3 Years of COVID-19: What now for children’s health and well-being?
Tips for parents to help children recover from the pandemic
It’s been a distressing few years for children in South Asia. The COVID-19 pandemic, climate disasters and rising food prices caused by economic shocks have cast a shadow over the health and well-being of millions of them.
Depression, anxiety, grief, loneliness, the loss of parents and loved ones, missed childhood vaccinations, long COVID, delayed development, difficulties settling back into school and catching up on lost learning. It’s a heartbreaking and overwhelming list.
We caught up with UNICEF health and child protection experts on some of the challenges children might be facing — and how parents can best support them.
Direct to
Depression, anxiety and stress
The last few years have created an extremely challenging environment for children — and feeling upset and worried is a natural response for them to have.
These feelings may have continued for a long time, or even got worse as life has returned to ‘normal’ and children have struggled to adjust.
In South Asia, many children and young people can also find it hard to talk to their parents about mental health because of stigma and generational differences.
If your child is struggling, has lost their appetite, is having trouble sleeping or is anxious, talking with them openly and non-judgmentally about how they are feeling is an important first step to helping them through it.
>> Read one family’s story of helping their child struggling with mental health
"What is depression?"
Depression is one of the most common types of mental health conditions and often develops alongside anxiety.
Depression can show up in children and adolescents as prolonged periods of unhappiness or irritability and loss of interest in regular activities. It is quite common among older children and teenagers, but often goes unrecognized.
Depression can happen as a reaction to something like abuse, violence in school, the death of someone close or family problems like domestic violence or family breakdown. Someone might get depressed after being stressed for a long time. It can also run in the family. Sometimes we may not know why it happens.
"How do I know if my child is depressed?"
All children feel low or down at times, it’s a natural part of growing up. But these emotions can be worrisome when felt intensely over long periods of time, especially if they affect your child’s social, family and school life.
It’s normal and healthy for children to experience a wide range of emotions. But pay attention if your child is regularly expressing that they are feeling sad.
Some common symptoms of depression include:
-
Changes in weight
-
Trouble sleeping or too much sleeping
-
Unusual and persistent sadness or irritability
-
Sudden loss of interest in activities they once enjoyed
-
Withdrawal from others and loneliness
-
Sluggishness
-
Feelings of worthlessness, hopelessness or guilt
-
Thoughts of or attempts at suicide or self-harm
Only a doctor or a mental health professional can diagnose depression. Ask your health-care provider for advice if you are worried about your child.
"How can I help a child who is showing symptoms of depression?"
Depression can be treated and there are things you can do to help your child feel better:
-
Find out what’s happening: Ask your child how they’re feeling and in what situations they feel sad.
-
Listen carefully to what they say about how they feel — without judgment or advice.
-
Never push your child to share, instead, encourage other forms of creative expression like painting, crafts or journaling their thoughts.
-
Ask people you trust and who know your child (like a favourite teacher or close friend), if they’ve noticed anything that might be worrying about your child.
-
Help your child stay engaged throughout the day, with structure and an exciting routine that has a mix of activities — including fun, leisure, play, learning, daily chores and time for family, sleeping and rest.
-
Teach them relaxation exercises, like deep breathing, and practice them together.
-
Encourage positive habits: Help your child stick to regular eating and sleeping habits and stay active. Physical activity and music are both great ways to boost their mood.
-
Protect them from stressful surroundings: Try to keep your child away from situations where they may experience excessive stress, maltreatment or violence.
-
Create an environment of positivity and warmth at home to help your child feel relaxed and supported. Tell them that you love and support them. Try listening to songs together that make them feel positive about life and get involved in their favourite activities with them.
-
Reassure your child as often as possible: Ask how they are doing and encourage them to come to you whenever they are upset. Let them know that you will do your best to help them.
-
Spend quality time with them: Take an interest in your child’s life, (like how their day was at school or what they love most about their friend) and do activities together that they will enjoy. Put your phone and other devices away to minimize distractions and help you be fully present for them.
-
Take care of yourself: If you are happy, it helps your family be happy too.
"When should I seek help for my child’s depression from a mental health professional?"
Depression can be treated and the sooner you speak to an expert, the sooner your child can feel better.
It’s important to know that children and adolescents who experience depression are at greater risk of self-harm and suicide. However, this is preventable when appropriate support is provided.
Seek support from a mental health professional if:
-
Your child is showing symptoms of depression for more than two weeks
-
There is a major change in your child’s sleeping and eating habits
-
Your child talks about, or tries to, run away from home.
Seek help from a mental health professional immediately if:
-
Your child starts to abuse substances/drugs
-
Your child has self-harmed or is having suicidal thoughts and behaviours.
>> More information on depression can be found here
"What is anxiety?"
Anxiety is the feeling you get when you’re worried or scared about something. Small amounts of worry and fear can help keep us safe. But sometimes anxiety can make us feel like things are worse than they are and stop us from doing things we enjoy or living life fully.
Anxious children tend to need constant reassurance from their parents and caregivers. They may also be quiet and eager to please. This means their condition can be easy to miss.
Signs and symptoms of anxiety in children include:
Physical
-
Shortness of breath, headaches or feeling faint
-
A racing heart and sometimes high blood pressure
-
Feeling fidgety, trembling or feeling weak in the legs
-
Feeling sick in your stomach – cramps, diarrhoea or frequent visits to the bathroom
-
Having trouble sleeping or a reduced appetite
-
Dry mouth, excessive sweating or feeling hot.
Emotional and mental
-
Struggling to focus on things
-
Feeling panicky, nervous or on edge
-
Feeling overwhelmed or a sense of dread
-
Feeling out of control in a situation
-
Feeling tired and grumpy.
Be alert to the signs of anxiety so you can seek help and care for your child early if needed. Remember, feelings of anxiety among children are preventable and can be managed.
"How can I help my child cope with anxiety?"
Explore the feeling together: Ask your child to tell you what is happening when they feel anxious. (How do they feel? How long does the feeling last? What might be the reason for feeling anxious?) Remind them that the feeling will pass.
Help them shift their focus to the present moment: You can ask questions like, “What would you like to have for dinner?” or ask them about some of the things they can see and smell around them.
Help them get enough sleep:
Experts recommend
-
Children aged 6-12 have 9-12 hours of sleep a night.
-
Teenagers have 8-10 hours of sleep a night.
Limit their screentime at night to help them sleep better: Consider making their bedroom a device-free zone.
Help them do belly breathing: When we’re anxious we can forget to breathe deeply. Belly (abdominal) breathing is very calming and helps us to draw oxygen deep into our lungs. Here’s an easy 3-step process you can teach your child to do:
-
Place your hand on your stomach
-
Take 5 deep breaths – spend 5 seconds breathing in and 5 seconds breathing out, breathing in through your nose and out through your mouth
-
Explain that when your child inhales, they are blowing up their tummy softly like a balloon, and when they exhale the air is going slowly out of the balloon again.
"When should I seek help for my child’s anxiety from a mental health professional?"
If anxiety is impacting your child’s daily life, speak to your health-care provider about your child’s symptoms and the best options for them.
Your child can also call one of the child helplines (listed above) to speak to a trained counsellor.
>> More information on anxiety and how to support your child
Stress
Children can experience stress when they cannot cope with threatening, difficult or painful situations.
Many things can lead to stress in children – negative situations at home, violence in schools, exams, moving house and changes in the world around them. Even positive changes, like making new friends, can be stressful.
Signs and symptoms of stress in children include:
-
Shallow breathing, sweating and a racing heart
-
Headaches, dizziness and difficulty sleeping
-
Nausea, indigestion or digestive problems
-
Weight gain or loss from eating too much or too little
-
Aches and pains and falling sick more often
-
Irritability, anger and temper outbursts
-
Withdrawing from family and friends
-
Neglecting responsibilities
-
Difficulty concentrating
-
Emotional distress, such as continuously feeling sad or being tearful.
These symptoms can often lead to more stress, so it’s important to help your child find ways to cope with stress as soon as it happens.
The below resources include activities to help you help your child manage stress:
>> Learn more about stress and effective ways to help your child deal with it
Grief
Countless children in South Asia have lost loved ones and parents during the COVID-19 pandemic. And if children have never been exposed to death before, facing loss for the first time can be as confusing as it is upsetting.
There is no ‘correct’ way to grieve, and no specific stages in which different emotions or behaviours should appear.
A child’s reaction to the death of a loved one will vary depending on their age, intellectual ability, previous life experiences and relationship with the person who passed away.
Children under the age of 5
-
Often don’t understand that death is permanent
-
May ask if the person who has died is coming back
-
May become clingier with their caregivers
-
May show some regressive behaviours like wetting the bed. (Regressive behaviours are very common and will usually stop over time.)
Children aged 6 to 11
-
Start to understand that death is forever
-
May worry that other loved ones will die
-
May ask questions and want to understand what happened
-
May show their grief through anger
-
May experience physical aches or pains.
Children and teenagers aged 12 and older
-
Can understand that death is irreversible and happens to everyone, including themselves
-
Are often interested in understanding why things happen
-
Will have varied reactions that can include apathy, anger, and extreme sadness
-
May be unable to concentrate.
Here are some ways you can support children through their grief:
-
Involve children in mourning in any way you find appropriate, and that they feel comfortable with. Mourning helps children come to terms with the death of their loved one, celebrate their life and say goodbye.
-
Hold a commemoration to celebrate the person and their importance to all of you.
-
Find ways for your child to connect to, and show their love for, the person who has passed away. For example, painting a picture or writing a song, letter or poem.
-
If your family is a member of a particular faith, you could contact your spiritual leader for support in explaining the death and providing comfort to you all.
Here’s how you can help children feel better and protect their mental health:
-
Make sure they are getting loving and consistent care (from you, a parent, relative or carer who they trust and know well).
-
Keep life routines and structure as much as you can, with time in the day for activities like schoolwork, exercise and play.
-
Make sure other children in your child’s life know about what has happened, through their teachers or parents, so that they can support your child on their return to school.
-
Help infants and young children feel secure and loved through singing, cuddling and rocking.
-
If children’s behaviour becomes challenging or regressive, do not punish them. It’s their way of showing what they cannot verbalize.
-
Take care of your own physical and mental well-being. You cannot help your child if you are unwell. Get sufficient sleep, eat properly, exercise, take time to relax (for example by listening to music), avoid alcohol and drugs and have someone who you can turn to for emotional support.
>> More information on talking to your child about the death of a loved one
>> More information on how parents can support their child through COVID-19 losses
Long COVID
Fortunately, children have a very low risk of becoming severely unwell from COVID-19. Most children make a full recovery from the virus without showing any symptoms at all.
However, some children have gotten sick, and some have developed long COVID, where they experience symptoms that affect their physical, mental or social well-being for months after a COVID infection.
This can affect their ability to do daily activities like schoolwork or sports. For example, children who used to be actively engaged in sports may now be barely able to make it down the street without taking a break.
There’s still a lot we don’t know about long COVID, including why some children who only experience mild symptoms of COVID-19 go on to develop long COVID. This lack of certainty can be frustrating for children who are suffering from the condition and their parents.
>> Some of the latest research on long COVID in children can be found here
Children and adolescents might have one or several of the following symptoms of long COVID:
-
Getting easily exhausted
-
Constantly feeling tired
-
Anxiety or tightness in the chest
-
Difficulty breathing
-
Difficulty thinking (also known as brain fog)
-
Hair loss
-
Loss of appetite and weight loss (from a loss of smell or taste)
-
Sore muscles
-
Joint pain or swelling
-
Dizziness
-
Skin rashes
-
Diarrhoea
-
Earache or ringing in the ears
-
Insomnia (trouble sleeping)
-
Feeling sick
-
Mood swings
-
A more noticeable or racing heartbeat (heart palpitations)
-
Fever
-
Sensitivity to light
-
Sore eyes or throat
"What treatments are there for children with long COVID?"
If your child is experiencing symptoms of long COVID, it’s important to get them seen by an experienced paediatrician.
Treatment for long COVID is aimed at improving their overall quality of life and is most effective when it addresses each symptom individually.
The evaluation your child receives should depend on their individual symptoms. For example, if your child is having mostly chest pain, they should be sent to a cardiologist for an evaluation. If they are having trouble thinking clearly, they should have an evaluation more focused on neurology.
In most cases, children recover from long COVID within a few months. But for some children, it can take a long time to feel better.
During this time, it’s important that parents keep an eye on their child’s mental health. Mental health problems can creep in and further delay children’s recovery if they’re not properly addressed.
>> More information on long COVID
"How can parents protect their children against long COVID?"
The best way you can protect your children from long COVID is by doing everything you can to avoid getting infected with COVID-19 in the first place. Avoid crowded places, wear a mask when you can’t keep a distance, open doors and windows to improve ventilation indoors and follow the public health guidance where you live.
This includes getting your child vaccinated against COVID-19 when it's available to them. Vaccination helps stop children from getting severely sick from COVID-19 and could also help reduce their risk of getting long COVID.
>> More information on children and COVID-19 vaccination in South Asia
Missed childhood vaccines
Childhood vaccines are the safest way to keep children healthy, happy and protected against many dangerous, but vaccine-preventable, diseases.
When life was disrupted during the pandemic, millions of children in South Asia missed their routine vaccine doses. This has left them at risk of devastating diseases, like polio and measles, that could harm their health for life and even shorten their lives.
There are 22 different childhood vaccines. These vaccines are given to children at different ages and intervals, depending on where you live and the diseases most prevalent in your country.
If you are unsure whether your child has missed any childhood vaccines, check their routine vaccination record and then compare it with your country’s vaccine schedule. You can also contact a health worker for guidance.
>> Learn more about childhood vaccines and what to do if your child might have missed some
Socializing, learning and development
Lockdowns and school closures had a serious impact on children’s development.
Keeping children indoors kept them safe from COVID-19. But it also robbed them of critical experiences that help them develop.
As children navigate life beyond the COVID-19 pandemic, parents should watch out for a few possible scenarios:
-
Children and teens who are overly cautious and fearful
Now that it’s safer to be back in the world, it’s important that children start to return to the normal activities that go with childhood and adolescence.
Urge and support your children to spread their wings. If they're feeling nervous about heading back into the world, remind them that they don't have to do everything all at once. They can take small steps. Remember, avoidance feeds anxiety, especially over time.
Parents may also worry as children return to normal life. Ordinarily, children branch out into the world gradually, making the process more comfortable for parents. It's not easy to go from having your child very close to home to gaining the kind of independence that might be age-appropriate now.
It can help to talk with other parents who raised children the same age as your child before the pandemic. This can reassure you about what 10-year-olds, 13-year-olds and 16-year-olds can be expected to do independently. If you feel confident that your child can manage independently, it also helps to build their confidence that they can do things on their own.
If you are still worried about your child’s development, seek advice from a healthcare professional or talk to your child’s teacher.
-
Children who are struggling to interact with others
Between birth and the age of five, children’s brains grow rapidly, as they develop social, emotional and intellectual skills. These early moments matter. But pandemic restrictions limited opportunities for them, especially for the youngest children.
Some children may be socializing and making up for lost time, but other children’s social skills may still be out of practice. They could be finding it difficult to make friends, build relationships and communicate in a group.
We shouldn't expect children to figure it all out on their own — and you may need to give your child more coaching and role modelling than you’ve had to in the past.
The most important thing you can do is to be very clear with children about how you want them to handle the challenges they run into. For example, if your child grabs a toy from another child, you could say to them, “Of course you want the toy. But here’s how you can ask for it: You say, ‘When you are done with that, can I have a turn?’”.
Don't get frustrated with your child for not always knowing the appropriate ways to interact with others. Continue to play, learn and grow together. The greatest thing you can do for your child is to provide them with love, support and care.
-
Children who have fallen behind in school
Most children had a really difficult time learning during school closures, especially girls, children from low-income households and children with disabilities. Three out of four 10-year-olds in South Asia cannot read a simple sentence, a number that is much higher than before the pandemic.
With children back in the classroom, it’s important to assess and understand where they are in their learning so that teachers and parents can provide tailored support to help them catch them up. This is no easy feat, because the range of what was learned (or not) during school closures — even in a single classroom — was enormous.
To support older children, make sure they are going to school regularly. Keep an eye on how they are doing with their homework and if they have any worries about completing specific tasks. Talk to their teachers about what you’ve observed and make sure your child is getting the support they need to catch up. Give them time and space to spend on their learning and with their fellow students and friends.
If you have a young child, try engaging them with stimulating activities like reading books, telling stories, singing songs, going outside, naming objects, counting or drawing things. These will all help boost their brain development and learning recovery.
It can be hard to see your child struggling in their learning — especially if it’s making them feel anxious and affecting their self-esteem.
Remember, you are the best person to help shape your child’s behaviour, development and choices. Strive to be their best teacher in their life by providing encouragement, support and organising non-classroom-based activities to help them develop, learn and socialize. For example, outdoor sports, picnics, visiting relatives and friends, quizzes and board games.
Remember to look after your mental health too and let your child know it’s OK to fail, it’s all part of learning.
With your support, guidance and love, it’s possible to help children catch up and feel better.
>> More information and resources to help children catch up on their learning
