rising in June 2020. However, the number was still far from normal.

Earlier studies showed that teachers in schools were worried about the potential adverse impact of such isolation on very young learners, starting school for the first time. Would they be able to communicate, develop language skills, and learn to read and write, as earlier generations of children had? Would they play well with others, form teams and develop strong relationships with those other than their primary caregivers?

The context of the postulated deprivation of these socially learned skills in preschool children is also important, since parents are often stressed out with the loss of employment, childcare and opportunities for socialization following the pandemic-related restrictions. Stress in the parents is linked to poor parenting and a decreased quality of family life, and most importantly, less responsive care of their children, which in turn impacts the child's development.

Some studies reported a higher persistence of emotional and behavioral problems with children older than two years in the pandemic period, though the extent to which this is simply due to greater opportunities to observe the children.

How was the study done?

The current paper reports a more detailed study of these issues and the coping measures adopted by these families. The aim is to understand these experiences so as to offer proper support and guide appropriate decisions in future pandemics.

Using the nurturing lens to look at the child-parent relationship in this pandemic, the researchers focused on the formation of attachment between the children and other people other than the primary caregivers. Nurturing is based on attachment theory that considers the relationship between child and primary caregiver as the foundation of a warm and responsive relationship with others thereafter. Such relationships are considered to be essential to providing support to children in difficult times.

Most participants were mothers, and at least one parent was at home without work during the lockdown period.

What were the findings?

With the onset of these restrictions, preschool children were faced with not being able to go out to play or to do any public activity, but without the means of understanding why.

Explanations would have to include the nature of the virus, its spread and the containment measures. These explanations, as well as the sudden change in daily routines and perhaps in lifestyles, could cause children to feel anxious and even frustrated.

A prescribed change in behavior within traditionally close relationships such as those with grandparents and friends could also breed sadness, enhanced by the lack of understanding.  

Some parents said their children reacted well to the increased time spent at home with their immediate family, with security and happiness being the immediate outcomes. The change in the time spent with the family was described as being a little more, indicating that these families were already close before the lockdown.

Transitioning to school

One mother thought it was "not healthy being around each other all the time" and looked forward to the start of primary school when the child would be away from her for some time. Other parents also looked forward to school as an expected change, with attendant changes in their family routine.

Some parents were apprehensive about the coming change because the lockdown prevented their garnering much information about the school; in other cases, the schools communicated virtually, relieving much anxiety. However, the lack of personal visits at school to introduce the child to the new environment was felt keenly.

Behavioral and sleep changes

Other parents observed negative changes in their children's behavior during this period of restriction, such as temper tantrums and anxiety, unpredictable activities, and sadness. Mostly, these were attributed to not having enough opportunities to play, be with their loved ones and friends, fear about the unknown virus, and the lack of stimulation.

Sleep issues were reported in half the cases, especially falling asleep. Boredom, lack of physical play, anxiety, and more time spent watching screens, were the chief causes, according to parents. One parent perceived a benefit from lockdown, which gave her time to set and carry out a bedtime routine. She had not had time to put the child to bed at a regular time before, when she was working.

Loss of routines

New routines in the absence of school were difficult for parents to conceive and execute alone, and this led to increased use of technology by children to connect with their friends. While this was introduced by the parents, it was not always productive, with the children perceiving its inadequacy relative to personal interactions.

What are the implications?

Overall, the parents in this study were trying to explain the changes in their lives because of COVID-19 to their children, and to keep things running as well as possible so the child would still keep up relationships with friends and extended family. They also tried to understand why the child's behavior was showing changes, whether positive or negative.

Moreover, they singlehandedly tried to smooth these changes for the children. They looked forward to school in most cases and felt their children were prepared for the t transition. However, some earlier studies on teachers reveal that this group harbors fears about the loss of life and learning skills, especially for children from a deprived background or those with special needs.

Some families said the lockdown had helped them to bond, corroborating earlier UK studies that the pandemic had allowed families more time together with beneficial effects on closeness.

Changes in household routines were the most demanding, since parents were largely left alone. Though this study was conducted in the first wave of the pandemic, repeated restrictions had to be imposed as case rates moved up. However, even as most children continued to face remote learning, centers for preschoolers and primary schools did not close down for the rest of the year.

This study was obviously biased towards nurturing educated parents, and with struggling parents, the findings could be quite different. Leaving out hypothetical considerations, the study shows that with resilience and love, parents were able to recognize and respond to the concerns of their children during the lockdowns.

Some areas of concern remain, however, when it comes to parents with mental issues, and abusive caregivers, since child deaths have increased by 30% to 119% compared to the previous year. Financial instability as a contributing factor to parental stress and consequent child care was not explored in this study, but should be the focus of future research.

Such studies may shape parent support measures in future restrictions, especially as things move back to normal over the long term.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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