Supporting Children’s Well-Being in a Pandemic

In the early days of the lockdown, I took to going up to the terrace of the building I live in to spend a few hours under the open sky. Invariably, I’d meet Kristen, my 11-year-old neighbour who would accompany her parents on rooftop walks. On one occasion, mid-sentence, she darted off to one corner of the terrace, shouting back a greeting and waving at her friend, also on a terrace two buildings away. There was much excitement at the sighting. Over the next few weeks, this became a repeated occurrence.

In past summers, Kristen wasn’t to be found anywhere near her home. Holidays were spent outdoors with friends in the neighbourhood. ‘We’d normally play football, cricket, go cycling, go for walks, simple activities that we’d really enjoy. Then I’d come back home, eat dinner, bathe, sleep. But the main part of my life in my house was just me sleeping and eating,’ she says, laughing. With the lockdown and social distancing norms brought on by the COVID-19 pandemic, the tenor of her days has changed. Largely confined indoors and cut off from sharing any physical space with her peers and schoolmates, she has questions about when she can step out into the world again: ‘When will this end? Are we at the worst part of the pandemic yet? Or is it going to get worse? When is the next time I can actually leave my house? When will the risk be so low that I can actually go out and be like – I’m free!’

COVID-19 and the impact on children

Kristen is not alone in her experience of uncertainty about what to expect in days to come and in voicing her frustration about the same. While the virus seems to be sparing most children from the worst of its effects, they are not immune to the stress of living in the middle of a pandemic — particularly since it has upended routines and the day-to-day rhythms of their lives. Fear, anxiety and high levels of parental stress coupled with confinement-related distress, disruption in schedules and isolation from peers has affected children across ages. Add to this the socio-economic impacts on families and those already living in vulnerable situations, and the effects are compounded.

While research is still underway on how the pandemic is affecting children’s mental health, a study published in JAMA Paediatrics from Hubei province in China found that of the 2,330 children surveyed, 22.6% reported depressive symptoms while 18.9% were experiencing anxiety. The study also found that physical activity of children had declined by 7.3 hours per week while screen time had increased by 30 hours per week compared to before the pandemic. These findings were shared in April 2020 after children had been in lockdown for an average of 33.7 days.

India has already been in lockdown for over three times that duration. With more than 1/3rd of India’s population under the age of 18, the impact of the pandemic on the mental health and well being of children cannot be ignored. In another study on the psychological effect of COVID-19 from Italy and Spain, 85.7% of parents observed changes in children, like difficulty in concentrating (76.6%), irritability (39%), restlessness (38.8%) and nervousness (38%).

What makes children more vulnerable is their difficulty in communicating their feelings coupled with a limited understanding of the crisis and coping strategies. Dr. Jehanzeb Baldiwala, Director of Mental Health Services at Ummeed Child Development Centre in Mumbai, says,

We’re hearing a lot around adjusting to a new way of being. For a lot of the young people, there’s grappling with when are things going to become okay? Initially, there was an intense feeling of wanting to know, to just telling yourself that it’s going to be a month or two months and now I see more and more are reaching a space where they’re feeling this is never-ending. So there’s a lot of fear and anxiety, of course, and a sense of being low, disconnected, and isolated.

As this parallel crisis unfolds, it has become more urgent for parents and caregivers to recognise signs of distress and respond to children’s needs. Drawing attention to this, in April 2020, the UN released a statement by Secretary-General Antonio Guterres on the risks children face and made an appeal to ‘protect our children and safeguard their well-being.’ A policy brief released alongside stated the importance of ‘providing practical support to parents and caregivers, including how to talk about the pandemic with children, how to manage their own mental health and the mental health of their children.’

Unpacking children’s well-being

The Cambridge dictionary defines well-being as ‘the state of feeling healthy and happy’. It’s a word used in common parlance to describe subjective feelings and experiences linked to the fulfilment of desires. In the context of children’s well-being, it’s a subject that has been well researched since the 90s. By the mid-2000s, a multidimensional approach gained emphasis, which included mapping mental/psychological, physical and social dimensions. Researchers Ben-Arieh and Frønes in 2007 added factors like economic conditions, peer relations, political rights and opportunities for the development of a child – in essence, situating a child’s experience in the context and environment they live in.

As the Organisation for Economic Cooperation and Development (OECD) states in its 2015 report, How’s Life: Measuring Well Being: ‘the relevant dimensions of child well-being should relate to aspects of children’s lives that are intrinsically valuable to children today and that might impact on their future’. In this context, any response to the pandemic’s impact on children has to take into account how children are experiencing well-being in the ‘here and now’. Or as Ben-Arieh and the co-authors of the Handbook of Child Well-Being put it, ‘Children’s well-being is rooted in the interplay of a series of factors on the micro-level, framed by the social structures of the wider society.’ It resonates with psychologist Urie Bronfenbrenner’s 1979 Ecological Systems Theory of Child Development which maps the different interactions and systems with whom the child engages, thereby influencing a child’s development. The child is placed at the centre in this system, around which are concentric circles representing multiple systems — family and peers, institutions like school and healthcare, and policies and cultural systems — that affect the well-being of the child.

This approach reflects what Dr. Baldiwala emphasised in her work — ‘locating the problems, concerns and difficulties that people are experiencing in a context that they’re living in. We don’t believe that people are their problems but that problems really exist in systems, and that people are always responding to this.’ It’s why any response to a child’s distress or anxiety has to be understood in the context of their environment and circumstances because thoughts, emotions and body responses are part of the larger social context. At this moment, that means acknowledging that we are all living in the middle of a pandemic and even if its effects don’t always feel immediate, families and children’s emotional and behavioural states are affected by it.

Recognising warning signs of distress

Since the lockdown was imposed five months ago in India, Bengaluru-based entrepreneur, Sophia Philips, parent to 7-year old Ritwin, has been grappling with her son’s response to being forced to stay indoors.

I keep wondering what long term effect this isolation will have. Ritwin is a very outdoorsy person and naturally, he was very agitated and kept wanting to go out to play. I can see him already being sad, gloomy. I see random shifts in his behaviour where he is crying one moment, weeping, throwing a lot of tantrums, and one of the most important things is that he feels that his friends who are continuing to play outside, will forget him when he gets out after the pandemic.

It’s an experience common to other parents as well. For Kevin Saldanha, father of two children, it was a physical reaction to stress he observed in his 15-year old son: ‘He gets skin allergies under stress, so I could see that manifesting itself that way.’

Dr. Baldiwala shared that there are multiple warning signs of distress parents and caregivers should keep an eye out for:

Sleep, appetite – those things I would look out for. But also if you’re finding change in emotional responses like the child growing very quiet or having outbursts. Like everybody’s a little more irritable and those things, but I think if you’re seeing it consistently over a period of time that the child is expressing irritability or is crying a lot, then I would be a little bit more concerned.

Another issue that has come up for many parents is how to talk to children to explain what the situation is in a way that acknowledges the uncertainty of this time, but without exacerbating a child’s anxiety. Philips, for instance, said she was concerned about consciously treading this line with her son,

To make him understand how serious this pandemic situation is we kept trying to tell him about how people are dying, how they can’t get medicines. Then suddenly it occurred to us – how does information impact him? Will he be scared? Will he be worried? Will he be thinking of or get preoccupied with the concept of death?

For each child, based on the networks and systems that affect them depending on where they live, their socio-economic conditions, and the resources and support they have access to, the responses to the pandemic vary. Paying attention to warning signs and creating room to acknowledge it is a big step in the direction of creating spaces for children’s experiences to be seen and heard.

Building resilience and well-being

We’re all living in a moment in time that is in many ways different from past occurrences of community trauma, like natural disasters. This time, the threat is invisible and in that, it can feel ambiguous. This is why a starting point is to acknowledge that the uncertainty is stressful, and that all the kinds of reactions it’s evoking are normal.

Dr. Baldiwala says,

One of the things that I think is helpful overall is for all of us to just lower our expectations — from ourselves, from our kids, from our schools, from our teachers, because there is a pandemic. So for us to pretend like we can all just keep racing on and being productive is ridiculous.

Chennai-based Divya Badami-Rao, a parent to two boys, a 4-year old and a 7-year old, has been practising this through her own learnings and observations of what her boys need.

Children are capable of a lot by themselves and learning a lot by themselves as long as you let them explore things that they want to explore, in the way in which they want to explore. These are the kinds of freedom that we need to be giving our children just now. It’s an opportunity to know your children for who they are and not for what curriculums are teaching them.

This letting go, in the true sense of the word, and allowing for so-called ‘unproductive’ time is something that makes room for children to express what they are feeling, whether it’s verbally or non-verbally. Saldanha chose a similar route with his daughter, Kristen, an active and high energy 11-year-old. ‘With her in the beginning it was how do we keep her engaged? She loves sleeping so that was a no brainer, to let her sleep in till 9 am, which would never have happened on a normal school day,’ he says.

Open, unstructured time — to play, laugh and have fun is more important than ever at this moment. It’s something Badami-Rao has been conscious of with her kids,

Play is intrinsically motivated. It keeps you healthy and not just physically healthy, but also mentally and emotionally. Not being forced to do anything, in particular, is for me a great way of dealing with the situation because I mean as it is, we are all kind of doing things that we weren’t used to or living a life which we are not accustomed to. So within the limitations, to be able to do whatever it is that you want is probably one of the ways of dealing with it and for children, I think that is play.

Parental responses are based on the knowledge of each individual child, and trusting that instinct is important when building resilience. Many are doing this by having ongoing conversations about what we are facing and allowing for spaces to emote — to shout, cry and release. Dr. Baldiwala says,

Parents obviously know their children best, so just making sure that conversation spaces are open is key. I think a great starting point is always sharing what it’s been feeling like for you, and that can also be an opening. If there’s someone closer in age like a cousin, you could even have them connect or reach out and have those conversations with young people.

Accessing support systems and networks, just holding space for a child to be heard — these are powerful and necessary ways in which to tend to the well-being of children, even as we continue to grapple with the uncertainties that will unfold in the days to come. As Badami-Rao says,

I think if we look back at this moment 15- 20 years from now, it’s going to be a blip in terms of what’s happening with our children’s education. I think it’s more important at this moment to focus on their psychological well-being, their emotional well-being and their physical well-being.

Deepika Khatri is the co-founder of The Curio-city Collective and co-host of a podcast on cities and well-being. A development practitioner, her interests lie in child rights, strengthening governance systems and in examining the linkages between social justice and well-being.

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