The COVID-19 epidemic is affecting all of us in different ways. Some of us have lost jobs, or seen our hours greatly reduced, resulting in a loss of income that threatens every aspect of our lives from housing to putting food on the table.

Some of us are now tele-commuting to do some or most of our work, often while caring for children and suddenly finding ourselves home-schooling.  Those in health care and other first responders are on the front lines of a dangerous and overwhelming pandemic, worried about bringing the virus back home to our families.  Uncertainty abounds.

When faced with danger or uncertainty that might mean danger, our brains go on high alert—our lower brain functions take over. The lower brain houses those more primitive responses that help us in times of imminent danger—causes us to respond rapidly and to freeze, fight or flee.  The higher brain houses those responses we have learned over time that help us to cope—we affiliate with our social network by turning to its members for advice and relief; we organize, develop goals, plan ahead, problem solve etc.

Our social networks are a big part of our usual coping mechanisms as adults—we turn to our spouses or partners, our extended families, our friends and colleagues, our spiritual and government leaders for support and guidance. One of the big challenges of this pandemic is that the social distancing required reduces the effectiveness of one of our healthiest approaches to stress—social networking. The members of our social network are facing similar difficulties and are similarly stressed.  Single parents, those who are more isolated or who already have underlying anxiety disorders may find it even harder in the midst of such stress to focus their attention, organize daily tasks, help their children with schoolwork, etc.

The Impact on Children

In the midst of this pandemic, those who have children at home are struggling with the impact of social distancing on their children and themselves, while dealing with the stress and distress of less or no income and the risk of infection.  Parents have concerns about the decline or complete loss of weeks to months of learning for their children. Parents of children with disabilities particularly worry about the loss of essential services such as special education and speech therapy, their ability to fill in the gap, and how to preserve the gains their child has made.

 

While schools make efforts to transfer to on-line learning, not all families have iPads, computers or internet access. In a 2017 study, about 75% of American families had internet access although fewer had broadband and some families only had mobile access on their handheld device. A further challenge is the closure of libraries, which fill a gap for patrons who don’t otherwise have internet access.

In a 2017 study, about 75% of American families had internet access although fewer had broadband and some families only had mobile access on their handheld device.

Like adults, when children are faced with perceived danger, their lower brains take over. In fact, the amygdala, which we can think of as the brain’s danger alert system, is part of the lower brain and develops very early in the first year of life.  When the alert system perceives danger (hunger, discomfort), the infant or young child alerts their parent to their distress by crying, which in turn alerts the caregiver to respond. This alert system triggers the closeness with caregivers infants rely on for safety.

 

Higher brain functions are housed in a variety of structures that begin to develop in infancy but don’t reach full maturity until the mid-20s. The architecture of the brain is built over time from the bottom up, from lower to higher brain functions, in the context of at least one responsive, attuned caregiver who is continuous over time in the child’s life.  For infants and young children, and even teens, their safe, stable, nurturing caregivers help calm the brain’s alert system and build the brain structures that help us regulate our emotions and behaviors, organize, set goals, respond rationally, etc.  

The Pediatrician’s Role

Pediatricians, along with other front-line responders, are dealing with all the same stressors as their patients’ families during this pandemic.  While intensivists and emergency department staff are under the most pressure caring for the very ill, primary care and subspecialty pediatricians have had to rapidly adapt to a large reduction in office visits while continuing to serve patients and families as best they can by phone and telehealth.  This has created multiple challenges given the slim financial margins many pediatric offices already survive on.  The rapid shift to telehealth and telephone care to serve families has created new stressors.  

 

Lost income, staff health risks and childcare issues have led to furloughing office staff.  Many pediatricians lack adequate supplies of PPE.  These stressors are layered onto the high rate of pediatrician burn-out prior to the COVID 19 pandemic. Yet, pediatricians remain parents’ most trusted advisors.  They rely on us to help them help their children through difficult times. Thus, we have gathered together here some advice that pediatricians can offer parents during this challenging time.  It is divided into several categories:

Positive Parenting

Activities for Children

Parental Self-Care

Positive Parenting

Many of these tips apply to children of all ages and can be adapted to the child’s age and stage of development.  Overall, children, including adolescents, take their cues from their parents. They are very attuned to even minute changes in the mood of caregivers.  None of us can totally shield children from stress and distress in life; instead it is our job as parents/caregivers to teach them how to manage and cope, adapt and grow.  A little stress is in fact crucial to normal growth and development—for example, it is stress about a test that compels us to study for it.  Larger stressors, such as the death of a grandparent or weathering a hurricane, are tolerable with the buffering provided by responsive, attuned caregivers who remain stable in the child’s life over time. It does not mean that parents have to be on their A-game 100% of the time—the underlying foundation of love and support that we provide our children is a strong one and can withstand our occasionally making some mistakes.

 

We begin this journey of being a safe stable nurturing caregiver who buffers stress for our children when they are born.  Through our responsive, predictable caregiving, and appropriate response to our child’s needs we build a foundation of trust. We smile and coo at them when they are calm and soothe them when they are upset. It is in the safe harbor of the family, and this serve and return relationship between parent and infant, that the child begins to develop their personal, innate resilience.  The parent provides safety, stability, and nurturing and the child responds, coming to view the caregiver and the world as safe and predictable.

 

This pandemic, and the uncertainty, stressors and sense of danger it encompasses, have thrown all of us off balance, child and adult.  Yet, the job of parenting remains—to keep our children safe (right now through social distancing, hand-washing, no play-dates) and to teach them (including, how to manage stress and distress and manage time, emotions and behavior in this unusual time) so they emerge as resilient competent adults at the other end.

 

We are going to visit some of the main ways in which caregivers can apply positive parenting strategies during this time when many parents themselves feel anxious, stressed and challenged.  No one is perfect and certainly no one is a perfect parent.  In fact, we don’t have to be perfect.  But, we might have to make extra efforts, despite our own stress and anxiety, to hold our child at the center, to keep their mind in mind, so we can meet their needs, enjoy them, and nurture them.

Reassurance, Routines and Regulation

Positive Parenting Principles

Dr. Moira Szilagyi

Moira Szilagyi, MD, PhD, FAAP

mszilagyi@mednet.ucla.edu

© 2020 by Moira Szilagyi, MD, PhD