The COVID-19 pandemic has been impacting lives globally for over two years. The magnitude of this event has meant that most of us have spent the majority of this time hoping for answers while also tracking multiple changes in the information available. Despite having so much more knowledge and resources at this juncture, there are still many questions unanswered. For most parents all over the world trying to make decisions to protect their children, the continued uncertainty has caused anxiety and exhaustion.
Undoubtedly, many years will need to pass before more in-depth information is available about how much, and in what ways, the pandemic has impacted our lives – in particular, the lives of young children. However, my hope is to include here some of the current findings that are trying to help families make sense of how their young children – ages 0-5 primarily – could be impacted by the on-going pandemic. Some of what I will include in this writing will be information on early childhood development and mental health; health information pertaining to infection from COVID in children; and the social implications of this public health emergency on families.
It is important to note that, although everyone has felt the effects of the pandemic, the disparities in impact to people from traditionally marginalized communities are profound and not random. BIPOC people, the LGBTQI+ community, and neurodiverse people, for instance, have suffered exponentially more during this time than their white cisgendered and neurotypical counterparts. The systemic injustices that run through institutions in the United States, and in many other countries, have caused devasting increases in mortality and poverty for those who already were put at a higher risk even without a public health crisis. As we take inventory of what has happened, as well as all that continues to happen as the pandemic evolves, this truth must be centered and held with urgency so we can continue to move towards social justice change at all levels.
Although this blog post is not meant to cover every piece of information out there, it is my hope that it will be a starting point to guide families in finding some data that can support them in making the best decisions possible for their young children.
Early Childhood Mental Health and Development
Perhaps one of the most influential studies right now on the pandemic and early childhood development is one published by researchers at Columbia University. The study found that babies born during the first year of the pandemic had slightly lower scores on a developmental screening test at 6 months, regardless of whether their mothers had COVID during pregnancy. These scores were compared to those of babies born just before the pandemic, and were lower in areas such as motor and social skills. It is interesting that this study did not find a link between exposure to COVID in-utero and neurodevelopmental deficits, something that many suspected was possible as viral infections during pregnancy can at times be associated with these diagnosis. Instead, it points to elevated rates of stress in the pregnant parent as a potential link to the developmental progression of the infants. Nearly half of the mothers in the study had COVID during pregnancy with mild or asymptomatic illnesses.
Interpretations of this data seem to be differing among many experts. Some say that there is hope in seeing a small, as opposed to severe, impact to development in babies born during the first year of the pandemic. However, others indicate that this could signal a significant negative change in the way that development progresses for the infant population with potential long-term effects. Other studies point to these concerns as well. For example, additional data from Massachusetts General Hospital suggests that babies born to birthing parents who were infected with COVID-19 while pregnant were about twice as likely to receive a diagnosis of neurodevelopmental disorder by 12 months of age. This is in comparison to babies who were not exposed to COVID-19 in -utero.
All of this information continues to direct our attention heavily to high stress in pregnancy as highly relevant to how we understand the mental, social, and emotional wellbeing in infancy and early childhood. Pregnancy itself can be a challenging and multilayered experience on its own, but compounding that with the fears and worries that COVID has brought upon families has placed the mental health of pregnant parents at risk. The numbers of pregnant people reporting concerning levels of anxiety, depression, loneliness, and Post traumatic stress disorder associated with the pandemic went up significantly, according to information reported by Harvard University. When considering concerns about illness, professional demands, challenges with caring for additional children in the home, as well as other stressors, it is not difficult to see how pregnancy during the pandemic has increased incidences of perinatal and postpartum mood disorders. In addition, although much of this was known prior to the pandemic, studies done during COVID times continue to confirm the impact of prenatal stress on the emotional regulation of infants and children. Without question, this information should continue to raise awareness in all communities – professionals included – that we can’t support babies without supporting their parents.
COVID infection and vaccines
Parents all over the world have been exposed to confusing information about COVID-19 infection in young children. If misinformation is thrown into the mix, all of us have heard everything from “kids can’t get COVID” to “the vaccine will change my child’s DNA”.
In 2022, as the Omicron variant continued to spread quickly at a global level, the highest numbers of hospitalizations for young children due to COVID were reported. Children younger than age 5 were seen more frequently by hospital medical providers, and the rates of children of color affected by COVID infection were disproportionate. Experts continue to report that overall hospitalizations for children are low as compared to those of older adults. Regardless, babies younger than 6 months are particularly vulnerable and represented nearly half of the hospitalizations among young children during the Omicron Surge.
This brings us to a discussion about vaccination. On November 2, 2021 the CDC announced that vaccines would be available to children ages 5-11. Vaccination for young children slowed, and trends continue to show that there is hesitancy from parents to get their children vaccinated despite evidence suggesting that vaccination is the best way to prevent the illness, reduce likelihood of severe illness, and limit exposing others to the virus.
Take a look at this data from the CDC summarizing some of the most recent information on the impact of COVID as related to vaccination:
- Only 28.8% of U.S children aged 5 through 11 years have completed their primary series.
- 14.4% of rural children 5 through 11 received at least one dose of the COVID-19 vaccine as of April 27, 2022, compared to 39.9% of children in large urban areas.
- Almost 90% of children hospitalized for COVID-19 during the Omicron surge were unvaccinated, and over half of the hospitalized children were Black or Hispanic.
- As of mid-May 2022, over 82 million COVID-19 cases and over 1 million COVID-19-related deaths have been reported in the U.S.
- Unvaccinated people aged 5 years and older had a 10 times greater risk of dying from COVID-19 when compared to people vaccinated with at least the primary series.
- A new analysis indicated that vaccines could have prevented at least 318,000 COVID-19 deaths in the U.S. between January 2021 and April 2022.
This information is a lot to hold, and at the same time it is clear that vaccination, although not 100% effective, continues to be the best way for us to keep our children, families, and communities safe and healthy. It is also clear that more work is needed at all levels to make life-saving vaccines readily available and continue to grow the capacity of those at the forefront of providing accurate, science-based information for those who may have limited access to education.
It is not too challenging to see how a virus like COVID-19 can cause a public health emergency due to how transmissible it is, and how severely it can impact the human body leading to death in many cases (especially at the beginning of the pandemic and prior to vaccines being available). However, the virus has shown us much more than a constellation of symptoms, and virus mutations. Social disparities linked to race, gender, sexuality, age, and ability, among many other factors, have been painfully revealed to us as we look at who are the people who have suffered the most, and will continue to suffer in the long-term.
RAPID, an early childhood and family survey launched in April, 2020 in response to the COVID-19 pandemic, has been gathering information from families all over the United States to capture how their lives have been impacted during the past two years. They report on a key finding from their data: for families who have experienced increased material hardship during the pandemic, caregiver stress has increased. In turn, signs of distress in their young children have also increased. This hardship chain reaction has impacted Black and Latinx families disproportionately, leaving all of us with urgent questions about what this means for the long term mental health outcomes of children of color.
Social and economic inequities extend to those who live in this country with vulnerabilities such as being undocumented immigrants. Even when the virus itself had not yet caused infection in these communities, the lack of access to high-quality healthcare, employment opportunities, economic mobility, paid time off, childcare, and community services was enough to increase stress, mental health concerns, illness and even death. They arrived at the pandemic set up to have the greatest losses and the poorest outcomes.
Unfortunately, global data points to similar trends. Child mortality and child poverty has increased all over the world due to COVID-19. Children who did not die due to COVID-19 infection still experienced increased mortality risk due to loss of caregivers, hunger, and compounding hardships leading to dire outcomes.
While examining this information, we must all reflect on the quality of life and emotional wellbeing of children in these circumstances. Children thrive in the context of healthy and safe relationships, but when stress and trauma permeate the lives of families in all areas – home life, community life, socio-political context- the effects on the overall health of a child are alarmingly negative.
Let’s get to work
As we have seen here, interesting data is beginning to emerge about the effects of the pandemic on children and families. However, little is known about the long-term effects of this crisis, and it will take many years for us to know how the developmental trajectories will continue for young children born in COVID times.
Nevertheless, we do have a lot of information about what supports a healthy social and emotional development in children, and this information remains unchanged by the current health emergency.
Take a look at the recommendations below from Zero To Three, an organization devoted to advocating for better outcomes for infants and toddlers:
Promote Foundational Developmental Skills
Social skills in young children are complex and depend on a foundation of more basic skills. By promoting these basic skills, children may be able to grow their social skills and adapt to more sophisticated social environments.
To play with others, it is essential that children can communicate what they are thinking and be understood by their partner(s). Being able to understand and express emotions is important, and helping children label emotions specifically (e.g., sad, frustrated, angry vs. just “bad”) is also a precursor to social skills.
Ways to practice:
- When talking to children, label objects, expand on what children can say, and describe what is happening in the world.
- Singing and playing are great ways to promote vocabulary and help children learn and remember new words.
- Read, read, read—and pay attention to the emotions of the characters in the story, discuss how they express their emotions and what they do when they have big emotions.
Language and emotion feed into self-regulation skills. The ability to manage one’s own emotions and stay calm is one of the more difficult parts of social interactions for young children. Children who are not being successful in social interactions may have emotions that are overwhelming. It takes strong inhibition skills for children to wait their turn or not grab the toy they want. The ability to control one’s actions is a developmental skill that improves markedly between 3 and 5 years old.
Ways to practice:
- Play games that require children to stop their body, such as freeze tag, red light/green light, or Simon says.
- Find some strategies that your child can use when they experience big emotions, such as taking deep breaths or hugging themselves.
- Talk out loud about the times that you are frustrated or disappointed and model acknowledging the emotion and problem-solving in a constructive way.
Theory of Mind
Theory of mind is the ability to understand what someone else thinks or feels, and that it can be different from what you yourself think or feel. Sustained interactions with others necessitate understanding what someone else would like. Compromising and negotiating take substantial theory of mind. This skill also develops greatly between 3 and 5 years old.
Ways to practice:
- Talk about the connection between what other people feel and how they behave. This can be done with people, babies, pets, or fictional characters.
- Talk about what goes on inside people’s heads—wanting, feeling, liking, thinking, knowing.
- Point out when two people think or feel differently about something.
Knowledge of Social Expectations
Social competence also involves knowing a set of “rules” of behavior. For example, a person should tell others their name when meeting them for the first time, take turns when playing a game, and ask to join in with other children playing. Pretend play is the perfect way to practice such skills because it allows some distance from the emotions.
Ways to practice:
- Act out meeting someone and asking to play (can be done with puppets, stuffed animals, etc.). Model kind and polite language when pretending.
- Introduce social dilemmas into the child’s pretend play. What if piggy wants to go the barn but cow wants to go swimming? How could bulldozer and excavator work things out if they both wanted to dig in the same spot?
- Choose TV and media content that shows positive interactions between children and intentionally teaches skills like sharing, identifying emotions, and being kind. Barney, Sesame Street, Daniel Tiger, and Alma’s Way are some examples.
Encourage Interactions in Safer Contexts
It is important to acknowledge that every decision has a trade-off, and families and schools are being put in the nearly impossible position of trying to balance physical safety with promoting children’s holistic development. Yet, given the length of this pandemic, it is important to pay attention to children’s social development and possibly be creative in providing opportunities.
- Encouraging people to meet up outside may be one of the simplest ways to promote safe child interactions that may not need to require masks.
- Interacting with other children online is another option. With children 3 years and younger, online interactions can be difficult; however, video calls can provide children with the sense that other children are in the world and interested in them.
- To support online interactions between very young children, expect to keep them very brief, and plan a specific activity like singing a song or reading a book.
- For older children, parallel play where both children are playing with things like play-dough or blocks can provide a concrete thing to show and talk about.
As the pandemic continues, we must remember that we are all working wounded. Taking time to be gentle and compassionate with ourselves and others will allow for us to heal from the collective stress and trauma brought upon by our circumstances.
As shown by the recommendations that encourage us to stay connected with our children, and to offer them as much engagement and loving interaction as possible, it is wise for all of us to continue to find opportunities to maximize our time spent in activities that soothe and regulate our nervous systems. A body under stress places us and our loved ones in unsustainable situations, so let’s continue finding chances to nourish ourselves and the communities that hold us together.
- COVID– 19 parenting
- A regulation song for you and your kids
- Supporting Mental Wellness and Family Life During COVID-19
- Washington State Department of Health COVID-19 resource: The Ingredients of Resilience
- King County Crisis Line: call 866-4CRISIS for immediate crisis support. Additional information online.
- King County’s Community Support and Well-Being Resources.