Reassurance, Routines & Regulation

We will begin with the 3Rs—the most basic things parents can do to help their children during this time—Reassurance, Routines and Regulation:

Reassurance

Parents/family are a child’s safe harbor. Children rely on their parents for safety, both physical and emotional. During this time, especially with younger children, it is important to reassure your child.

  • You can offer extra hugs, more frequent touch, and say “I love you” more often.

  • Children may be particularly frightened if you are leaving the house to go to work or do groceries.  This may be expressed in words, crying at the separation, increased irritability or refusing to say good-by.  Take the lead and tell them ahead of time in a calm and reassuring tone of voice where you are going, how long you will be gone, when you will return and that you are maximizing your personal safety.

  • Remind older children that because you love them you are keeping them safe by following the best health advice from health leaders—this means social distancing, no in-person play dates, and maintaining schoolwork and schedules as much as possible.

  • Answer children’s questions about the pandemic simply and honestly.  It is okay to say that people are getting sick, but that if your family follows the rules about sheltering at home, social distancing and hand-washing, they will be alright.  You can say that lots of smart scientists are working hard to figure out how to help people who get ill and that things will improve.

  • Children may also worry about a grandparent who is living alone or a relative or friend with an underlying illness.  Reassure them that you are in touch, making sure that the grandparent or relative have what they need.  Facetime with a relative or friend can ease their anxiety.

 

Even when we are all living in the same home 24/7, there are natural transitions that separate us as parents work from home, children play, and everyone goes to bed at night.  Young children may have much more difficulty with bedtime during any stressful period.  Maintaining routines while offering extra reassurance is important.  Parents can reassure children by putting a family picture by the child’s bed, leaving little “love” notes with them, or adding an additional lovey or transitional object so parents “can leave some extra love” with them until morning.

Routines

All children, even teens, benefit from structure and routines that are predictable while remaining somewhat flexible.  Routines build a sense of safety and predictability and promote self-efficacy since children know what to expect, where the boundaries are, and they learn to manage the steps themselves over time.

Bedtime:

  • With infants, we advise parents to establish bedtime routines at a very young age that involve: moving to more calming activities as bedtime nears and dimming the lights as they move through a predictable sequence of steps (bath, book, and bed), letting the infant fall asleep in their own bassinet or crib (alone, on their back, no bumpers, blankets pillows or stuffed animals).

  • For toddlers and older children, we add brushing hair and teeth (Bath, brush, book and bed) and allow blankets, pillows and stuffed animals in the bed.

  • It is important as children mature, even into the teen years, that bedtime routines remain in place and a reasonable time be set to go to bed so they get adequate sleep. They may now read their own books at bedtime, but there should still be no electronics (TV, phone, computer etc.).

  • Bedtime can shift on week-ends for older children and teens, but it is wise to keep it in a narrow range so as not to throw the child’s sleep-wake cycle off.  Too little sleep makes it more challenging for children and adults to learn and to modulate their emotions. Thus, parents should try to get 7-8 hours of sleep a night also, while teens need about 9 hours and younger children 10.

Other routines:

During the pandemic, it is more important than ever to maintain bedtime and other routines (wake-up time, getting dressed for the day, school work and play schedules, screen time) because they create a sense of order to the day that conveys reassurance and predictability in a very uncertain time.  Because the usual routines are disrupted (no school or childcare, no sports teams, no dance class etc.), parents should establish a new daily schedule for week-days and week-end days.

 

Older children and teens can help with the structure of the day but the sequence should include: wake-up routines and getting dressed, breakfast, active play, quiet play, school work, snacks, lunch, chores, exercise, social networking on-line to connect with friends, homework, supper, family time, reading and bedtime.

 

The key is to have predictable yet flexible routines that meet an individual child’s needs.  More energetic children need more time in active play during the day.  School work is ideally broken up when possible so children get breaks during the day to vent energy through play. Some individual items need time-frames assigned (such as on-line gaming with friends).

Regulation

One of the most challenging things we do as parents is teach emotional and behavioral self-regulation to our children.  This begins in infancy, when we soothe our crying infant, dampening the infant’s stress responses and allowing the serve and return interactions that help the brain move from the limbic system that is alert to danger to the thinking and learning parts of the brain.  We know from science that the primitive limbic system develops in infancy while it takes over two decades, and lots of role modeling, teaching, soothing, and guidance for the higher brain regulatory systems and executive functions to fully mature.

 

Everyone is more anxious and worried during the current pandemic.  The absence of the usual routines of childcare and school, conversations or news about people getting sick and dying, or parental stress about job loss and finances can make children fearful.  The brain’s alarm system is robust in children and scans the world for danger.  Young children also do not have the insight to understand nor the rich vocabulary to describe all of their feelings.   Thus, the younger the child, the more likely stress, anxiety or fear are to present as behaviors (which can in turn upset parents, particularly if they are already stressed).  But, we also have some ways to help children.

The Parent as Emotional Container

All children, including teens, read their parents’ moods and rely on their parents to help them navigate the world they live in.  The younger children are, the more they take their cues from their parents—but, adolescents and older children also "read" their parents and pick up on their emotions.  One of the major ways parents help children in times of emotional distress is by remaining calm, at least on the surface. We call this being an emotional container

 

One example of this is the parent who remains calm during their child’s tantrum.   While all parents may feel upset on the inside as their child rages out of control, we model the calm that enables the crying and screaming child to regain control (some do this faster than others).  As a parent, this means recognizing that the child’s tantrum is not about the parent, even if directed at them, but about not being able to have something they want, their adjustment to new schedules and routines, or an expression of their anger or frustration.

 

We all know that it is harder for us adults to think and learn when we are stressed. This is also true for children. It is only when the child is calm that they find their way back from their lower brain to their thinking and learning brain and it is in these calm moments where we can offer some guidance to the child about their emotions and behaviors. 

Parents as Co-regulators

  • Validate the child’s feelings (We calmly say things like: I can see that you are frustrated because…).  The simple act of being validated can reduce the child’s emotional intensity.
     

  • Provide words for feelings.  A child having a tantrum might look angry, but might in fact be feeling disappointed, frustrated, humiliated, embarrassed or scared.  As parents, we reflect on what precipitated the tantrum to understand the emotion underlying the behavior. And, we then help the child when they are calm by assisting them to recognize and name their feelings—to in essence build a “feelings vocabulary”.  Only after children have a vocabulary for feelings can they use words for feelings.  
     

  • Model how to manage our feelings. One important way parents do this is by “talking through” (in a calm voice) an event and the feelings generated and how they managed them. (“I am worried about Grandma since I cannot go visit her.  The best I can do is to check in with her more often by phone. I will put a reminder on my phone to call her in the morning and the afternoon until this pandemic ends. It will help her to know she can depend on me to check on her.”) 
     

  • Reflective conversation. For older children, we might have a conversation about their feelings and what caused them.  This involves attuned attentive listening and asking some guiding questions. (“I can see that you are upset about something…I have my listening ears on.  Would you like to tell me about it?”). Teens often need us to listen and ask some guiding questions so they can resolve an issue themselves. (“I know it is disappointing not to be able to hang with your friends right now.  How do you think you can stay in touch with them?”) 
     

  • Reframe or offer a different perspective. Sometimes children get stuck in one narrative of events and may need parents to see the larger picture.  For example, during this time, some families may be breaching social distancing by continuing play dates with close friends.  For the child who is asking for the same privilege, the parent may want to help the child think through what the right thing to do is in a pandemic.  (“I know Jamie’s parents are letting him have friends over. Let’s look up what our health leaders and scientists are saying is safe right now.” One could go to the CDC website and look up the rules and then have a conversation about what the safe thing to do is.  Or, validate the child’s feelings. “I know it is hard. I would like to see my friends too right now. But, it is my job to keep you safe and the health experts are saying….perhaps we can find ways for you to connect with friends online.”)

 

It is through this process of co-regulation with caregivers that children and teens gain insight into their own feelings and develop the skills to think about them, express them more appropriately, and ultimately manage their emotions and behaviors. We can help them to reframe the meaning of stressful events when they are calm, and by being a role model.

The CDC and American Academy of Pediatrics have learned from other disasters that discussing what is happening with older children and teens and answering their questions honestly and calmly are helpful.

Asking about their understanding of the events can also reveal some flaws in their knowledge or reasoning that can be corrected.  Parents and children can look up information together on-line using respected sources such as the CDC and the AAP.  If parents are out of work and worried about finances, children can even engage in ways they might as a family have some fun cost-effective times together at home.

Dr. Moira Szilagyi

Child and Family Advocate

Moira Szilagyi, MD, PhD, FAAP

mszilagyi@mednet.ucla.edu

© 2020 by Moira Szilagyi, MD, PhD