The first part of this blog will address helping children manage worry generally. Given the emerging concerns and impact of the Coronavirus disease / COVID-19, there is a second part of the blog that specifically addresses worry to help parents support children around this situation.
Part 1: General Worry Support for Kids
It is normal for children to experience worry and be afraid at times. A common trajectory of the different types of worry that children might have at different ages and developmental stages includes:
- Infants (0-1) often have a fear of strangers
- Toddlers (2-3) commonly experience separation anxiety from parents/caregivers
- Preschool age children (3-5) express fear of the dark, scary dreams, and concerns about “pretend” things such as imaginary creatures and masked characters, as well as loud noises such as thunder or fireworks
- Tests, grades, natural disasters, fitting in with friends, bullies, being left out, death, and “bad guys” breaking into the house are common concerns for elementary school age children (7+ years of age) who often share concerns about “real-life” dangers
- School success, academic performance, friendships, physical appearance and social status are common worries for pre-teens and teenagers
Worry can be productive and facilitate planning and problem solving for an upcoming event or figuring out how to prepare for an upcoming challenge. It can enhance focus and motivation. For example, if your child is worried about an upcoming test- this can encourage productive studying and enhance performance to be beneficial for academic achievement or if there was a hurricane predicted, you might use your concern to gather supplies and be ready to evacuate if necessary. Worry can help a child be more cautious and moderate risk when there is real danger.
When worry is addressed or facilitates productive action it is a manageable and helpful part of normal life. However, worry is an ineffective method to solve problems if thoughts begin to focus on extremes (the “what if…” 1% possible negative outcome discussions), become stuck or out of balance, and are left unchallenged. When worry is excessive, frequent and/or interferes with enjoying and full functioning in life it can become a serious problem. It can also be a problem when the worry is unrealistic and the risk is significantly exaggerated to cause a child to not participate in an expected or otherwise enjoyable activity.
Worry is the thought component of anxiety. Physical sensations (our fight or flight response) and emotional reactions are also part of anxiety. Relaxation strategies (diaphragmatic “belly” breathing, progressive muscle relaxation, and guided imagery) can help reduce the physiological symptoms of anxiety. Some suggestions for helping children manage anxious thoughts and worry (particularly when it is problematic) are presented below.
TIPS and TECHNIQUES FOR MANAGING WORRY
Teaching children that they can reduce worry and that worry thoughts are connected to how they feel is the first step to helping them effectively manage worry. Helping children identify and choose more helpful and realistic thoughts is the goal, so that children realize that they are able to handle worry and feel better by noticing and transforming self-talk, perspective, and the thoughts.
For young children and infants experiencing common worries offer comfort. Hug your child, soothe your child, say comforting words, and help him or her feel safe. Offer calm reassurance and connect with your child.
- Limit scary images and shows for young children.
- Be calm and listen to your child or teen, ask how he or she is doing.
- Show that you care and that you understand concerns.
- Help your child identify and express his or her feelings.
For older children and teens help turn worries into action steps to prepare for challenges. Facilitate problem solving and work together to come up with a plan rather than offering a solution or fixing the problem so your child is empowered to address the problem.
- Help keep the worry in perspective. Validate feelings first. Don’t minimize feelings or dismiss worry (how helpful is it when someone dismissively tells us a concern is “no big deal” or tells us to relax when we are worried). Listen. Model calm. Acknowledge concerns and then help them come up with more useful thoughts.
- Model healthy coping and express how you manage worries.
- If worry is problematic, ask your child to tell you another helpful thought after the worry thoughts. If worry is unrealistic and out of proportion to the situation, provide alternative perspectives after listening and validating concern.
- Ask what is the worst thing, best thing and most likely thing to happen?
- Limit worry time. Designate 30 minutes (not near bedtime) to write worry or talk about worries. If worry thoughts occur during the day, remind the child to postpone thinking about worries until that set time.
- Often worry begins with “what if” questions. When a child is concerned or scared about a what if this happens you can guide them to coming up with more helpful and realistic possible outcomes. One-way to do this is to ask your child to give you some “what else” endings to the worry thought.
Part 2: Worry and the Coronavirus Disease 2019 (COVID-19)
Uncertainty. A cornerstone of worry. Add the following: Global pandemic. Highly contagious. Unknown impact on health. Ongoing media updates of predicted infection rates. Now add concerns about limited health care system resources and response. Stock market impact and potential work loss. Finally, add school closures and the challenging of finding toilet paper and hand sanitizer. My heart rate is staring to increase, yours?
It is no wonder that the level of worry for many adults and children is high. Along with trying to keep up with the continuously updated infection rates and emerging scientific data and research findings are the barrage of social media posts of warnings, personal stories, and opinions. For many of us there is also a concern for those in our family who might be at higher risk for serious illness due to compromised immune systems, age, recent travel, underlying health conditions, or working front line in a clinic or hospital setting. So how do we manage the worry and support our children during this time of uncertainty?
Below are some additional specific strategies for managing worry in this evolving situation.
Prepared not panicked. Focus on what is in your control. Aim for preparedness and not panic. Worry is helpful to facilitate problem solving and planning when it is realistic and can be used to identify action steps and taking action. Only thinking about what could happen, what might happen or worst-case scenarios without making and taking action will make you feel bad and is a very ineffective way to manage stress or problem solve.
Hand-washing and social distancing are choices that can minimize exposure and help slow the spread to help reduce possibility of overburden on hospitals. Stocking up on two weeks of essentials (food, drinks, medications) is one way to be prepared. This will help if (when) social distancing is recommended or requests to self-isolate.
Develop a plan consistent with CDC guidelines for reducing exposure and risk of infection, and follow recommended CDC steps if you have symptoms or become ill.
Here is a helpful step-by-step approach to help with uncertainty (5 Steps to Living with Uncertainty During Coronavirus. A guide for responding to anxiety and lack of control (https://www.psychologytoday.com/us/blog/biofeedback-and-mindfulness-in-everyday-life/202003/5-steps-living-uncertainty-during)
Check the facts. The Centers for Disease Control and Prevention (CDC) provides updated information about prevalence and findings from ongoing research being conducted around the world. (See https://www.cdc.gov/coronavirus/2019-nCoV/index.html)
Limiting time spent reading about and thinking about Coronavirus and COVID-19. Try to limit time reading about the Coronavirus. Limit social media use and check reliable evidence based reputable sources only a few times a day. One strategy to limit worry is to give yourself a designated time to think about or read about it. Any automatic worry thoughts that arise get dismissed to a designated time (and tell yourself, I will think about that at X time. Preferably not near bedtime to minimize disruption to sleep.
Talk with your children. It is almost certain that your children have heard about Coronavirus/COVID-19. Ask what they know and clear up misconceptions. Answer questions with clear and developmentally appropriate information. Know what you want to say before having the conversation. Presenting information in a calm manner can help a child understand what is happening and manage worry. Assure safety. Reinforce what they can do and what might happen (If schools close, coming up with a new routine and plan and letting children help make some decisions will help with the transition). Limit time children view stories and news coverage and consider age and temperament of child when addressing questions.
Tips for Addressing Children’s Worry: See blog above for general strategies. Address children’s concerns calmly and with compassion. Try to be in a calm state when talking with your child. Don’t minimize or dismiss concerns. Let children express fears and concerns. Gently guide a balanced perspective and offer comfort. It is ok to not have the answer to some questions. It is ok to tell children, let me worry about that. I will come up with a plan and we will stay as safe and healthy as possible.
This is a particularly good resource with a table that outlines some possible child reactions according to age group and the best ways you can respond. NCTSN Parent/Caregiver Guide to Helping Families Cope With the Coronavirus Disease 2019 https://www.nctsn.org/sites/default/files/resources/fact-sheet/outbreak_factsheet_1.pdf
For example, for Preschool aged children: recommendations to maintain routines, provide calm activities before bedtime, provide reassurance, have patience, allow temporary sleep arrangement changes as anxiety might be displayed by expressing fear of being alone, bad dreams, bed wetting, change in eating, increased temper tantrums or clinging behaviors as a reaction to worry and fears about this situation.
School age children might have stomachaches or report physical symptoms, show sleep and appetite disturbance, or withdrawal from peers and exhibit forgetfulness about what they learned. Parent recommendations included helping children do regular exercise, talk about the situation and encourage questions, allow connection to friends via phone or internet, and play education games or activities.
Self-care: This is essential. Get adequate sleep. Exercise. Eat healthy. Practice relaxation strategies (diaphragmatic breathing, progressive muscle relaxation). If you are having a hard time managing your own anxiety, please seek support.
When is worry a problem? While all children worry, some worry more than others and it can affect their enjoyment and engagement in life activities. Worry is problematic when it is excessive, lasts longer than expected for age, and interferes with functioning at home or school. If you have concerns about anxiety please talk with your pediatrician or a child therapist. If you want more help in addressing your child’s worry or managing anxiety we are happy to help.
RESOURCES AND REFERENCES
- Helping Kids Handle Worry at https://kidshealth.org/en/parents/worrying.html
- What is Worry worksheet: https://www.therapistaid.com/worksheets/what-is-worry.pdf
- Go Zen 49 phrases to calm an anxious child (https://gozen.com/49-phrases-to-calm-an-anxious-child/)
Coronavirus / COVID-19 Resources:
- Parent/Caregiver Guide to Helping Families Cope With the Coronavirus Disease 2019
- World Health Organization, WHO: https://www.who.int/health-topics/coronavirus
- Resource for Pregnant Women: What you need to know about the coronavirus if you are pregnant or postpartum: https://pebbleparents.com/coronavirus/?eType=EmailBlastContent&eId=e5a41508-9ccc-4fa4-bfca-8bea43479958
- What to do when you worry too much: A children’s guide to overcoming anxiety. Worry Says What?
- Don’t feed the worry bug
- Hey Warrior
- When My worries get too big
- Emma’s Worry clouds