Helping children cope with the COVID-19 pandemic is something most parents have been grappling with since last spring. We spoke with Erik von Hahn, MD, Tufts Medical Center Pediatrician who works at the Center for Children with Special Needs. We asked him about how to help your kids get through the winter months and talked with him about why a schedule is crucial to both helping them feel secure and stay on track.
Do you see more children dealing with anxiety at this point in the COVID-19 pandemic?
“It really varies from child to child. Some kids respond very well to being at home with their families. They enjoy having more time with their parents,” explains Dr. von Hahn, “but for other children, it is a struggle. If children have separation anxiety or social anxiety, what we’re seeing is that those kids seem to be happier. Things that may usually make them feel anxious like being at school or talking with peers are no longer happening. The problem is that they are not being challenged the way we would want them to be.” Dr. von Hahn says other kids are dealing with increased anxiety levels. “Some kids are afraid to go out, because they’re afraid of catching COVID, or they’re worried about the health of an adult in the home who might be vulnerable, such as their grandparents. Those kids need good information about how the virus gets transmitted, what to worry about, and what to not worry about. But not all of them are reassured so easily. They can end up taking excessive time washing their hands or avoiding going outside. Should anxiety or fear reach a level where it’s interfering with your child’s daily life, it’s probably time to seek professional help.”
Why is structure important for children during these times?
“There’s no question that a predictable schedule is a big key to a child’s success. That’s true at all times, not just during a pandemic,” says Dr. von Hahn. “The challenge is that the daily schedule can easily fall apart when we are home all the time. This problem is bigger for young kids and for kids with disabilities. The reason for this is because self-regulation skills depend upon a predictable schedule.” Self-regulation refers to managing emotions, managing attention, and managing your energy level to fit the situation. Kids need to shift from low energy activities like eating and sleeping, to high energy activities like playing outside, to middle-energy activities like paying attention for learning.” Unfortunately, not all kids can do this smoothly or successfully. Many of them struggle when they have to shift between these different energy levels. They end up being too cranky, too excited, too hyper, or even too quiet or sleepy. Dr. von Hahn’s biggest recommendation is having children adopt a regular sleep schedule as well as regularly scheduled mealtimes. “Sleeping and eating should occur at fixed times. The wake-up time should be fixed, and eating times, including snacks, also need to be set. Sleeping and eating on a schedule actually changes how hormones get released in your body. When the timing is fixed, your child will experience a sense of wellness.”
Aside from meal and sleep schedules, how regimented should the rest of their day be?
“Once you have your child’s eating and sleeping on a schedule, it’s much easier to arrange all of the other activities of the day,” says Dr. von Hahn. “You can schedule your child’s daily activities like remote learning by the clock, but not all your child’s activities need to be so regimented. They just need to occur in a predictable order.” Dr. von Hahn says the pattern parents should aim for is work before play. “Make sure you ask your child to do the hard things or tasks they consider boring, such as homework or cleaning, before they have access to fun things such as playing outside or screen time.” He says most kids hate the schedule at first because they feel it’s only there to make them do what adults want them to do. “You can get around that by making sure they know about all of the fun activities that are in the schedule too. Once they get used to it, most kids crave the schedule. It’s their way of knowing when they get to do fun stuff and also gives them a sense of security. This security and predictability helps them manage their emotions, behaviors, and attention span.” Dr. von Hah says that means fewer tantrums, less hyperactivity, and more successful tasks.
Do you have special advice for parents of very young kids or children with disabilities?
“Like all kids, young children and those with disabilities want to know when they can do fun things like play video games or have TV time,” explains Dr. von Hahn. “If their schedule is not consistent, they are much more likely to get angry when their parents don’t let them do what they want to do. Unless they understand there’s a sequence to their day, they’re going to feel their parents are ‘stealing’ something from them whenever their parents say ‘no’ or ‘later’. Some parents I work with really struggle with this. It’s hard to set up and stick to the schedule,” he said. “but without it, the world seems unpredictable and frustrating to the child.” Dr von Hahn says a visual schedule which uses pictures or printed words can be helpful in these instances. The kids can better grasp their schedule when it’s visual. When parents talk about the schedule, the information sometimes goes in one ear and out the other. The visual schedule helps children “see” their day. Once they have this type of visual schedule, parents can ask the children to tell them what they need to do. For example, they can ask: “What’s on the schedule today?” or “When are you going to have your play time?“ as well as “What are the jobs that you’re going to get done first?” Using this approach takes the heat off the parent."
For kids in a remote learning model, do you have other advice on how to ensure the day runs smoothly?
“I love the idea of starting the day with a family meeting to go over expectations,” says Dr. von Hahn. “A meeting organizes the parent as well as the child and gives the parents an almost fail-safe plan. It takes the guesswork out of the schedule and gives kids a head up.” Dr von Hahn stresses the importance of giving kids a bit of choice within their day. For example, let your child decide if they want to go straight from online class to homework or would they prefer a break in between. “Obviously they must still get their work done, but the choice of doing it all at once or with a planned mental health break in-between helps kids take responsibility.”
How do parents help their kids cope with this disappointment?
“I don’t think this conversation will be very different than having to explain to your kids why they’re not going to school right now, or why they’re only going in two days a week,” says Dr. von Hahn. “Parents should give thought to how they can create community and celebrations when stuck at home. We can do it with on-line video platforms like Zoom or Microsoft Teams. If you have a child with a short attention span or limited language, you can’t expect too much. I’ve heard of some families creating potluck dinners and then getting together to eat at the same time on Zoom. It does create a feeling of a shared meal. Our world is on the screen right now, so we’re going to have to do much of our socializing that way until the pandemic subsides.” Dr. von Hahn also recommends getting outside to see others whenever possible. “It’s great for everyone’s psyche, no matter how old or young you are. Walk with neighbors. Visit grandparents outside. People are medicine, and we need each other to feel well.”
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