Supporting Children’s Health During and After the COVID-19 Pandemic
Currently, children without underlying chronic conditions do not appear to be at high risk for COVID-19 and the illness seems to be milder in children than adults. But while most children may be unlikely to have adverse health effects from the illness, COVID-19’s overall impact on children’s health outcomes will likely be far reaching.
“When we ask, ‘how is this coronavirus affecting children’s health?’, we need to look at its impact beyond contracting the disease,” says NICHQ President and CEO Scott D. Berns, MD, MPH, FAAP. “Health care resources are stretched thin, schools are closed, and families are feeling significant stress in response to an ever-changing crisis—all of this will impact children’s health and well-being, now and in the future.”
Identifying how COVID-19 will affect children’s health is the first step to uncovering solutions—both those that can be implemented immediately and those that will require long-term systems-based improvement.
COVID-19 may affect children with chronic conditions differently. Learn more about information for children with asthma and sickle cell disease here.
Below, we outline some of the key challenges we’ve seen and heard about to date from our partners—public health professionals, community health workers, health care providers, and families. When we can, we share potential solutions and relevant resources, and we invite our network to email us with additional resources and ideas. We will work hard to update this article regularly as new information emerges and we recognize that there are many challenges that may continue to unfold.
Jump to COVID-19's impact on:
- Social determinants of health
- Communication with pregnant women
- Home-visiting services
- At-home learning
- Social emotional health
- Parent and caregiver mental health
- Online safety
COVID-19 will impact social determinants of health like housing and food insecurity
When stocking up on food, try not to buy items with a WIC symbol. The Women Infants and Children (WIC) program provides needed nutritional support to low-income pregnant and postpartum mothers and their families. Families who use these items can’t switch to another brand if stores run out. Help spread the word among your friends and colleagues.
To limit the spread of COVID-19, federal, state, and local governments have introduced important safety measures that encourage people to stay home. While necessary, these measures mean that many businesses have closed temporarily, resulting in lost wages for countless workers. And because of school closures, many parents have had to take unpaid time off work to care for their kids. Without regular income, families may be forced to make life-altering decisions, like choosing between buying groceries, paying the rent, or getting gas so they can bring their child to a doctor. And families already facing financial hardships will be forced to make these urgent decisions sooner and more frequently, leading to immediate and long-term negative consequences for their families’ health.
Put another way, without national coordinated interventions, COVID-19 may set off a chain-reaction for low-income families—one that starts with lost income; then causes housing loss, food insecurity, and less access to health care; and ultimately ends with a widened gap in health outcomes between the richest and poorest families in the U.S.
Federal legislation that provides economic relief is vital, as are community-level efforts to support those in need—such as through local food banks and shelters. But these immediate efforts are only the beginning. It will take months to grasp the full fall-out from COVID-19. Public health professionals, community advocates, and policy makers must be prepared to promote comprehensive and sustainable solutions to support under-resourced communities who are already being hit the hardest.
- Summary of key provisions from Families First Coronavirus Response Action
- Details of coronavirus aid package
- The United Way Community Response and Recovery Fund: United Way’s 211 number connects people affected by COVID-19 with food, housing, utility, and health care resources. Learn more here.
- Many states are offering emergency TANF payments to individuals who lost employment. Check your state’s response to identify potential resources.
- Food assistance:
- The CDC recommends that families check with their school facilities about availability of grab and go meals. Learn more here.
- The U.S. Department of Agriculture (USDA) can issue nationwide waivers to ensure access to meals through the child nutrition programs as communities respond to the COVID-19 pandemic. Learn more here.
Communication between providers and pregnant families is vital
The CDC does not know if pregnant women have an increased chance of contracting COVID-19 or getting severely ill from it, though caution is advised. It is also too early to definitively know whether COVID-19 may adversely impact pregnancy outcomes or be transferred to babies during pregnancy or through breastmilk.
Given that much is still unknown about the impact of COVID-19 on pregnancy and pregnancy outcomes, being pregnant during the COVID-19 pandemic may lead to heightened anxiety. One key way to address this is to optimize strong communication between health care providers and families. During prenatal visits—which are likely being conducted over the phone or through a video call—providers can walk families through any COVID-19-related process changes. For example, some hospitals are sending families home quicker after birth to protect them from COVID-19 and pediatric providers are managing follow-up visits. Providers can also encourage families to submit questions through online patient portals, prompting a continuous conversation to help offset the disconnect mothers might be feeling if they aren’t seeing their provider in-person. And for new parents, isolation and anxiety may increase the risk of maternal and paternal depression, which makes early screening and intervention critical.
Given COVID-19’s impact on the economy, talking to expecting families about social determinants like housing, food, and employment, is more important now than ever before. Providers can play a vital role in helping families plan for the future by connecting them with public resources and services.
- Facts about pregnancy and COVID-19 from the CDC (including recommendations on breastfeeding)
- Maternal Depression: First Steps Families and Advocates Can Take to Help Mothers and Babies Thrive
Home-visiting services have been suspended
Through state home-visiting services, community health workers connect families with important resources and interventions, from helping mothers breastfeed to promoting positive parenting techniques. But because of COVID-19, many home-visits have been temporarily suspended. In the meantime, states are looking into other options for reaching families, including launching virtual visits where community health workers connect with families over the phone or through video calls.
While a promising strategy, virtual visits may prove challenging for those serving families who have limited cell phone service or internet coverage, or who access internet through libraries or restaurants, which are closed. According to the Ounce of Prevention Fund, states can address these barriers by providing devices or connectivity as needed. Even with virtual visits, many families will likely need additional support after in-person visits resume.
- Free internet options in response to COVID-19
- Home visitors can share this resource from ZERO TO THREE with families with infants and toddlers. It offers tips on age-appropriate responses to common questions, a guide to self-care, and activities for young children experiencing social distancing.
At-home learning will be easier for some than others
Due to school closures, many children are being taught at home—either by their parents or through virtual learning. This is challenging for all children and families, but it is uniquely difficult for children with learning disabilities and disorders who rely on a team of support specialists: speech, learning behavior, vision, and so on. There is simply no immediate comprehensive solution for these families, but public health and education providers can talk to families to better understand the challenges they’re facing. Then, when schools re-open, they’ll have a plan in place to provide extra support and resources and help children overcome any setbacks.
The increase in at-home learning may also exacerbate existing inequities in school districts and communities. Not all districts can provide virtual learning; and not all families have computers or internet access at home—and libraries are closed. The longer social distancing continues, the greater the impact, and the greater the need for public education solutions that give every child the opportunity to catch up.
- Questions and answers on providing services to children with disabilities during the coronavirus disease 2019 outbreak
- General information from the CDC on children’s health and education during COVID-19
- CDC guidance for child care programs that remain open
Protecting children’s social emotional health is vital, now more than ever
COVID-19 has upended children’s daily lives, resulting in added stress and uncertainty. Studies show that adversity during childhood, including adversity stemming from natural disasters, can have lasting impacts on children’s social emotional health. And troublingly, this adversity will disproportionately affect low-income families who have fewer resources.
Fortunately, families can take steps to support and protect children’s emotional well-being during the COVID-19 crisis. Read an article from ChildTrends for actionable recommendations from experts.
Additional helpful resources about talking to children about COVID-19:
Parent and caregiver mental health needs to be prioritized
Like children, parents’ mental health is also at risk during the pandemic. Lost jobs or cut back hours, working from home while simultaneously caring for children, social isolation, anxiety about the unknown… parents are facing a myriad of stressors from COVID-19 that can increase the risk of mental health problems, especially for those with pre-existing conditions, and exacerbate alcohol and drug misuse. And when a parent’s mental health suffers, so too does their child’s health and well-being.
Health professionals can help by talking to parents about the importance of self-care and healthy coping mechanisms, like walking outside, meditation, and talking to friends or counselors on the phone. For individuals with pre-existing conditions, continued treatment is vital. Helping parents learn how their mental health affects their children’s health can be a powerful motivator for prioritizing self-care and, when necessary, seeking treatment.
- Disaster distress hotline from the Substance Abuse and Mental Health Services Administration
- High-stress situations can increase the risk of domestic violence and child-abuse. Find strategies for helping parents build buffers against high-stress situations while practicing social distancing here.
- Massachusetts General Hospital curated mental health resources with a particular emphasis on materials that will be of use to providers and those they serve.
Families can protect children from increased risk for online abuse
The FBI recently released a statement saying that, due to school closings, children may be at increased risk for online sexual exploitation and child abuse. Since children need to be home all day, they will likely spend more time online, which increases their chances of connecting with someone trying to exploit them. The FBI provides a number of recommendations for families here, including discussing internet safety with children and managing personal internet privacy settings.
Thank you to those on the frontline
While COVID-19 has brought significant health challenges, it has also illustrated the fortitude and dedication of countless health care providers and public health professionals. In hospitals across the country, doctors, nurses, and hospital staff risk their health to help their patients, even in the face of significant resource shortages. In community, county, city and state health departments, public health professionals work tirelessly to ensure families can still benefit from needed public programs. As an organization, we are profoundly grateful for and inspired by their unswerving devotion to children and families.
A Physician’s Reflections on Racism and Treating Sickle Cell Disease
For NICHQ’s current and future work, I am motivated by wanting to be a better version of myself in service of others. Wondering whether my own implicit biases impacted my care of patients and families, I realize that I cannot redo past ER experiences. If I could go back, I would slow down to acknowledge and try to set my biases aside and approach patients from a personally more informed perspective. But now, I can use my past, present, and future experiences to ensure NICHQ is amplifying important lessons from this multi-year effort reflecting the compassion, care, and commitment of hundreds of dedicated professionals in pursuit of equitable, accessible, and quality healthcare for people living with sickle cell disease.
Navigating Well-Child Visits and Vaccinations during COVID-19
Well-child visits and recommended vaccinations are essential, ensuring children stay healthy and are protected from preventable diseases and illnesses such as measles, whooping cough, and seasonal flu. But, as the COVID-19 pandemic persists, data shows that fewer childhood vaccinations have been given and many children have fallen behind on their scheduled appointments. Healthcare professionals should utilize the following strategies to work with parents and caregivers to get their children caught up on missed appointments and recommended vaccinations.
Exploring a Nonbinary Approach to Health
NICHQ is not abandoning the traditional use of the terms “mother” and “maternal.” We are embracing the inclusive language of “birthing person/people” across our work. A move toward inclusive language does not force us to stop using language that so many people identify with; at its core, inclusion is about creating more space for one another. We are taking care to expand the use of these terms in our communications, on our website, in our resources, and eventually, in all our projects.
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