Amedeo I.

Avenoso F.

Bruni J.

Guido C. A.

Loffredo L.

Spalice A.

Zicari A. M.

Archivio della ricerca- Università di Roma La Sapienza

OPINIONpublished: 15 October 2020doi: 10.3389/fpubh.2020.580720Frontiers in Public Health | www.frontiersin.org 1 October 2020 | Volume 8 | Article 580720Edited by:Daniel Bressington,Hong Kong Polytechnic University,Hong KongReviewed by:Setareh Forouzan,University of Social Welfare andRehabilitation Sciences, Iran*Correspondence:Alberto Spalicealberto.spalice@uniroma1.itSpecialty section:This article was submitted toPublic Mental Health,a section of the journalFrontiers in Public HealthReceived: 06 July 2020Accepted: 26 August 2020Published: 15 October 2020Citation:Guido CA, Amedeo I, Avenoso F,Bruni J, Zicari AM, Loffredo L andSpalice A (2020) Risk Factors andMental Health Promotion Strategies inChildren During COVID-19.Front. Public Health 8:580720.doi: 10.3389/fpubh.2020.580720Risk Factors and Mental HealthPromotion Strategies in ChildrenDuring COVID-19Cristiana Alessia Guido, Ilaria Amedeo, Federica Avenoso, Jacopo Bruni,Anna Maria Zicari, Lorenzo Loffredo and Alberto Spalice*Paediatric Neurology Division, Department of Maternal Sciences, Sapienza University, Rome, ItalyKeywords: risk factors, COVID19, mental health, children, strategiesSince 5 March 2020, the Italian government has ordered a nationwide school closure as anemergency measure to prevent diffusion of the infection. The emergency home-schooling plan hasbeen strictly implemented thanks to the hard work of schools and teachers to create online courses.Furthermore, in a first step, public activities were discouraged, and now, they are firmly forbidden.Researchers have established that such measures should have both negative psychological andphysical effects on children. Stressors, such as prolonged duration; fears of infection; frustration andboredom; inadequate information; lack of in-person contact with classmates, friends, and teachers;lack of personal space at home; and family financial loss can have evenmore problematic and lastingeffects on children and adolescents (1).Evidence suggests that when children are out of school (e.g., weekends and summer holidays),they are physically less active, have much longer screen time, have irregular sleep patterns, andhave less favorable diets. Such negative effects on mental health are expected to be much worsewhen children are confined to their homes without outdoor activities and interaction with friendsof the same age (3), which are essential for their normal psychological development and well-being.The uncertainty about the personal and global effects of COVID-19 is creating great concern, inaddition to the specific psychological effect of quarantine (2). Some children might be separatedfrom their parents due to the infection. Parental separation pushes children into a state of crisisand might increase the risk of psychiatric disorders, as well as a higher risk of developing mooddisorders, psychosis, and death by suicide in adulthood (2). The age of the initial separation isknown to be relevant to psychological development disrupting the ongoing attachment processeswith significant outcomes if this happens in the first year after birth (3). In this rapidly changingsituation, children are experiencing substantial changes to their daily routine. At the same time,they are exposed to large amounts of information and high levels of stress and anxiety in theadults around them (2). Sprang et al. (4) reported that children who were isolated or quarantinedduring the influenza A (H1N1) pandemic in 2009 were more likely to develop acute stress disorder,adjustment disorder, and pain. Conversely, anxiety in children and adolescents can also manifestitself in challenging externalizing behaviors, such as acting or arguing (3). In Sprang’s sample,30% of children who were isolated or quarantined met the clinical criteria for posttraumatic stressdisorder (PTSD) (4). Adult concern about the implications of COVID-19 could impair their abilityto recognize and respond to children’s ideas or distress (4).It should be stressed that children may respond in a different way to an outbreak dependingon their age. In this respect, the National Child Traumatic Stress Network (NCTSN) has suggestedsome reactions according to age group, assuming that preschoolers might manifest fear of stayingalone, bad dreams, speech difficulties, loss of bladder/bowel control, constipation, bed-wetting,change in appetite, increased temper tantrums, whining, or clinging behaviors. School agechildren (ages 6–12) might be irritable, plaintive, or aggressive; have nightmares or sleep/appetitedisturbance; and show physical symptoms (headaches, stomach aches), withdrawal from peers, lossGuido et al. Risk Factors in Children During COVID-19of interest, competition for the attention of parents, andforgetfulness of household chores and new information learnedat school.Lastly, adolescents (ages 13–18) may complain of physicalsymptoms (headaches, rashes, etc.), sleep/appetite disturbance,agitation, decrease in energy, or apathy, as well as ignore healthpromotion behaviors, isolate from peers and loved ones, beconcerned about stigma and injustices or avoid/cut school. Inthis particular contingency, children are exposed to unexplainedand unpredictable behavior, which can be perceived as a threat,resulting in a state of anxiety (3). Children are well-attuned tothe emotional states of adults; indeed, a strong relationship wasfound between clinically significant levels of PTSD symptoms inparent respondents and their children; nearly 86% of respondershad children who also met the clinical cut-off score (4).Mental health responses to previous emergencies anddisasters have included widespread psychological first aid,focusing on psychoeducation about normative reactions andcoping strategies.Promotional videos can be useful to motivate children tohave a healthy lifestyle at home by increasing physical activitiesand having a balanced diet, regular sleep pattern, and goodpersonal hygiene (1). These are expected to help maintaina daily routine and cope with this difficult moment. In theevent of home confinement, parents are often the best andclosest resource for children to ask for help; children needhonest information about changes; when this information isabsent, children try to make sense of the situation on theirown (1, 2). They are constantly exposed to news related to theepidemic, so having direct conversations with children aboutthese issues could mitigate their reactions, such as anxiety andpanic. Close and open communication with children is alsothe way to identify any physical and psychological problems,comfort them, and resolve them (1). We agree with Liu andcolleagues who propose that pediatric health professionals shouldreceive training to facilitate early identification of children’smental health problems by learning to discern their normaland abnormal behaviors and to use rapid screening tools formental health (3). Additionally, it is important to considerpostpandemic surveillance of mental disorders among thesechildren, remembering that the identification of PTSD or othermental health disorders in parents should trigger an investigationof behavioral health disorders in their family members.AUTHOR CONTRIBUTIONSCG, IA, FA, and JB wrote the manuscript. AZ and LL revisedthe manuscript. AS revised and write the manuscript. Allauthors listed have made a substantial, direct and intellectualcontribution to the work, and approved it for publication.REFERENCES1. Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of homeconfinement on children during the COVID-19 outbreak. Lancet. (2020)395:945–7. doi: 10.1016/S0140-6736(20)30547-X2. Dalton L, Rapa E, Stein A. Protecting the psychological health of childrenthrough effective communication about COVID-19. Lancet Child AdolescHealth. (2020) 4:346–7. doi: 10.1016/S2352-4642(20)30097-33. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerationsfor children quarantined because of COVID-19. Lancet ChildAdolesc Health. (2020) 4:347–9. doi: 10.1016/S2352-4642(20)30096-14. Sprang G, Silman M, Posttraumatic stress disorder in parentsand youth after health- related disasters. Disaster MedPublic Health Prepared. (2013) 7:105–10. doi: 10.1017/dmp.2013.22Conflict of Interest: The authors declare that the research was conducted in theabsence of any commercial or financial relationships that could be construed as apotential conflict of interest.Copyright © 2020 Guido, Amedeo, Avenoso, Bruni, Zicari, Loffredo and Spalice.This is an open-access article distributed under the terms of the Creative CommonsAttribution License (CC BY). The use, distribution or reproduction in other forumsis permitted, provided the original author(s) and the copyright owner(s) are creditedand that the original publication in this journal is cited, in accordance with acceptedacademic practice. No use, distribution or reproduction is permitted which does notcomply with these terms.Frontiers in Public Health | www.frontiersin.org 2 October 2020 | Volume 8 | Article 580720

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Risk factors and mental health promotion strategies in children during COVID-19

Risk Factors and Mental Health Promotion Strategies in Children During COVID-19

Risk Factors and Mental Health Promotion Strategies in Children During COVID-19

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