WE all know that lockdowns are temporary measures to control the spread of Covid-19 within the community and lessen the healthcare burden. However, there are major concerns about how they can negatively affect people’s mental health. As a paediatrician, I receive numerous calls and visits by parents worried about their children’s health – especially those less than five years old. Most parents assume that the older age group would understand the pandemic better than the young ones and thus handle it better. I beg to differ.
Here are some observed effects of lockdowns on children.
> Developmental milestones – For school-going children, repeated school closures and strict movement control cause a significant reduction in having direct contact with their peers. Such measures also prevent children from participating in social activities like going to the playground or having playdates.
This situation may make them feel lonely and anxious and some (especially young adults) experience early depression. Some may develop attention-seeking behaviour ranging from excessive tantrums and not sleeping to bedwetting while some may complain of recurring abdominal pain or headaches of unknown cause.
For infants and toddlers, their method of learning is mainly through observation during play. Their senses need tactile, auditory and visual stimulus, and when some of these areas are neglected, it may hinder them from achieving appropriate milestones. Studies are showing that lockdowns do affect the development of children’s speech, language and social milestones.
And we have yet to study the effect of uncontrolled screen time on these children.
> Physical health, growth and nutrition – Regardless of age, lockdowns and strict movement control may also affect children’s physical health as they would not have enough space to play and exercise safely unless they live in homes with big gardens.
Being indoors most of the time, they would have limited exposure to the sun and this may subject them to vitamin D deficiency and stunted growth.
The lack of exercise and perhaps poor balanced nutrition might cause some put on weight. As the country struggles with the pandemic-caused economic turmoil, some children will have limited access to well-balanced nutrition – an unhealthy diet may be the only diet affordable. All this may affect their baseline immunity, thus putting them at health risk.
Parents’ fear of leaving the house may cause delays in seeking medical attention when their children are unwell or even postponing vital immunisation appointments. Delayed or missed follow-ups that are important for children with chronic illnesses can affect their treatment plans and health progression.
> Education – School cluster outbreaks have caused repeated school closures, and these disrupt a student’s education progress. They need appropriate exposure and repeated stimuli to learn – and some students need it more than others. Online learning actually reduces instructional exposure and getting constructive feedback. This can affect overall outcome.
Furthermore, school is not just about completing syllabi and exams, it is a place where students learn to develop certain skills, abilities and behaviours necessary for educational success. Even before this pandemic, studies have shown that school absenteeism may lead to dropping out and exposure to unwanted risky behaviours like smoking, drug usage, teenage pregnancy and such.
> Child safety – The Women, Family and Community Development Ministry recorded 4,349 cases of physical, sexual and emotional abuse of children last year, along with 2,287 cases of domestic violence. The numbers were especially high during the lockdowns.
To some children, school is their safe haven from a disruptive environment at home. Some find refuge and help from their peers or teachers when facing abusive situations. With lockdowns, these children are unable to access such help. Limitations on social worker home visits also gives poorer insight of what is going on behind closed doors so many cases go undetected.
With all these negative effects lockdowns have on children, are we opposed to them? It cannot be argued that during massive spikes in case numbers, lockdowns can help to curtail the spread of the virus.
Vaccination in parallel with lockdowns is, of course, the better solution. Unfortunately, children below 18 years old cannot be vaccinated as there is a lack of data on how the vaccine would affect them.
To achieve good herd immunity, we need vaccine coverage of at least 80% percent of the adult population. In the meantime, as lockdowns continue, how do we help children to thrive and develop skills?
As parents we should try our best to make our children understand that this is the “new normal”. Be frank and open and use simple language so they understand that this disruption to their lives is to protect them from getting ill.
However, do not instil fear as it will create unnecessary anxiety. Allay fears by teaching them how to protect themselves by washing hands properly, wearing a mask in public and keeping a distance from non-family members when outside the home. They need repeated reassurance that by complying with the advice, they can minimise the risk of being infected by the virus.
How to maintain some normalcy at home? One way is to do some physical activities together as a family indoors (and outdoors too if the situation permits). Be creative in planning these activities. Talk to relatives, friends or colleagues with children of similar ages and brainstorm together. And involve the child when making plans.
Have some personal time slotted in too so you can have some time off – do know it is OK to have quiet time and let the child be idle for a while. Sometimes they appreciate that, and they can start to learn to be independent too.
Be involved in their school lessons and get in touch with their teachers. Children learn differently from one another and some do better in a classroom setup than with virtual learning. If your child is struggling to cope with remote learning, ensure that he/she at least understands the basics of reading, writing and counting before moving forward with his/her syllabus.
If you find that the child’s struggle is unusual, do get an expert to asses the child for possible learning difficulties or disorders that will require an intervention.
Take this opportunity to strengthen the family bond. Encourage children to talk about their fears and worries. Allow them to keep in touch with their peers and relatives through regular voice or video calls without you checking on them all the time. Nonetheless, be sure to limit screen time and switch on parental controls for inappropriate channels online.
Although this is the new normal, certain rules must be kept. Maintain household routines for children, like waking up at the same time in the morning and bathing and having meals and bedtimes at appropriate hours. Involve them in age appropriate chores.
As parents, do remember we are not perfect. This pandemic affects us adults too. Do seek help if you feel overwhelmed or are experiencing burnout. Our children can sense our emotions but that does not mean you should swallow them all. Talk to trusted friends or family members or call available helplines (see below).
Finally, we can also start living healthier. Ensuring that the family has a healthy, well-balanced diet and doing some form of physical activities is key to improving our immune system. Make sure children's vaccinations are up to date to protect against other communicable diseases and do not delay getting them unnecessarily. And, of course, we must get ourselves vaccinated against Covid-19 if we are eligible.
Take care and stay safe!
DR SHARIFAH AIDA ALHABSHI
MSU Medical Center, Shah Alam
Those suffering from problems can reach out to the Mental Health Psychosocial Support Service at 03-2935 9935 or 014-322 3392; Talian Kasih at 15999 or 019-261 5999 on WhatsApp; Jakim’s (Department of Islamic Development Malaysia) family, social and community care centre at 0111-959 8214 on WhatsApp; and Befrienders Kuala Lumpur at 03-7627 2929 or go to befrienders.org.my/centre-in-malaysia for a full list of numbers nationwide and operating hours, or email firstname.lastname@example.org.