Paediatric pandemic planning: children's perspectives and recommendations

Children and adolescents' mental health during the COVID-19 pandemic: A qualitative study of their experiences

TOPIC

Public health measures implemented in response to the COVID-19 pandemic severely disrupted children and adolescents' (C&A) lives, affecting their sense of structure, predictability, and security.

PURPOSE

To examine C&A' experiences during the COVID-19 pandemic to better understand how this context and its associated public health measures affected them and their mental health, and to identify helpful coping strategies.

SOURCES USED

The study was guided by a participatory hermeneutic framework. Semistructured interviews were conducted with 25 C&A aged 6-17 years during the first and second pandemic waves. Participants' interviews were analyzed following a narrative synthesis approach, through which C&A' experiences were contrasted and contextualized to highlight relevant themes.

CONCLUSIONS

Participants described a distinct pattern related to their mental health as the pandemic unfolded, which followed the severity of the pandemic in the province. Negative repercussions on their mental health were linked to the loss of social activities, imposed public health measures, transition to online learning, and challenges with family relationships. Certain youth shared positive societal and moral reflections triggered by the pandemic context. Coping strategies reported include: having a variety of hobbies; expressing their emotions; and accessing financial and material resources. This study highlights the importance of supporting C&A' mental health during crisis situations such as a pandemic. Their perspectives are vital for clinical practice and policy improvement, particularly to find means for social engagement while maintaining safety.

Children as an afterthought during COVID-19: defining a child-inclusive ethical framework for pandemic policymaking

BACKGROUND

Following the SARS pandemic, jurisdictions around the world began developing ethical resource allocation frameworks for future pandemics-one such framework was developed by Thompson and colleagues. While this framework offers a solid backbone upon which decision-makers can rest assured that their work is driven by rigorous ethical processes and principles, it fails to take into account the nuanced experiences and interests of children and youth (i.e., young people) in a pandemic context. The current COVID-19 pandemic offers an opportunity to re-examine this framework from young people's perspectives, informed by advances in childhood ethics and children's rights.

MAIN BODY

In this paper, we revisit the Thompson et al. framework and propose adaptations to the ethical processes and values outlined therein. This work is informed by expertise in clinical ethics and literature related to impacts of COVID-19 and other pandemics on the health and well-being of children around the world, though with particular attention to Canada. During the processes of drafting this work, stakeholders were consulted-aligned with the approach used by Thompson and colleagues-to validate the interpretations provided. We also propose a new principle, namely practicability, to indicate the complex balance between what is possible and what is convenient that is required in ethically sound decisions in the context of services affecting young people. We outline and discuss the strengths and limitations of our work and indicate next steps for scholars in the areas of childhood studies and child health.

CONCLUSION

Efforts to ensure frameworks are truly child-inclusive should be the status-quo, so pandemic impacts and policy implications can be considered in advance of emergency preparedness contexts.

Psychosocial well-being of Flemish foster children residing in their foster homes during the COVID-19 lockdown

The measures implemented to contain the COVID-19 pandemic profoundly affected the lives of children and families all around the world, probably affecting children's psychosocial well-being. The negative consequences of lockdowns are presumed to hit even harder on vulnerable groups such as foster children who already struggle with their psychosocial well-being in normal circumstances and who face specific challenges during lockdowns such as: additional help that is no longer available or only offered digitally and physical contact with birth parents that is forbidden. Nevertheless, some scholars point to the positive side of lockdowns (e.g.: relief due to closure of schools). This study aims to asses the psychosocial well-being of Flemish foster children residing in their foster homes during the COVID-19 lockdown and the factors that are associated with the change in their psychosocial well-being. 888 foster parents reported on the psychosocial well-being of just as many foster children through the Brief Assessment Checklist for Children and Adolescents. The COVID-19 lockdown was not associated with a decreased psychosocial well-being of Flemish foster children residing in their foster homes during the lockdown. Foster parents reported a slight improvement in their relationship with their foster child during the lockdown which points to a positive consequence of the lockdown. In addition, this improvement was positively associated with an increased psychosocial well-being during adverse circumstances and should therefore be enhanced. The type and amount of contact with birth parents is significantly associated with foster children's changed psychosocial well-being during the lockdown. Foster parents who reported an increase in alternative contact (e.g., (video)calls and messages) between their foster child and his/her birth parent(s) during the lockdown, also reported an increase in their foster child's psychosocial well-being during that period.

Hiding and seeking: Children's lived experiences during COVID-19

A qualitative study explored the perspectives and lived experiences of school-age children during COVID-19 using a child rights lens. Twenty children between the ages of 7 and 12 participated in open-ended, virtual interviews. Our hermeneutic analysis found children's right to play and education were severely compromised leaving children to navigate between two worlds: the adult world of public health restrictions and that of their childhood. Despite challenges and lost childhood opportunities, children emerged as competent social agents and responsible citizens. Planning for future pandemics should include policies and practices that balance public health needs with the protection of children's rights.

'We can play tag with a stick'. Children's knowledge, experiences, feelings and creative thinking during the COVID-19 pandemic

Using a relational approach, we draw on repeated interviews with a group of 30 diverse children from Ontario to share and reflect on their knowledge, experiences and feelings early in the COVID-19 pandemic. Prioritising relational interdependence and relational agency, this paper illustrates our participants' embedded engagements with the pandemic and their contribution to the co-production of knowledge. We emphasise their thoughtful responses to the pandemic; their creative, self-reflexive strategies for managing a difficult time; and their advice to others. We thus prioritise children's viewpoints and emphasise their relational interconnections with others during a time that was marked by social isolation.

What makes Dutch youth comply with preventive COVID-19 measures? An explorative study

The measures to contain the spread of COVID-19 are challenging for youth, especially the social isolation measures. These measures are antagonistic to healthy youth development, which requires sufficient social contact with peers and adults. This explorative study examined what factors are associated with adherence to COVID-19 measures in a sample of Dutch youth (N = 263; 79.8% female) with ages ranging between 16 and 24 years (M = 21.1 years; SD = 2.44 years), who completed an online questionnaire about their compliance to measures, resilience, coping strategies, mental health, and availability of a natural mentor. Results showed that youth with fewer depressive symptoms adhered better to measures of social distance. Youth who were less suspicious, more resilient, and those with an active coping strategy or a natural mentor more often complied with COVID-19 measures. These results can be used to help youth comply with the COVID-19 measures.

Impact of the COVID-19 pandemic on children's mental health: A systematic review

BACKGROUND

The outbreak of COVID-19 in December 2019 has caused unprecedented disruption to the structure of children's daily lives due to school closures, online learning, strict social distancing measures, limited access to outdoor activities and many other restrictions. Since children are more susceptible to stress than adults and there is a growing concern about the potential debilitating consequences of COVID-19 for children's mental health, the present review aims to provide empirical evidence on the groups who are most at risk of mental health problems and uncover the risk and protective factors of children's mental health.

METHODS

A systematic search was performed, in accordance with PRISMA guidelines, in the electronic databases Web of Science (including SSCI and A&HI) and EBSCOhost (including ERIC, MEDLINE and APA PsycArticles and APA PsycINFO), for any empirical studies published between January 2020 and February 2022 that focused on children ≤ 12 years old.

RESULTS

An initial search identified 2,133 studies. A total of 30 studies fulfilled the inclusion criteria and were analyzed. The evidence showed that many children were affected by the COVID-19 pandemic and experienced internalizing and externalizing behaviors. Worsened child mental health outcomes reflected socioeconomic inequalities as most at-risk children had parents with low educational attainment, were from families of low socioeconomic status and lived in small homes. Key risk factors were identified, including unhealthy lifestyle behaviors (extended screen time, sleep disturbances and less physical activity), increased pandemic-related stressors among parents and deteriorated mental health of parents, which were directly or indirectly associated with the pandemic safety measures, such as home confinement or social distancing. Protective factors including parents' resilience, positive parent-child relationship and school connectedness in relation to children's mental health were reported.

CONCLUSION

The overall results highlight the urgent need for the implementation of tailor-made interventions for children with signs of internalizing and externalizing behaviors. Health promotion and prevention strategies by the government to maintain the mental health of children, particularly those from lower SES families who are at higher risk of worsened mental health are essential for post-pandemic policies.

How do children and adolescents experience healthcare professionals? Scoping review and interpretive synthesis

OBJECTIVE

Explore children's and adolescents' (CADs') lived experiences of healthcare professionals (HCPs).

DESIGN

Scoping review methodology provided a six-step framework to, first, identify and organise existing evidence. Interpretive phenomenology provided methodological principles for, second, an interpretive synthesis of the life worlds of CADs receiving healthcare, as represented by verbatim accounts of their experiences.

DATA SOURCES

Five key databases (Ovid Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Web of Science), from inception through to January 2019, reference lists, and opportunistically identified publications.

ELIGIBILITY CRITERIA

Research articles containing direct first-person quotations by CADs (aged 0-18 years inclusive) describing how they experienced HCPs.

DATA EXTRACTION AND SYNTHESIS

Tabulation of study characteristics, contextual information, and verbatim extraction of all 'relevant' (as defined above) direct quotations. Analysis of basic scope of the evidence base. The research team worked reflexively and collaboratively to interpret the qualitative data and construct a synthesis of children's experiences. To consolidate and elaborate the interpretation, we held two focus groups with inpatient CADs in a children's hospital.

RESULTS

669 quotations from 99 studies described CADs' experiences of HCPs. Favourable experiences were of forming trusting relationships and being involved in healthcare discussions and decisions; less favourable experiences were of not relating to or being unable to trust HCPs and/or being excluded from conversations about them. HCPs fostered trusting relationships by being personable, wise, sincere and relatable. HCPs made CADs feel involved by including them in conversations, explaining medical information, and listening to CADs' wider needs and preferences.

CONCLUSION

These findings strengthen the case for making CADs partners in healthcare despite their youth. We propose that a criterion for high-quality child-centred healthcare should be that HCPs communicate in ways that engender trust and involvement.

A scoping review on psychosocial consequences of pandemics on parents and children: Planning for today and the future

The COVID-19 worldwide pandemic has forced individuals into an unnatural way of life. Families with children experience unique stressors, such as school closures, disrupted childcare arrangements, requirement of parents to uptake additional responsibilities such as homeschooling, possible financial strain, and lack of breathing space between family members. The adjustments required of parents and children during a pandemic presumably impacts the psychosocial wellbeing of parents and children in different ways. To better under the psychosocial consequences of pandemics on parents, children, and youth, this scoping review used Arksey and O'Malley (2005) five-stage framework to examine the existing research literature on Severe Acute Respiratory Syndrome (SARS), Influenza Type A virus (H1N1), and COVID-19 to answer the following two research questions: (1) What are the psychosocial consequences of pandemics on parents of children and youth? (2) What are the psychosocial consequences of pandemics on children and youth? With the application of inclusion criteria, 29 articles were selected for analysis. Four major themes, including sub-themes emerged: 1) Each family members' emotions influence one another; 2) Parents experience greater levels of psychosocial problems than adults without children; 3) During a pandemic, parents require informal (social) and formal (specialized professional) support and; 4) Psychosocial consequences of pandemics on children/youth are understudied, indicating the need for more research on children/youth under the age of 20 years. Clinical prevention and intervention suggestions to support the psychosocial wellbeing of parents, children and youth during a pandemic are discussed.

Review: The mental health implications for children and adolescents impacted by infectious outbreaks - a systematic review

BACKGROUND

This systematic review synthesized available research on the psychological implications for children and adolescents who either were directly or indirectly exposed to an infectious outbreak. On this basis, the current paper aims to provide recommendations for future research, practice and policy regarding children during pandemics.

METHOD

A total of 2195 records were retrieved from the PsycINFO, SCOPUS and MEDLINE databases, and three from Google Scholar.

RESULTS

Including only those papers that focused on children or adolescent's mental health in association with respiratory infectious outbreaks, 11 articles were identified. The majority of research utilized qualitative or retrospective hospital record data. Children and adolescents reported fear and anxiety, as well as disruptions to their day to day routines as a result of outbreaks. However, children were also able to demonstrate resilience during outbreaks with the right support.

CONCLUSIONS

Children's psychological response to the outbreak appeared to be largely attributed to how their parents, healthcare providers and the media communicated the event. Recommendations for policy, practitioners and researchers concerning the current COVID-19 outbreak concludes the paper.

Noli Timere: The Role of Reassuring Adults in Dealing with COVID-19 Anxiety in Pediatric Age

Since the earliest stages of the Corona Virus Disease-19 (COVID-19) spread, the elderly has been identified as the most vulnerable and health authorities have rightly focused on that population. Minor attention was paid to pediatric populations and their emotional reactions. Actually, children and adolescents faced severe anxiety, fear and stress conditions. An efficient management of the pandemic, therefore, must take into account the pediatric population which cannot be neglected as a minor matter compared to the elderly, the economy and health care. Since the lockdown time is over, children and adolescents must recover sociality, return to living in the open air, rediscover playing, free time, aiming for the beauty of their everyday life. In order to mitigate the long-term impact of COVID-19, the key response is the reassuring presence of the adult as 'a secure base'. The current study aimed to collect an overview of the recent references that report evidence on the role of adults in containing pandemic anxiety COVID-19 in pediatric populations, suggesting the need to ensure a reassuring presence of the adult, an effective child-parent communication, a child-friendly day and a long-lasting shared time with parents.

Children Coping, Contextual Risk and Their Interplay During the COVID-19 Pandemic: A Spanish Case

The COVID-19 pandemic has changed the lives of millions of people around the globe and some of the unprecedent emerged disruptions, are likely to have been particularly challenging for young children (e.g., school closures, social distancing measures, movement restrictions). Studying the impact of such extraordinary circumstances on their well-being is crucial to identify processes leading to risk and resilience. To better understand how Spanish children have adapted to the stressful disruptions resulting from the pandemic outbreak, we examined the effects of child coping and its interactions with contextual stressors (pandemic and family related) on child adjustment, incorporating in our analysis a developmental perspective. Data was collected in April 2020, through parent-reports, during the acute phase of the pandemic and, temporarily coinciding with the mandatory national quarantine period imposed by the Spanish Government. A sample of 1,123 Spanish children (50% girls) aged 3 to 12 (Mage = 7.26; SD = 2.39) participated in the study. Results showed differences in the use of specific strategies by children in different age groups (i.e., 3-6, 7-9 and 10-12-year-olds). Despite the uncontrollable nature of the pandemic-related stressors, child disengagement coping was distinctively associated to negative outcomes (i.e., higher levels of behavioral and emotional difficulties), whereas engagement coping predicted psychosocial adjustment across all age groups. Moreover, interactively with child coping, parent fear of the future and parent dispositional resilience appear as relevant contextual factors to predict both negative and positive outcomes, but their effects seem to be age dependent, suggesting a higher contextual vulnerability for younger children. These findings might have implications for identifying individual and contextual risk and informing potential preventive interventions aimed to reduce the impact of future pandemic outbreaks on children of different ages.

Telling the Truth to Child Cancer Patients in COVID-19 Times

A notable feature of the COVID-19 pandemic is that children are less at risk of becoming infected or, if infected, less likely to become seriously unwell, so ethical discussions have consequently focused on the adult healthcare setting. However, despite a lower risk of children becoming acutely ill with COVID-19, there nevertheless may be significant and potentially sustained effects of COVID-19 on the physical, psychological, and emotional health and well-being of children. Focusing on the context of children's cancer care, and specifically bone marrow transplant (BMT), we describe some of these effects and then address one specific ethical challenge that arises. That is the question of what and how much to tell children whose cancer treatment has been changed because of COVID-19. Drawing on our previous work on the ethical reasons for telling the truth to younger children (aged 5-12) we link different ethical reasons to the different types of information that could be given to children in this context. We argue that children should be given an explanation of the changes that they will directly experience, including some changes to the process of their actual medical treatment; but not about increased risk associated with these changes, unless they specifically ask for this information.

Perceived Impacts of the COVID-19 Pandemic on Pediatric Care in Canada: A Roundtable Discussion

Like other recipients of health care services, pediatric patients and their families/caregivers have been profoundly impacted by health care shifts and broader societal restrictions associated with the COVID-19 pandemic. An online roundtable discussion was facilitated with 7 pediatric clinicians and investigators of a current study examining the impacts of COVID-19 on pediatric care at multiple Canadian sites. Discussants represented a range of pediatric specialities: developmental disability, mental health, cardiac transplantation, respiratory medicine, hematology, and palliative care. We offer the transcript of the roundtable in which discussants reflected on clinical and programmatic experiences of the pandemic, including perceived impacts on children receiving care and their families, potential opportunities for improved health care delivery, impacts on health care providers, and recommendations as we move toward easing restrictions and pandemic recovery. Discussants convey a range of considerations that may have varying relevance for pediatric specialities in terms of practice and program planning.

A Bibliometric Analysis of Corona Pandemic in Social Sciences: A Review of Influential Aspects and Conceptual Structure

Corona pandemic has affected the whole world, and it is a highly researched area in biological sciences. As the current pandemic has affected countries socially and economically, the purpose of this bibliometric analysis is to provide a holistic review of the corona pandemic in the field of social sciences. This study aims to highlight significant, influential aspects, research streams, and themes. We have reviewed 395 journal articles related to coronavirus in the field of social sciences from 2003 to 2020. We have deployed 'biblioshiny' a web-interface of the 'bibliometrix 3.0' package of R-studio to conduct bibliometric analysis and visualization. In the field of social sciences, we have reported influential aspects of coronavirus literature. We have found that the 'Morbidity and Mortality Weekly Report' is the top journal. The core article of coronavirus literature is 'Guidelines for preventing health-care-associated pneumonia'. The most commonly used word, in titles, abstracts, author's keywords, and keywords plus, is 'SARS'. Top affiliation is 'The University of Hong Kong'. Hong Kong is a leading country based on citations, and the USA is on top based on total publications. We have used a conceptual framework to identify potential research streams and themes in coronavirus literature. Four research streams are found by deploying a co-occurrence network. These research streams are 'Social and economic effects of epidemic disease', 'Infectious disease calamities and control', 'Outbreak of COVID 19,' and 'Infectious diseases and the role of international organizations'. Finally, a thematic map is used to provide a holistic understanding by dividing significant themes into basic or transversal, emerging or declining, motor, highly developed, but isolated themes. These themes and subthemes have proposed future directions and critical areas of research.

Preparing Children for Pandemics

COVID-19 has given us a food for thought that whether we are prepared for such pandemics or not. Developed nations may say that they have enough resources to tackle such situations, but when it comes to the physical and emotional security of the children, even they have to think manifolds because preparing children for such pandemics need lot of effort and apt planning. The purpose of this chapter is to reflect issues related to children during any infectious disease outbreak like COVID-19. Adults are mature enough to control their emotions and can act patiently, but immature minds are always perplexed and act in a very clingy way when some adverse situation is thrown to them. Children are ardent observers and act according to the reactions of the folks around them. It is difficult for them to conceal their behavior, and it is difficult for parents as well to manage their anxiety levels. During crisis period when social distancing and refrained outdoor activities have brought our children into a knotty situation, it is necessary that we understand their fears and myths, try to resolve their concerns in a polite way and strengthen their minds. At this stage the role of parents, teachers, educational institutes, social media, and international children’s organizations need to be redefined. The importance of the decisions taken by the governing bodies should be explained to the children in an effective way, so that they do not panic and reflect a brave attitude. UNICEF in collaboration with international health support systems and departments has a major role to play. Appropriate planning for preparing the children for pandemics has to be incorporated in our system, so that any future crisis can be dealt in an easier way. Schools colleges and other educational institutes should execute immunization and hygiene and health practices in advance to promote prevention.

Pediatric perspectives on diabetes self-care: a process of achieving acceptance

We conducted this qualitative study to explore children's and adolescents' perspectives about diabetes self-care, their knowledge of diabetes, and their emotions associated with having the disease. Drawing on the new sociological approach that acknowledges children's competence in discussing complex issues that concern them, we conducted individual interviews with a cross-sectional sample of 48 patients between the ages of 5 and 18 years. We recruited participants from a diabetes outpatient clinic within a large pediatric hospital in one of Canada's major urban centers. In this article, we present data from the following major themes: self-care, knowledge, and emotions. Through an in-depth analysis of these integrated themes, we offer validation that emotional support, along with disease education, provides supportive conditions for engaging in self-care and a process of acceptance.