Guidance from Public Health England: Supporting children and young people's mental health and well-being during the coronavirus outbreak
What you need to know
The coronavirus (COVID-19) outbreak is going to affect everyone’s daily lives, as the government and the NHS take necessary steps to manage the outbreak, reduce transmission and treat those who need medical attention.
Regardless of their age, this may be a difficult time for children and young people. Some may react right away, while others may show signs of difficulty later on.
How a child or young person reacts can vary according to their age, how they understand information and communicate, their previous experiences, and how they typically cope with stress. Negative reactions may include worrying thoughts about their health or that of family and friends, fear, avoidance, problems sleeping, or physical symptoms such as stomach ache.
During this time, it’s important that you take care of your family’s mental health – there are lots of things you can do, and support is available if you need it.
This advice is to help adults with caring responsibilities look after the mental health and wellbeing of children or young people, including those with additional needs and disabilities, during the coronavirus (COVID-19) outbreak.
For wider information on how to protect yourself and others please see Coronavirus (COVID-19): what you need to do
This guidance will be updated in line with the changing situation.
Looking after your own mental health
As well as thinking about the children or young people in your care, it is important to take care of your own mental health and wellbeing. Children and young people react, in part, to what they see from the adults around them. When parents and caregivers deal with a situation calmly and confidently, they can provide the best support for their children and young people. Parents and caregivers can be more supportive to others around them, especially children, if they are better prepared.
Please see advice on how to look after your mental health and wellbeing during the coronavirus (COVID-19) outbreak or visit Every Mind Matters for clear advice and actions to take care of your mental health and wellbeing.
Helping children and young people cope with stress
Here are some key points to consider about how you can support your child or young person:
Listen and acknowledge: Children and young people may respond to stress in different ways. Signs may be emotional (for example, they may be upset, distressed, anxious, angry or agitated), behavioural (for example, they may become more clingy or more withdrawn, they may wet the bed), or physical (for example, they may experience stomach aches). Look out for any changes in their behaviour.
Children and young people may feel less anxious if they are able to express and communicate their feelings in a safe and supportive environment. Children and young people who communicate differently to their peers may rely on you to interpret their feelings. Listen to them, acknowledge their concerns, and give them extra love and attention if they need it.
Provide clear information about the situation: All children and young people want to feel that their parents and caregivers can keep them safe. The best way to achieve this is by talking openly about what is happening and providing honest answers to any questions they have. Explain what is being done to keep them and their loved ones safe, including any actions they can take to help, such as washing their hands regularly.
Use words and explanations that they can understand and make sure you use reliable sources of information such as the GOV.UK or NHS website – there is a lot of misleading information from other sources that will create stress for you and your family.
It will not always be possible to provide answers to all the questions children and young people may ask, or to allay all their concerns, so focus on listening and acknowledging their feelings to help them feel supported.
Be aware of your own reactions: Remember that children and young people often take their emotional cues from the important adults in their lives, so how you respond to the situation is very important. It is important to manage your own emotions and remain calm, listen to and acknowledge children and young people’s concerns, speak kindly to them, and answer any questions they have honestly.
See further guidance on how to look after your own mental wellbeing during the outbreak.
Connect regularly: If it is necessary for you or your children to be in a different location to normal (for example, staying at home in different locations or hospitalisation) make sure you still have regular and frequent contact via the phone or video calls with them. Try to help your child understand what arrangements are being made for them and why in simple terms.
Create a new routine: Life is changing for all of us for a while. Routine gives children and young people an increased feeling of safety in the context of uncertainty, so think about how to develop a new routine – especially if they are not at school:
- make a plan for the day or week that includes time for learning, playing and relaxing
- if they have to stay home from school, ask teachers what you can do to support continued learning at home. Online educational resources and activities to support children’s learning are available from the BBC
- children and young people need to ideally be active for 60 minutes a day, which can be more difficult when spending longer periods of time indoors. Plan time outside if you can do so safely or see Change4Life for some ideas for indoor games and activities
- don’t forget that sleep is really important for mental and physical health so try to keep to existing bedtime routines
- it may be tempting to give them treats, such as sweets or chocolate, to compensate for being housebound, but this is not good for their health, especially as they will not be able to be to run around or be as active as they normally do - see Change4Life for ideas for healthy treats
Limit exposure to media and talk about what they have seen and heard: Children and young people, like adults, may become more distressed if they see repeated coverage of the outbreak in the media. A complete news blackout is also rarely helpful as they are likely to find out from other sources, such as online or through friends.
Try to avoid turning the television off or closing web pages when children or young people come into the room. This can peak their interest to find out what is going on – and their imagination can take over. Instead, consider limiting the amount of exposure you and your family get to troubling media coverage.
Young people will also hear things from friends and get information from social media. Talk to them about what is going on and ask them what they have heard about. Try to answer their questions and reassure them in an age appropriate manner, avoiding too much detail.
How children and young people of different ages may react
All children and young people are different, but there are some common ways in which different age groups may react to a situation like the coronavirus (COVID-19) outbreak. Understanding these may help you to know how to support your family. The common reactions to distress will fade over time for most children and young people, though could return if they see or hear reminders of what happened.
For infants to 2-year olds
Infants may become more easily distressed. They may cry more than usual or want to be held and cuddled more.
For 3 to 6-year olds
Preschool and kindergarten children may return to behaviours they have outgrown. For example, toileting accidents, bed-wetting, or being frightened about being separated from their parents or caregivers. They may also have tantrums or difficulty sleeping.
For 7 to 10-year olds
Older children may feel sad, angry, or afraid. Peers may share false information but parents or caregivers can correct the misinformation. Older children may focus on details of the situation and want to talk about it all the time, or not want to talk about it at all. They may have trouble concentrating.
For preteens and teenagers
Some preteens and teenagers respond to worrying situations by acting out. This could include reckless driving, and alcohol or drug use. Others may become afraid to leave the home. They may cut back on how much time they connect with their friends. They can feel overwhelmed by their intense emotions and feel unable to talk about them. Their emotions may lead to increased arguing and even fighting with siblings, parents, caregivers or other adults. They may have concerns about how the school closures and exam cancellations will affect them.
Children and young people who are accessing mental health services
Children and young people with an existing mental health problem may find the current uncertainty around the coronavirus (COVID-19) outbreak particularly difficult. Their increased stress may lead to a change in their behaviours and their mental health needs. If you are concerned about how to access support if they need to stay at home, you may want to think about the following actions:
Speak to your child or young person’s mental health team
Contact your child or young person’s mental health team to discuss any concerns and check how care will continue to be accessed while you are at home. Update any safety and care plans as agreed.
Identify how the support your child or young person normally receives can be maintained
Ask about having appointments by phone, text or online, and how their health professional can offer extra support if your child or young person needs it.
If you usually have support in your home, check who you would need to contact in your local authority to let them know you’re staying at home. Make sure it is clear if support is still needed for your child or young person.
If your child or young person has been admitted to an inpatient mental health unit, talk to the staff about their policies on access to cell phones and think about how you can stay in contact, particularly if you have to stay at home. Ask the unit if you could participate in a ‘virtual ward round’ so you can keep in touch with your child and/or young person’s mental health team. If you need to stay at home this will also impact on whether your child or young person can come home on leave, so talk to your child or young person about what might happen so they are fully informed.
If your child or young person becomes affected by coronavirus (COVID-19) they will need to be cared for appropriately, so talk to the unit about what plans are in place should this happen and how best to communicate these to your child or young person.
Plan how you will access medication
You might be able to order repeat prescriptions by phone. Or you may be able to do this online using an app or website, if your doctor’s surgery offers this.
Ask your pharmacy about getting medication delivered or think about who you could ask to collect it for you. The NHS website has more information about getting prescriptions for someone else and checking if you have to pay for prescriptions.
Continue to order repeat prescriptions in your usual timeframe. There is no need to order for a longer duration or larger quantities.
Your GP might convert your child or young person’s repeat prescription to one that is supplied under the repeat dispensing arrangements, this means you can go back to the pharmacy for a certain number of repeats without having to get a repeat prescription from the practice.
Be careful about buying medication online. You should only buy from registered pharmacies. You can check if a pharmacy is registered on the General Pharmaceutical Council website.
You might also want to make arrangements for your child or young person if you become unwell, for example making sure a partner, friend, family member or neighbour is aware of important information including their care plan, medications and emergency numbers.
Children and young people with learning disabilities
Children and young people with learning disabilities can feel a loss of control in times of uncertainty such as the coronavirus (COVID-19) outbreak. They may need extra words of reassurance, more explanations or adapted explanations about the event, and more comfort and other positive physical contact from loved ones.
A good way to help them is by supporting their decisions, representing choices visually through written words, pictures, symbol systems or objects if helpful, supporting them to express their emotions and letting them know they are not alone. While listening, take their feelings seriously and don’t judge their emotions. They may feel anxious about big changes, such as going to new places or the possibilities of having to stay at home for a long period.
Where possible, it can be helpful to explain any upcoming changes to routine and circumstances before they happen and help them to plan and come up with solutions, such as finding a hobby or doing exercises to relax and cope with anxiety.
For useful tips for talking about feelings, see Skills for Care advice. For further guidance on coronavirus (COVID19) for those with learning disabilities please see the Mencap website (includes easy read materials)
Autistic children and young people
Irrespective of cognitive ability and language, autistic children and young people may struggle to identify any physical symptoms of coronavirus (COVID-19), as well as having difficulty talking about the emotions the situation will create. Keep an eye out for changes in behaviour which may help you to identify their emotional state, as well as physical symptoms.
There is going to be disruption for all of us during the outbreak, for example they may not be able to follow their normal routines, or visit older family members, so help them to manage these changes using the typical strategies you know work for your family.
It is important to be clear when communicating about the situation, how to stay safe and the symptoms of the virus. Try to avoid giving definitive statements about the future - this is a rapidly developing situation and your child or young person may be more distressed if things change when they were told they would not. Keep up to date with reliable information about coronavirus (COVID-19).
If your child or young person becomes ill, they may struggle to manage the physical experience. You know what works with your family, so help to manage this situation knowing what helps your child or young person.
You should continue to access support of local autism groups online or via the telephone. The National Autistic Society guidance on managing anxiety might also be helpful - you can call the Autism Helpline on 0808 800 4104 for further advice.
Children or young people with physical health issues
Children or young people with long term physical health issues, such as those who need continuous use of a breathing machine or are confined to a wheelchair or bed, may have stronger reactions to the coronavirus (COVID-19) outbreak. They might have more intense distress, worry or anger than children without these issues because they have less control over day-to-day wellbeing than other people. Support them by listening to their concerns, providing open and honest explanations about the situation, and giving them information about what is being done to protect them.
You may also be concerned about how you will continue their care if you have to stay at home, or you may be worried about infecting them. If you usually have support in your home, check who you would need to contact in your local authority to let them know you’re staying at home. Make sure it is clear if support is still needed for your child or young person.
For further information about the conditions that put children and young people at risk please see the guidance on shielding and protecting people defined on medical grounds as extremely vulnerable.
Children and young people who care for others
Some children and young people also have existing caring responsibilities for adults or siblings. They may be anxious about what will happen if the person they care for becomes unwell, or what will happen if they themselves become unwell and unable to support the person they care for. Even if they don’t currently act as a carer, it is possible that they may become one if they are in a household with one adult.
Planning with your child or young person what will happen if you or another member of the family they care for or may need to care for becomes unwell, including contact details for others who can step in and support them, will help to reduce anxiety.
Unfortunately, the coronavirus (COVID-19) outbreak has led to some individuals experiencing discrimination and harassment, often because of their ethnicity or nationality. It is important to check that your children and young people are not experiencing bullying or bullying others.
Explain that coronavirus (COVID-19) has affected and is likely to affect people from many countries, in many geographical locations. Emphasise that your child or young person should be empathetic to anyone who has been affected, whatever country or area they are from.
Remind your children and young people that everyone deserves to be safe at school, online and at home. Bullying is always wrong, and we should each do our part to spread kindness and support each other. If they have been called names or bullied at school, they should feel comfortable telling an adult whom they trust.
For more help and advice resources, please see the Anti-Bullying Alliance website.
You may be worried about supporting your family if you have to stay home – this can have a big impact on your mental health. For guidance on what your rights are at work, what benefits you are entitled and what further support is available please see our guidance for employees or advice from citizens advice or the National Debt line.
Where to get further support
If you are worried about your or your child/ or young person’s symptoms. Please visit the NHS self-isolation advice website for information. If you are still worried, call NHS 111.
If you are worried about your child or young person’s mental health. Seek help from a professional. You may have services attached to your child or young person’s school or college who can help, contact your GP, or look up information on children and young people’s mental health services on your local CCG website or on the NHS website.
In a medical emergency call 999. This phone line should be used when someone is seriously ill or injured and their life is at risk. A mental health emergency should be taken as seriously as a physical health emergency. For more advice on where to get support for a mental health crisis please see this NHS page.