Helping Children and Teens to Understand and Cope with COVID-19 Anxiety

Talking to Pre-K Kids, Elementary School Pupils, Middle Schoolers, and High School Students about the Novel Coronavirus 2019: An Almost Exhaustive Annotative Bibliography

Evelyn E. Smith, Ph. D.

When I cautioned a class of sneezing and coughing sixth-grade language arts students last Friday not to touch their faces because doing so might mean they could possibly catch the coronavirus, one student quickly objected to this unsolicited advice, “But I like to touch my face. Is it because it might cause pimples? Whereupon she demonstrated this, moving her hands all over her face, rubbing her nose and touching her mouth!  Her response thus provided the inspiration for this blog entry: Adults need to talk to kids about COVID-19 in a way they can understand the danger it poses and how to prevent its spread without traumatizing them. 

Even though parents are this blog’s primary target audience, teachers might benefit from reading it as well. Accordingly, at the end of the blog page, middle school and high school teachers will find a wide selection of free-of-charge lesson plans that will provoke challenging discussions and promote critical thinking skills.

As for adults who wish to stay informed about COVID-19, I have already published three annotated bibliography entries on my STEM Library Science blog: http://evelynsmithsstemscienceblog.blogspot.com/

Additionally, the Center for Disease Control (CDC) and The New York Times publish regular updates on the COVID-19 virus. 

Bonding Over Talks About COVID-19

Ducharme, Jamie. (2020, February 4). How to talk to your kids about the coronavirus outbreak. Time. https://time.com/5776857/how-to-talk-to-kids-coronavirus/

Pediatric psychologist Molly Gardener recommends, “Stay informed, keep perspective, and be honest” since children’s “emotions feed off their parents’ [and teachers’] emotions.

Make sure the conversation fits the children’s [mental and emotional] age.

Most teens can hand frank discussions, although adults should ask if they are worried about any rumors or news they might have heard or read.

Parents and mentors of elementary school children as well as preschoolers should listen to find out what they already know about the coronavirus and discuss what they fear most.  Do not sugar coat the discussion and be afraid to use words like “death” and “dying”. 

Emphasize the importance of doing everything possible to stay healthy.

Grosse, Jessica. (2020, February 28).  Ho to talk to kids about coronavirus. NYT Parenting.  The New York Times. https://parenting.nytimes.com/childrens-health/coronavirus-kids-talk

The New York Times provides various links about coronavirus-19 that parents might wish to click on before and after the article. 

Assess what your child knows:

Start by asking about what the child knows about COVID-19. Parents, however, might not want to bring up the topic if children are under age six and haven’t heard anything about it.

*Note: Parents, however, can start to teach good hygiene habits like when and how to wash one’s hands and coughing and sneezing into one’s elbow.

Process your own anxiety first:

·         An anxious demeanor might unnecessarily stir up a child’s fears.

Don’t dismiss your child’s fears:

·        Actively listen and respond to what children are saying instead of belittling their concerns, perhaps citing instances of how they dealt with their own childhood fears after hearing frightening news stories.

·         Gear any discussions to an age-appropriate level; for instance, depending upon a child’s age, explaining how the COVID-19 virus is different from the cold or flu.

Emphasize good hygiene:

·         Stress the necessity of washing one’s hands at least 20 seconds before and after meals, after going to the bathroom or blowing one’s nose or putting a hand over the nose or mouth.

·         Everyone can sing “Happy Birthday” twice when vigorously washing hands under running water.  Parents may want to avoid using a hand sanitizer with a younger child since it needs to evaporate fully to destroy any viruses or bacteria.

·         Some child psychologists suggest turning hand washing into a game.

·         Parents might need to also explain why a nose-picking kid needs to break this unsanitary habit.

When schools do close, maintain a daily routine that includes regular exercise.  Children might keep a journal and/or write or draw to relieve anxiety.

For additional help, The New York Times recommending accessing the Netflix “Ask for the Story Bots” called “How Do People Catch A Cold” for help in explaining how germs work. 

Keep Calm and Carry on Emphasizing Good Health Habits

Hays, Holly V. (2020, March 7). What to tell your kids about coronavirus.  Indy Star. MSN News. https://www.msn.com/en-us/news/us/what-to-tell-your-kids-about-coronavirus/ar-BB10QU8M

Explain what is happening “as calmly and accurately as possible,” counsels pediatric psychologist Jill Falstad. 

Be honest, not alarming

Since young [and either very imaginative or emotionally immature] children fill in information gaps with fantasy, tell them only about what can be explained by a verified, reliable source.

Examples:

If children notice that hand sanitizers are missing from supermarket shelves, explain the steps the family is taking to keep everyone safe.

If the children’s school cancels classes, emphasize that this is a step that adults took to keep the community from getting sick.  Then plan together some meaningful stay-at-home activities that they can do when not going to class. 

Coronavirus symptoms and prevention

Ask children to share if they do not feel well, explaining COVID’s early symptoms--fever and coughing that eventually leads to difficulty breathing.  Remember only to give them the information that they can emotionally and mentally handle.

Explain limiting person-to-person contact and emphasize the necessity of vigorously washing their hands.  For instance, explain and model singing the “Happy Birthday” song or “Twinkle, Twinkle Little Star” while washing the hands with soap under running water for 20 seconds.

Be available to talk about whatever worries children might have.

Remember that children listen when adults are talking amongst themselves.  Moreover, even very young children pick up non-verbal cues and body language.

How to talk to your kids about the coronavirus. (n.d.). Healthline. https://www.healthline.com/health-news/how-to-talk-to-kids-about-the-coronavirus

Main Points:

1)      Listen to children’s fears and not dismiss them. 

2)      Before talking to children about COVID-19, read up on the facts about the virus first.

Although this undated article gives the risk of “catching” COVID-19 in the United States as relatively low, it still brings up some helpful tips:

Stay on the to of the COVID-19 outbreak:  

Healthline and other Online sources (including the Centers for Disease Control and The New York Times) send out daily newsletters on the virus.

Know whether or not to broach the subject:

Help children work through their fears since they may have concerns even if they do not voice them, according to psychotherapist Haley Neldich.

Adults need to first make sure they understand the risks.

To be able to answer questions honestly go to reputable news sources; for example, the Center for Disease Control (CDC) explains that COVID-19 is a respiratory virus that if severe enough can cause pneumonia.

Also, emphasize that people infected with the virus might not show any symptoms of have symptoms ranging from mild to severe.

Compare COVID-19 with other viruses like influenza and explaining washing the hands regularly for 20 seconds after using the bathroom, before eating, or touching surfaces is an important way everyone can keep from getting the disease.  Additionally, stress that they should not touch their mouth or rub their nose or their eyes. 

Having the Talk

Actively listen to children’s fears and not dismiss them, helping children understand age and emotionally and intellectually appropriate facts about COVID-19.

Adults also must monitor and control their own fears about COVID-19

Healy, Maureen (2020, March 3) Talking to children about coronavirus. Psychology Today. https://www.psychologytoday.com/us/blog/creative-development/202003/talking-children-about-coronavirus

Maureen Healy admits that most people need not be alarmed if they practice good hygiene habits and keep a safe distance from anyone else showing symptoms, citing the World Health Organization recommendation to stay three feet away with any one with possible COVID-19 symptoms:  fever, coughing or shortness of breath.* 

1)      Facts

 Currently, no vaccine for COVID-19 exists, and most people infected with the virus will fully recover. 

  Older adults [starting at age 60] and individuals with underlying health problems might find it difficult to recover after being infected with the virus, however.

2)      Healthy Hygiene

      Medical professionals recommend

a)      Washing the hands for 20 seconds with soap and water after using the bathroom, before eating, or upon covering a cough or sneeze with one’s hands,

b)      Avoiding close contact with anyone else who is coughing, sneezing, or showing signs of any respiratory illness, including a cold or the flu,

c)      Giving children vitamins, especially those with immune-boosting Vitamin C,

d)      Wearing a face mask if showing signs of any respiratory illness.

3)      Preparedness:

Keep aware of local COVID-19 “community outbreaks” that may close schools and have on hand a supply of books, card and board games, and art supplies to occupy children who need to stay at home.

*While WHO recommends staying three feet away from all other people, the CDC recommends keeping a social distance of six feet.  This holds true even if others show no symptoms of COVID-19.

While Keeping Kids Informed, Share Some Family Fun!

Talking to children about COVID-19 (coronavirus): A Parents Resource. NASP: National Association of School Psychologists. (2020). https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/talking-to-children-about-covid-19-(coronavirus)-a-parent-resource

Over exposure to news reports and adult conversations about COVID-19 might make children feel anxious, so parents need to acknowledge this concern without showing any anxiety they possibly might have.  Failure to do so will not calm their children’s fears, nor will it reduce their risk of catching any respiratory illnesses.

If parents look worried, their children’s anxiety naturally rises.  Children on the other hand need to hear factual, age appropriate information about COVID-19 as well as how to avoid catching all communicable diseases.

Specific Guidelines

Remain calm and reassure the children:

1)      Children will be aware of both verbal and nonverbal cues, so explanations will either increase or decrease their anxiety.

2)      Emphasize that adults both at home and at school want to keep everyone safe and healthy.

Make yourself available:

Anxious children may need extra attention, so parents should give their children lots of affection and spend time talking with them, letting children know that a loved one is listening.

Avoid excessive blaming:

1)      Avoid stereotyping, making any group of people responsible for causing or spreading the illness.

2)      Bullying must be reported to school authorities in the United States.  [All fifty states have anti-bullying laws. For a sample of an anti-bullying law go to https://www.stopbullying.gov/resources/laws/texas].

3)      Be aware of what other adults are saying around your children since a mom or dad might need to explain some of what adults have said about COVID-19.

Monitor television viewing and social media:

1)      Limit TV and internet access.

2)      Discuss any news stories older children might have read or heard.

3)      Relay fact-based information about COVID-19 to reduce anxiety.

4)      Constantly watching updates, however, might increase unwarranted fears.

5)      Also understand that age-inappropriate news increases young children’s worries.

6)      Distract children that otherwise might be glued to their cell phones of the internet with other activities. 

Note: activities that family members of all ages might share in comparative isolation might include for following ideas; for instance,

·         Plant a healthy vegetable garden or a flower container garden,

·         Turn pulling weeds into a family sing along,

·         Teach the kids to play dominoes, checkers, or chess or various card games,

·         Everyone in the family could also learn how to crochet or knit,

·         Prepare the family’s long-time favorite recipes,

·         Walk the dog if it is possible to do so without walking down a busy sidewalk,

·         Watch classic movies together like The Wizard of Oz and/or The Sound of Music.

·         Check out some library books Online or else read from copyright free classics, taking turns reading aloud with the kids at least 20 minutes a day. 

Kowalczyk, Piotr. (2018, March 18). 25 sources of free public domain books https://ebookfriendly.com/free-public-domain-books-sources/

List of public domain (free) books for kids, by grade level. (n. d). Concrete Thoughts. http://concretecomputing.com/thoughts/list-of-public-domain-free-books-for-kids-by-grade-level/

See 

How reading 20 minutes a day impacts your child. (2017, February 14). WCPO Cincinnati. https://www.wcpo.com/brand-spotlight/how-reading-20-minutes-a-day-impacts-your-child-amazon-kindle

In other words, turn what otherwise what might be a scary time for children into a bonding experience.

7)      Reassess one’s own practices [and model] a healthy lifestyle. 

Encourage good hygiene habits:

Wash hands for at least 20 seconds, singing “Happy Birthday” or “Twinkle, Twinkle Little Star” twice. 

*For a list of alternate 20-second hand washing tunes and lyrics go to

Handwashing song. (n.d.). Centers for Disease Control (CDC). https://www.nurseryrhymes.org/hand-washing-song.html

Huckabee, Tyler. (2020, March 10) Give us clean hands: how long to wash your hands to classic Christian songs.  Relevant. https://relevantmagazine.com/culture/music/give-us-clean-hands-how-long-to-wash-your-hands-to-classic-christian-songs/

Martin, Catherine. (2020, March 10).  Tired of ‘Happy Birthday’?  Here are 12 songs from Texas musicians to help you wash your hands.  Dallas Morning News. 

https://www.dallasnews.com/news/public-health/2020/03/10/tired-of-happy-birthday-here-are-12-songs-from-texas-musicians-to-help-you-wash-your-hands/

Monnier, Jen (2020, March 3).  Sick of singing ‘Happy Birthday’ while washing hands to fight coronavirus? Try these pop hits. Instead.  Los Angeles Times. https://www.latimes.com/entertainment-arts/music/story/2020-03-03/coronavirus-hand-washing-20-seconds-happy-birthday-10-songs

Explain why everyone should cover the mouth with a tissue when sneezing and coughing, throwing it away immediately or else sneezing into the bend of an elbow.

Do not share food or drink [Admittedly, with some upper elementary and lower middle school students this is an up-hill battle].

Fist or elbow bump rather than shaking hands: 

·         Bhatia, Akanlsha. (2020, March 10). 10 acceptable ways to greet people without shaking nands of exchanging germs.  Health. https://www.scoopwhoop.com/health/10-acceptable-ways-to-greet-people-without-shaking-hands-exchanging-any-germs/

Upon review, most adults would not consider sticking out one’s tongue as socially acceptable.

Teaching children what they can do to avoid catching viruses gives them a greater sense of control and reduces anxiety.  

1)      Make sure everyone eats a balanced diet, gets enough sleep, and exercises regularly to build up their immune systems.

2)      Discuss new rules or practices at school.

Schools may enforce illness prevention habits:

The school nurse or principal may send home a letter or e-mail parents about any new rules and practices.

Communicate with your child’s school:

1)      Phone or e-mail the teacher or counselor if your scholar is sick since administrators might need to know if the child has fever. 

2)      Consult the school nurse, counselor, psychiatrist, or social worker if your child experiences any COVID-19 anxiety-related stress.  

3)      Follow all the school’s instructions.

Take time to talk:

1)      Patiently let your child’s question guide how much information you relay about COVID-19. Give the facts without causing a lot of stress. 

2)      Keep explanations age appropriate.

3)      Early elementary pupils need to hear simple, easily understanding explanations; for example, teach them step-by-step instructions on how and when to wash their hands and how to cover a sneeze of cough. 

4)      Upper elementary and middle-school students like to take a more active role in asking questions, although they may need help in telling the difference between fantasy and reality. 

5)      Upper middle school and high school students are better equipped emotionally and intellectually to discuss the COVID-19 virus in depth and can access appropriate sources.

Suggested points to emphasize when talking to children:

1)      Explain that concerned adults both at home and school are trying to keep them safe and healthy.

2)      Emphasize that not everyone will catch COVID-19, but almost everyone everywhere is working to make sure that COVID-19 will infect as few people as possible.

3)      Children need to respect one another’s feelings and leap to the conclusion that someone has COVID-19 just because they hear a cough or a sneeze.

Children need to learn how to take steps to ensure their own health:

1)      avoiding close contact with people who shows signs of a cold or flu [as well as keeping a social distance from others during epidemics],

2)      staying home when sick, 

3)      covering the mouth when coughing or sneezing and throwing tissues in the trash after blowing one’s nose or coughing or sneezing into tissues,

4)      Not touching the eyes, ears, and mouth,

5)      Washing hands rubbing vigorously with soap and water for 20 seconds, 

6)      If soap is unavailable, using a 60 to 90 percent alcohol-based hand sanitizer, 

7)      Cleaning and disinfecting frequently touched surfaces.

Free Lesson Plans on COVID-19

Coronavirus Lesson Plans and Resources. (2020, March).  https://sharemylesson.com/collections/coronavirus

Web site provides free lunch plans on COVID-19 for middle school and high school students ranging from lesson plans that teachers can use in life science, government, history, language arts/ English, and even math classes. 

What students should know about the corona virus. (2020).  PBS.  NewsHour Productions LLC  https://www.pbs.org/newshour/extra/daily-videos/coronavirus-a-global-health-emergency

The Public Broadcasting Service furnishes a free video that students can watch before answering discussion questions.  The Web page also gives access to selected links to new articles.