# data[].attributes.body
- COVID-19 and Children
- Evictions and COVID-19
- COVID and Mental Health

# data[].attributes.body
- Toll on children's mental health and education
- Health Care
- Vaccinations
- Masks
- Social Distancing

# data[].attributes.body
- COVID in California
- COVID in the U.S.A.
- Families & COVID
- Businesses & COVID

# data[].attributes.body
Hello, I work in the mental health field and I have seen so many different issues that have arisen at work and within my family life due to COVID. I am sure everyone in our group has been affected in some way or another.
I work at a state prison. I was the first person sent out to go take vital signs on a an inmate in his housing unit. Now mind you, this was in March of 2020 when COVID first started coming out.  I asked  why doesn't the inmate just come to TTA (treatment and return)? the answer was just do it at his housing. I wasn't told to take precautions as
in protective clothing, gloves, face mask, face mask, hair net etc. my gut feeling told me to get protected , so I did. On the way to the housing unit , I had all protective gear on like a space suit, it was hot so I  was sweating. I was praying while I was walking, asking God to cover me.
I took vital signs on 3 inmates and then returned to TTA and gave them my findings.
The next day was my day off. I got a call from my supervisor at the time. He told me that wanted to report to me that one of the inmates that I was in contact with the day before had a positive COVID test and I was exposed. That inmate was the first inmate diagnosed with Covid at that prison.
We as a people were just starting to hear about Covid, but there I was ,right, front and center , exposed.  I have asthma and I thought my lungs were going to close and I thought I was going to die.
I didn't get COVID. God covered me! We ended up having an all out outbreak at the prison and I did end up getting COVID in September of 2020. It was not my time to die, I survived. Thank God! To this day, it still affects my mental health.

# data[].attributes.body
As per an affect on children's mental  health and education, I wasn't really affected due to the fact that my children are grown.
I saw what was happening on the news. It was very sad to see certain stories about parents dying from COVID and leaving young children behind. I'm sure many children suffered some type of mental health issues from that.
Health care seemed null in void. You couldn't even go to the doctor or the ER.
Children lost their health care due to the fact their parents may have lost their jobs. No income coming in. I was blessed to continue to work throughout the COVID outbreak, though at the same time always scared to go to work and contract COVID.
When the vaccine was offered, I was so scared to take it and feel the symptoms of COVID again, I thought again that I would die from the vaccine. I didn't take it. I had to take weekly COVID test to keep working. Every week was mental health dread waiting for the results. This last month, we were told that the vaccine was mandatory to keep our employment or use religious or medical excuses. My 20 year old daughter, Summer told me she wanted to take the vaccine so I told myself, I have to take the vaccine anyway. I will Take it with her so she wont feel alone and If I die from the vaccine, it was so she wouldn't be alone. (more mental health issues to deal with). Summer was fine after the vaccine. I was sick for 3 days. slight fever, aches and panes throughout my whole body, chills, sleeping was the only time I was not in pain.
I wear a mask everyday, but at this point, I don't think anything is going to save you from getting COVID, Nothing. I think everyone is going to get it.

# data[].attributes.headline
According to the UC Berkeley Labor Center, California’s economy experienced massive job losses from the pandemic. California is still recovering and compared to other states we lost a larger proportion of jobs and California’s labor market has also had a big decrease. Many people are still experiencing financial hardship. Another concern is small businesses are also finding it hard to find workers for lower wage jobs. The Pandemic has been hard on families and created extra stress and worries for working parents. One positive thing for families has been that they have had more family time to spend together. https://laborcenter.berkeley.edu/californias-labor-market-in-the-time-of-covid-19-2021-chartbook/

# data[].attributes.subject
According to the UC Berkeley Labor Center, California’s economy experienced massive job losses from the pandemic. California is still recovering and compared to other states we lost a larger proportion of jobs and California’s labor market has also had a big decrease. Many people are still experiencing financial hardship. Another concern is small businesses are also finding it hard to find workers for lower wage jobs. The Pandemic has been hard on families and created extra stress and worries for working parents. One positive thing for families has been that they have had more family time to spend together. https://laborcenter.berkeley.edu/californias-labor-market-in-the-time-of-covid-19-2021-chartbook/

# data[].attributes.body
Cheri Caplinger

# data[].attributes.headline
Evictions and Covid19                      The state of California has really tried to help renters during the pandemic with rental assistance. The Rent Relief program pays eligible tenants 100 percent of the tenants past due rent and even  their past due utilities. The program is a free program and landlords are required to apply for rental assistance before they try to evict a tenant. https://housing.ca.gov/tenant/protection_guidelines.html      

# data[].attributes.subject
Evictions and Covid19                      The state of California has really tried to help renters during the pandemic with rental assistance. The Rent Relief program pays eligible tenants 100 percent of the tenants past due rent and even  their past due utilities. The program is a free program and landlords are required to apply for rental assistance before they try to evict a tenant. https://housing.ca.gov/tenant/protection_guidelines.html      

# data[].attributes.headline
     The number of kids getting help for depression and anxiety has risen since the pandemic the pandemic has been very hard on kids it is important to listen to kids and let them talk about their feelings, help them focus on what they can control. Help them use their time at home to learn things like music, reading and new hobbies. Encourage them that this is only temporary and wont last forever. It is important to get support from a doctor and family if they are depressed. https://www.childrens.com/health-wellness/covid-19-and-your-childs-mental-health

# data[].attributes.subject
     The number of kids getting help for depression and anxiety has risen since the pandemic the pandemic has been very hard on kids it is important to listen to kids and let them talk about their feelings, help them focus on what they can control. Help them use their time at home to learn things like music, reading and new hobbies. Encourage them that this is only temporary and wont last forever. It is important to get support from a doctor and family if they are depressed. https://www.childrens.com/health-wellness/covid-19-and-your-childs-mental-health

# data[].attributes.body
Cheri Caplinger

# data[].attributes.body
Covid has had a bad effect on children, besides basically uprooting due to switching between online and in person learning there is also the way some people are acting when it comes to some of the mandates this can possibly traumatize the children as evidenced by this site:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444649/

# data[].attributes.attachment_link.readable_text
Abstract

Background

COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe. This phenomenon has led to short term as well as long term psychosocial and mental health implications for children and adolescents. The quality and magnitude of impact on minors is determined by many vulnerability factors like developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection or fear of infection.

Aims

This paper is aimed at narratively reviewing various articles related to mental-health aspects of children and adolescents impacted by COVID-19 pandemic and enforcement of nationwide or regional lockdowns to prevent further spread of infection.

Methodology

We conducted a review and collected articles and advisories on mental health aspects of children and adolescents during the COVID-19 pandemic. We selected articles and thematically organized them. We put up their major findings under the thematic areas of impact on young children, school and college going students, children and adolescents with mental health challenges, economically underprivileged children, impact due to quarantine and separation from parents and the advisories of international organizations. We have also provided recommendations to the above.

Conclusion

There is a pressing need for planning longitudinal and developmental studies, and implementing evidence based elaborative plan of action to cater to the psycho social and mental health needs of the vulnerable children and adolescents during pandemic as well as post pandemic. There is a need to ameliorate children and adolescents' access to mental health support services geared towards providing measures for developing healthy coping mechanisms during the current crisis. For this innovative child and adolescent mental health policies policies with direct and digital collaborative networks of psychiatrists, psychologists, paediatricians, and community volunteers are deemed necessary.

Keywords: COVID-19, Lockdown, Mental health, Children, Adolescents

1. Introduction

There are more than 2.2 billion children in the world who constitute approximately 28% of the world's population. Those aged between 10 to 19 years make up 16 % of the world's population ( UNICEF, 2019). COVID-19 has impacted the lives of people around the world including children and adolescents in an unprecedented manner. Throughout the world, an essential modus of prevention from COVID- 19 infection has been isolation and social distancing strategies to protect from the risk of infection ( Shen et al., 2020). On these grounds, since January, 2020, various countries started implementing regional and national containment measures or lockdowns. In this backdrop one of the principal measures taken during lockdown has been closure of schools, educational institutes and activity areas. These inexorable circumstances which are beyond normal experience, lead to stress, anxiety and a feeling of helplessness in all.

It has been indicated that compared to adults, this pandemic may continue to have increased long term adverse consequences on children and adolescents ( Shen et al., 2020). The nature and extent of impact on this age group depend on many vulnerability factors such as the developmental age, current educational status, having special needs, pre-existing mental health condition, being economically under privileged and child/ parent being quarantined due to infection or fear of infection. The following sections discuss about findings of studies on mental-health aspects of children and adolescents impacted by COVID-19 pandemic and lockdowns being implemented at national or regional levels to prevent further spread of infection.

2. Material and methods

We searched the electronic data bases of MEDLINE through PubMed, Cochrane Library, Science-direct and Google Scholar databases, from January,2020 till June,2020. We carried out the search with the following methods like, MeSH or free text terms and Boolean operators were employed for PubMed; COVID-19 and Children [All Fields] OR (Children and COVID-19 effects [Terms] OR & Psychological effects of COVID-19 on children &Quot;[All Fields] OR (&Quot; COVID effects on children &Quot;[All Fields] AND &quot; &Quot;[All Fields]) OR effects on Children of COVID-19 &quot; Psychological effects of COVID, Children &quot;[All Fields]) OR (&quot;COVID-19 and children &quot;[MeSH Terms] OR &quot; Psychological effects of COVID-19, Children &quot;[All Fields]. This search strategy and terms were modified for other databases as appropriate. The searches were done by five independent reviewers. A manual search was also conducted of the references of the related articles to gather information about the relevant studies. Initial PubMed search with the term with " COVID-19 in children" showed only 12 results. Among these, only four articles were related to "Psychological effects of COVID in children". Therefore in order to make the review more comprehensive and informative, we also included studies that reported the effect on older children and impact of COVID1-19 on their lives. This was done keeping in mind the varied terminologies used to describe the phenomenon of 'Children and COVID-19". After using the above strategy, our search showed 112 results. Only articles in English language peer reviewed journals were included. Grey literature such as conference proceedings were not included due to possibility of insufficient information. We included case studies and review articles and Advisories by the WHO (World Health Organization), APA (American Psychiatric Association) and NHS (National Health Services) and Government of India Ministry of Health. Based on these inclusion criteria we included 22 articles. Three independent authors participated in study selection and all authors reached a consensus on the studies to be included. Being a narrative review, we did not attempt computation of effect sizes or do a risk of bias assessment for included papers.

The studies included were categorized under eight headings divided in various thematic sections and discussed with studies and reports found. The data is qualitatively analysed and reported in the paper. A summary of the papers included in this narrative review is presented in Table 1 .

Table 1

Sl.

Thematic area

Author and Year

Articles

Findings

Conclusions

1

School closures during COVID-19

Viner, R.M et al. (2020).

School closure and management practices during coronavirus outbreaks including COVID-19: A rapid systematic review
Lancet Child Adolescent Health

This systematic review included 16 articles on Closure of schools in China and its impact on transmission on COVID-19.
Studies using modelling method showed that closing the schools in itself contributes to 2-4% additional prevention of deaths due to COVID-19, which is quite less than using other methods of social distancing.

For academic social and psychological reasons, Policy makers need to consider combinations of social distancing measures which are less disrupting if restrictive social distancing policies are needed for long periods.

2

Mental health effects of School Closures

Lee, J. (2020)

Mental health effects of school closures during COVID-19. Lancet Child & Adolescent Health.

School routines are crucial for young people with mental health challenges as schools help them to cope and structure their behavior.
Children with special education needs are at high risk.
Also since the pandemic and lockdown has caused economic distress, there are indications of increased abuse towards children.

Since the pandemic is ongoing it is crucial to provide psycho social support to the minors who are highly vulnerable and are exposed to various economic and social stressors.

3

Mental health considerations for children quarantined

Liu.J.,Bao Y.,Huang X.,&Lu Lin.(2020).

Mental health considerations for children quarantined because of COVID-19. Short review

A large number of children have been quarantined in addition to the adult population.
Quarantine policies have been developed keeping in mind the impact of quarantine on mental health aspects of children

Paediatric health care workers need to focus on the emerging mental health issues of children. Recommendations should be made for early identification of mental health issues and appropriate referrals and management.

4

Impact on Young People with Mental Health Needs

The mental health charity Young Minds, 2020

Coronavirus: Impact on Young People with Mental Health Needs: 2020. Survey

Survey of 2111 individuals [age<=25 years] with history of mental health conditions in UK. The current pandemic and lockdown worsened their condition. About 26% of then were unable to access the mental health services. Since support groups and 'face to face services' were stopped.
Certain activities and routines were important coping mechanisms. Support by tele or online services was found challenging by some youth.

It was recommended that maintenance of social contact with families and friends by tele services or social platforms would help to reduce stress. However, excessive social media use should be under check.

5
Stress in students due to postponement of exams
Ng Kang chug, 5 April 2020

Coronavirus: stress over university entrance exams has skyrocketed amid Hong Kong school closures, study finds. (survey) South China morning post

The March poll, which interviewed 757 students before the first postponement of the Diploma of Secondary Education (DSE) exam - showed that over 20 per cent reported that the level of stress faced by them was maximum (10 / 10). The students reported feeling 'helpless' in this condition.

Authorities to be more transparent in their negotiations and to allow candidates sufficient notice to prepare emotionally as well. Students to be timely provided counselling.

6

Behavioral and Emotional Disorders in Children

Jiao, W. Y., Wang, L. N., Liu, J., Fang, S. F., Jiao, F. Y., Pettoello-Mantovani, M., & Somekh, E. (2020)

Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. The Journal of Paediatrics. Commentory

A collaborative working group of China-EPA-UNEPSA found
clinginess, difficulty in attention, and being irritable as commonest psychological conditions shown by all minors. Media entertainment was largely successfully used by families as a means to relieve their children's distress.

The measures suggested to the parents and their families were to increase communication with minors, playing collaborative games, encouraging physical activity, and music therapy . Moreover, parents need to focus on sleep problems and nightmares in children, and forbid augmented sleep during the daytime

7

Associations of social distancing with Mental and Social Health in adolescent.

Oosterhoff.B,et al (2020)
Adolescents' Motivations to Engage in Social Distancing during the COVID-19 Pandemic: Associations with Mental and Social Health.
98.1% respondent adolescents shared that they engaged in at least some method of maintaining social distancing. they found that different motivations for social distancing were related with the symptoms of anxiety and depression and feeling of burdensomeness and belongingness.

Among youth it is found that social distancing is viewed primarily as a social responsibility and is followed more sincerely if it is motivated by prosocial reasons to prevent others from getting sick, hence prosocial motivation for this cause should be encouraged.

8

Children and adolescents with eating disorders

David.C et al (2020).

Caring for children and adolescents with eating disorders in the current COVID-19 pandemic: A Singapore perspective. Journal of Adolescent Health.

Services for paediatric disorders related to eating habits care had made major adaptations in terms of the service delivery. This was done in response to the changing psychological and social requirements of the needs of people in Singapore during containment phase. Partnerships were established with school counselling and community services. They showed that "Coronaphobia" effected the patients' visits and increased existing health anxiety in some people.

The experience of the study provides suggestions to deal with stress and provide support for children and adolescents with eating disorders
in the present during periods of crisis.

9

Diagnosis, treatment, and prevention COVID 19 infection in children

Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, et al.

Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement. World J Pediatr 2020.

An expert committee was called to gather consensus and standardize COVID 19 prevention and management in children. It was found that psychological counselling improves rate of recovery. If children have complaint of mood swings, fear or psychological disorder timely psychological management is warranted.

Methods of promotion of healthy and balanced diet, maintaining oral health, physical exercise, proper rest, avoidance of fatigue, and enhancing immunity are prescribed measures to preventi infection, and improving mental health

2.1. Impact on young children

Stress starts showing its adverse effect on a child even before he or she is born. During stress, parents particularly pregnant mothers are in a psychologically vulnerable state to experience anxiety and depression which is biologically linked to the wellbeing of the foetus ( Biaggi et al., 2016; Kinsella and Monk, 2009). In young children and adolescents the pandemic and lockdown have a greater impact on emotional and social development compared to that in the grown-ups. In one of the preliminary studies during the on-going pandemic, it was found younger children (3-6years old) were more likely to manifest symptoms of clinginess and the fear of family members being infected than older children (6-18 years old). Whereas, the older children were more likely to experience inattention and were persistently inquiring regarding COVID-19. Although, severe psychological conditions of increased irritability, inattention and clinging behaviour were revealed by all children irrespective of their age groups ( Viner et al., 2020a). Based on the questionnaires completed by the parents, findings reveal that children felt uncertain, fearful and isolated during current times. It was also shown that children experienced disturbed sleep, nightmares, poor appetite, agitation, inattention and separation related anxiety ( Jiao et al., 2020).

2.2. Impact on school and college going students

Globally, the pre-lockdown learning of children and adolescents predominantly involved one-to-one interaction with their mentors and peer groups. Unfortunately, the nationwide closures of schools and colleges have negatively impacted over 91% of the world's student population ( Lee, 2020). The home confinement of children and adolescents is associated with uncertainty and anxiety which is attributable to disruption in their education, physical activities and opportunities for socialization ( Jiao et al., 2020). Absence of structured setting of the school for a long duration result in disruption in routine, boredom and lack of innovative ideas for engaging in various academic and extracurricular activities. Some children have expressed lower levels of affect for not being able to play outdoors, not meeting friends and not engaging in the in-person school activities ( Lee, 2020; Liu et al., 2020; Zhai and Du, 2020). These children have become more clingy, attention seeking and more dependent on their parents due to the long term shift in their routine. It is presumed that children might resist going to school after the lockdown gets over and may face difficulty in establishing rapport with their mentors after the schools reopen. Consequently, the constraint of movement imposed on them can have a long term negative effect on their overall psychological wellbeing ( Lee, 2020).

A study found that older adolescents and youth are anxious regarding cancellation of examinations, exchange programs and academic events ( Lee, 2020). Current studies related to COVID-19 demonstrate that school shut downs in isolation prevent about 2-4% additional deaths which is quite less if compared to usage of other measures of social distancing. Moreover, they suggest to the policy makers that other less disrupting social distancing strategies should be followed by schools if social distancing is recommended for a long duration ( Lee, 2020; Sahu, 2020; Viner et al., 2020a). However, in current circumstances, it is controversial whether complete closure of school and colleges is warranted for a prolonged period.

It has been reported that panic buying in times of distress indicate an instinctual survival behaviour ( Arafat et al., 2020). In present pandemic era there has been a rise in the hoarding behaviour among the teenagers ( Oosterhoff et al., 2020a). It is also found that among youth social distancing is viewed primarily as a social responsibility and it is followed more sincerely if motivated by prosocial reasons to prevent others from getting sick (Oosterhoff et al., 2020a). Further, due to prolonged confinement at home children's increased use of internet and social media predisposes them to use internet compulsively, access objectionable content and also increases their vulnerability for getting bullied or abused ( Cooper, 2020; UNICEF, 2020b). Worst of all, during lockdown when schools, when legal and preventative services do not functioning fully, children are rarely in a position to report violence, abuse and harm if they themselves have abusive homes.

2.3. Impact on children and adolescents having special needs

There are about 1 in every 6 children within the age group of 2-8 years who have some or the other neurodevelopmental, behavioural or emotional difficulty ( CDC, 2019). These children with special needs [autism, attention deficit hyperactivity disorder, cerebral palsy, learning disability, developmental delays and other behavioural and emotional difficulties] encounter challenges during the current pandemic and lockdown ( CDC, 2019). They have intolerance for uncertainty and there is an aggravation in the symptoms due to the enforced restrictions and unfriendly environment which does not correspond with their regular routine. Also, they face difficulties in following instructions, understanding the complexity of the pandemic situation and doing their own work independently. With the closure of special schools and day care centres these children lack access to resource material, peer group interactions and opportunities of learning and developing important social and behavioural skills in due time may lead to regression to the past behavior as they lose anchor in life, as a result of this their symptoms could relapse ( Lee, 2020). These conditions also trigger outburst of temper tantrums, and conflict between parents and adolescents. Although prior to the pandemic, these children had been facing difficulties even while attending special schools, but in due course they had learnt to develop a schedule to adhere to for most of the time of the day ( APA, 2020; Cortese et al., 2020; UNICEF, 2020a). To cater to these challenges, it is difficult for parents to handle the challenged children and adolescents on their own, as they lack professional expertise and they mostly relied on schools and therapists to help them out ( Dalton et al., 2020).

Since every disorder is different, every child has different needs to be met. The children with autism find it very difficult to adapt to the changing environment. They become agitated and exasperated when anything is rearranged or shifted from its existing setup. They might show an increase in their behavioral problems and acts of self-harm. It is a huge challenge for parents to handle autistic children due to lockdown. The suspension of speech therapy and occupational therapy sessions could have a negative impact on their skill development and the achievement of the next milestone, as it is difficult for them to learn through online sessions ( UNICEF, 2020a). The children with Attention Deficit Hyperactivity Disorder (ADHD), struggle to make meaning of what is going around them from the cues they get from their caregivers. It is difficult for them to remain confined to a place and not to touch things, which might infect them. Due to being confined to one place the chances of their hyperactivity increases along with heightened impulses and it becomes difficult for the caregivers to engage these children in meaningful activities ( Cortese et al., 2020).

Obsessive compulsive disorder (OCD) among the children and adolescents is estimated to be of 0.25%-4% among children and adolescents ( CDC, 2019). Children with OCD are suspected to be one of the most affected ones by this pandemic. Due to obsessions and compulsions related to contamination, hoarding, and somatic preoccupation, they are expected to experience heightened distress. Cleanliness is one key protective measure against the spread of COVID-19. According to United Nations' policy guidelines to fight the infection one has to be careful about washing their hands six times a day, and whenever they touch anything ( APA, 2020; United Nations, 2020). The lockdown, which has made the healthy population distressed about possessing enough food and prevention related resources like masks and sanitizers, has made it worse for people with hoarding disorder ( APA, 2020; Mukherjee et al., 2020)

2.4. Impact of lockdown on underprivileged children

Social inequality has been associated with the risk of developing mental health challenges. The pandemic and lockdown world has experienced global economic turn-down which has directly worsened the pre-existing social inequality. In developing countries, with the imposed lockdown, the underprivileged children face acute deprivation of nutrition and overall protection. The prolonged period of stress could have a long term negative impact on their development. For instance, in India, which has the largest child population in the world with 472 million children, the lockdown has significantly impacted 40 million children from poor families. These include children working on farms, fields in rural areas, children of migrants and street children ( Dalton et al., 2020; Rosenthal et al., 2020). An increasing number of poor and street children now have no source of income, making them a high risk population to face abuse and mental health issues with greater vulnerability and exposure to unfavorable economic, social and environmental circumstances ( Birla, 2019).

A home represents a source of security and safety in most families. However, for the poor and the underprivileged it is just the opposite. With the restriction of movement due to lockdown, these children have increased risk of being exploited and become victims of violence and abuse ( Cooper, 2020; United Nations, 2020). The Deputy Director of 'CHILDLINE 1098' India, announced that India saw a 50 per cent increase in the calls received on helpline for children since the lockdown began ( PTI, 2020). This increase in rate is alarming and has made an increasing number of child victims in their own homes.

During the time of lockdown an increasing number of poor families have no source of daily wages which lead to frustration and feelings of helplessness. By the reason of displacement, the frustration and family conflict may manifest itself in the form of violence towards children. This can make the child more vulnerable to depression, anxiety and suicide ( Jiao et al., 2020; Petito et al., 2020; Solantaus et al., 2020) School closure coupled with economic adversity may force children and adolescents into child labour. Likewise, children without parents or guardians are more prone to exploitation ( United Nations, 2020).

In order to cover up the loss of education during lockdown, many schools have offered distance learning or online courses to students. However, this opportunity is not available to underprivileged children as a result of which they face a lack of stimulation and have no access to online resource material to study. A study pointed out that in underprivileged families, in comparison to boys, girls have decreased access to gadgets, this may diminish their involvement in digital platforms of education ( McQuillan and Neill, 2009). Due to this gender inequality, increasing number of girls are prone to bear the consequences of school dropouts once the lockdown is lifted ( Cooper, 2020; PTI, 2020).

2.5. Impact due to quarantine and separation from parents

COVID-19 infection is expressed differently in children and adolescents. Yet the incidents of infection in the minors have been reported worldwide, which result in children being quarantined. Moreover, in many cases a single parent or both the parents are infected and quarantined. In either condition children are separated from their parents. Many countries have laid down strict quarantine policies as a measure to fight COVID-19 pandemic. Such as in China several adults, adolescents and children have been put in complete isolation to control the spread of infection. Although quarantining measures are for the benefit of the community at large, its psychological effects cannot be ignored ( Liu et al., 2020). The children who are in isolation require special attention as these children might be at risk of developing mental health problems due to grief caused by of parental separation. As during the formative years of life, the role of parents is very crucial, any disruption in the form of isolation from parents can have long term effects of perceived attachment of the child. It is found that separation from the primary caregivers can make a child more vulnerable and can pose a threat to a child's mental health ( Cooper, 2020; Jiao et al., 2020; Liu et al., 2020). The children may develop feelings of sadness, anxiety, fear of death, fear of parents' death and fear of being isolated in the hospital which may have a very detrimental effect on their psychological development ( APA, 2020; CDC, 2019; Dalton et al., 2020). Children have emotionally pent up feelings of distress which may turn inwards into emotional fear or outwards towards acting out behavior ( Liu et al., 2020). They might feel separated or alone as they have limited knowledge and level of maturity to understand the implications of the current pandemic situation in their limited world.

2.6. Advisories of international organizations

With the objective of universal prevention and mental health promotion, the International organizations and advisory bodies have issued various guidelines taking into account the mental health needs of children during the COVID-19. They have suggested parents to interact constructively with the children by communicating with them about the current pandemic, according to their maturity level and their ability to comprehend the crisis. Parents should plan their children's tasks one at a time, involve them in various home activities, educate them about following hygiene habits and social distancing, engage in indoor play and creative activities. In addition to these activities, adolescents are advised to be involved in household chores and understand their social responsibilities ( WHO, 2020b). Interventions supervised by adults can help them in understanding their concerns. The activities of children and adolescents should include more structure in home schooling activities. Children should be encouraged to socialize with their friends and classmates through digital forums under adult supervision ( WHO, 2020a).

The advisory committees have also provided guidelines for managing children with special needs and neurodevelopmental disorders ( UNICEF, 2020a, 2020b; WHO, 2020a). The children prone to risk for trauma and heightened anxiety. The children need early identification prompt management involving the parents and experts to prevent long term mental health morbidity.

2.7. Recommendations

It is imperative to plan strategies to enhance children and adolescent's access to mental health services during and after the current crisis. For this direct and digital collaborative network of various stakeholders is required. Recommendations for ensuring mental well-being of children and adolescents during the COVID-19 pandemic and lockdown and the role of parents, teachers, pediatricians, community volunteers, the health system and policy makers are being discussed. In addition a brief summary of the roles is given in Table 2 .

Table 2

S. no.

Target Group/Support System

Primary Roles

1
Young Children

2
School going children and adolescents

3
Children with special needs

4
Underprivileged/vulnerable children

5
Quarantined parents/children

2.8. Role of Parents

In the times of paramount stress and uncertainty, a secure family environment which the parents can provide is a strong protective factor ( Schofield et al., 2013). There is evidence to show that parental practices and coping measures affect the children's post disaster mental health ( Cobham et al., 2016). Parents need to respond to the needs of their children based on the developmental phase of the child is being discussed below:

2.12. Role of pediatricians

During a child's formative years when their personalities are shaped, parents are in regular touch with pediatricians, as parents reach out to their local pediatricians whenever they encounter health/ behavioral complaints associated with their children. Parents expect answers from them as they trust them. Hence a pediatrician's role is paramount in promoting mental health, developing resilience, recognizing mental health problems, and coordinate with the mental health care providers when it comes to mental health care of children. In the backdrop of COVID 19 specific roles of pediatricians are enlisted below:

2.15. Critical appraisal of the studies included

The studies included in the review were collected after setting criteria to have a comprehensive view of the global vision in managing the crisis of children in the COVID-19 pandemic. The majority of the studies included in the review were based on online self-reports( Bhat et al., 2020; Jiao et al., 2020; Oosterhoff et al., 2020b). The adults and older children were the respondents of the study( Lee, 2020; Liu et al., 2020; Viner et al., 2020b; Wang et al., 2020). The studies are mainly carried out in the developed nations and the East Asian countries. Studies have reported the concerns may not be generalizable throughout the globe. There are variations in the number of samples as well, thus they make it difficult to generalize the findings of their study alone.

The cross sectional studies are useful in understanding the immediate or short term impact apparent at a certain point of time. However the limitations of these cross sectional studies are that these studies cannot conclude about the long term impact of COVID-19, given that certain pre-existing vulnerabilities, high risk factors and stressors could be multiple, ongoing or recurrent and also the manner through which they work may vary. Consequently, there is a pressing need for carrying out longitudinal and developmental studies to be able to apprehend multiple layers of dynamic determinants playing role during this time of global crisis ( Holmes et al., 2020).The literature suggests the need for evidence based elaborative strategies and plan of action to cater to the mental health needs of children and adolescents during the period of pandemic ( Wade et al., 2020).

3. Limitations

The review articles for this review have been selected during the time of global lockdown, where the issues and challenges were new and the global crisis was at peak times. In our review, we were unable to track the measures of management targeted towards the children. The strategies reported in the studies were isolated to geopolitical conditions. The recommendations provided in this review can be modified to suit the needs of the places according to their local resources and geopolitical scenarios. Due to strict selection criteria and the short period of data collection and the only use of electronic databases for our research, there is a possibility of missing studies relevant to the care of children and adolescents.

4. Conclusion

Although the rate of COVID-19 infection among young children and adolescents is low, the stress confronted by them poses their condition as highly vulnerable. Many cross-sectional studies have been conducted to analyze the impact of COVID-19 and lock down on children and youth. The results of these studies show that the nature and extent of this impact depend on several vulnerability factors such as the developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection /fear of infection. Studies show that young children show more clinginess, disturbed sleep, nightmares, poor appetite, inattentiveness, and significant separation problems.

The containment measures like school and activity centers closures for long periods together expose the children and youth to the debilitating effects on educational, psychological, and developmental attainment as they experience loneliness, anxiety, and uncertainty. Compulsive use of internet gaming and social media puts them at higher risk. Children and adolescents with mental health conditions are not used to variation in the environment. Hence there could be an exacerbation in symptoms and behavioral problems.

The children who receive training, therapy, and other treatments are at high risk of being derailed from therapy and special educations. Economically underprivileged children are particularly prone to exploitation and abuse. Children quarantined are at high risk for developing higher risk for mental health-related challenges.

There is a need to ameliorate children and adolescent's access to mental health services by using both face to face as well as digital platforms. For this collaborative network of parents, psychiatrists, psychologists, pediatricians, community volunteers, and NGOs are required. There is a need for 'tele mental health compatibility' and be accessible to the public at large. This would be crucial to prevent during and post-pandemic mental challenges in the most vulnerable and underprivileged section of the society. The focal point of the health care system and policymaking should be prevention, promotion, and interventions corresponding to the public mental health system to meet the mental health needs of the population at large by taking the regional contextual parameters into account.

Disclosure of prior presentation of study data

This paper has not been submitted in full or part in any conference and is not being considered for publication elsewhere.

Financial disclosure

This is a completely researcher initiated study without any external funding whatsoever.

CRediT authorship contribution statement

Shweta Singh: Writing - review & editing, Software, Validation, Supervision, Data curation, Writing - original draft, Conceptualization, Methodology. Deblina Roy: Validation, Visualization, Investigation, Data curation, Writing - original draft, Software. Krittika Sinha: Visualization, Investigation, Data curation, Writing - original draft. Sheeba Parveen: Visualization, Investigation. Ginni Sharma: Visualization, Investigation, Data curation, Writing - original draft. Gunjan Joshi: Visualization, Investigation, Data curation, Writing - original draft.

Declaration of Competing Interest

There is no known conflict of interest.The authors whose names are listed below certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants, participation in spakers' bureaus arrangements, consultancies, memberships, stock ownerships, or other equity interest, or expert testimony and patent licencing arangements) or non financial interests such as ( personal or professional relationships, affiliations, knowledge or beliefs)in the subject matter or materials discussed in this manuscript. All the authors confirm that, all of them has contributed in the conception of design; analysis, interpretation of data; drafting the article; critically revisiting the article for important intellectual inputs; and approval of the final version. This paper has not been submitted elsewhere or is under review at another journal or publishing venue. The authors have no affiliation with any organization, with a direct or indirect financial interest in the subject matter discussed in the manuscript.

Acknowldegment

We would like to Acknowldge the efforts of Mrs. Meenakshi Seth and Mr. Prakhar Bhanu, who were involved in improving the language of the manuscript. Additionally the authors are gratefull to the CORONA Warriers i.e. the Health Care Workers for their selfless and tremendous service to the mankind.

Footnotes

☆ This paper is aimed at reviewing articles related to mental-health aspects of children and adolescents impacted by COVID-19 pandemic and lockdowns. There is a need to carry out longitudinal and developmental studies and plan strategies to enhance children's and adolescent's access to mental health services during and after the current crisis. For this direct and digital collaborative network of psychiatrists, psychologists, pediatricians, and community volunteers are of vital importance.

Supplementary material associated with this article can be found, in the online version, at doi: 10.1016/j.psychres.2020.113429.

Appendix. Supplementary materials

References

Arafat S.Y., Kar S.K., Marthoenis M., Sharma P., Apu E.H., Kabir R. Psychiatry Research. PMC; 2020. Psychological underpinning of panic buying during pandemic (COVID-19) [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

Cobham V., McDermott B., Haslam D., Sanders M. The role of parents, parenting and the family environment in children's post-disaster mental health. Curr. Psychiatry Rep. 2016:18. doi: 10.1007/s11920-016-0691-4. [[ PubMed] [ CrossRef] Google Scholar]

McQuillan H., Neill B.O. Gender differences in children's internet use: key findings from Europe. J. Child. Media. 2009;3(4):366-378. doi: 10.1080/17482790903233408. [[ CrossRef] Google Scholar]

Petito A., Pop T.L., Namazova-Baranova L., Mestrovic J., Nigri L., Vural M., Sacco M., Giardino I., Ferrara P., Pettoello-Mantovani M. The burden of depression in adolescents and the importance of early recognition. J. Pediatr. 2020;218:265-267. doi: 10.1016/j.jpeds.2019.12.003. [[ PubMed] [ CrossRef] Google Scholar]

Schofield G., Beek M., Ward E., Biggart L. Professional foster carer and committed parent: Role conflict and role enrichment at the interface between work and family in long-term foster care. Child Fam. Soc. Work. 2013;18(1):46-56. doi: 10.1111/cfs.12034. [[ CrossRef] Google Scholar]

Shen K., Yang Y., Wang T., Zhao D., Jiang Y., Jin R., Zheng Y., Xu B., Xie Z., Lin L., Shang Y., Lu X., Shu S., Bai Y., Deng J., Lu M., Ye L., Wang X., Wang Y.... . Diagnosis, Treatment, And Prevention Of 2019 Novel Coronavirus Infection In Children: Experts' Consensus Statement. World Journal of Pediatrics : WJP; 2020. Global Pediatric Pulmonology Alliance; pp. 1-9. PubMed. [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

26. Solantaus, Leinonen, T., Punamäki, J., & Raija-Leena. (200 C.E.). Children's mental health in times of economic recession: replication and extension of the family economic stress model in Finland. Dev. Psychol., 404,(3), 412-429. [ PubMed]

United Nations Policy brief: the impact of COVID-19 on children. United Nations. 2020:1-17. Policy breif] [ Google Scholar]

Articles from Psychiatry Research are provided here courtesy of Elsevier

# data[].attributes.attachment_link.title
Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations

# data[].attributes.attachment_link.description
COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe. This phenomenon has led to short term as well as long term psychosocial and mental health implications for children and adolescents. The quality and magnitude ...

# data[].attributes.body
While I haven't been around too many children affected by the Covid situation seeing some of the "adults" acting like animals on the news or other various media outlets when it comes to protesting going as far as harassing teachers for requiring the mandate while it is something ordered by the higher ups can cause the children to be terrified to go places when adults are outside acting like that.

# data[].attributes.body
I agree with what the person above me stated while it has been positive with families getting to spend time together it also brings out more negatives such as people becoming fools and taking their anger out on others they see as scapegoats due to things people in positions of power have said in the recent past.

# data[].attributes.body
I agree with you. Spending more time with family has just as many advantages. Everyone may agree that California's economy, particularly small businesses, suffered greatly prior to the pandemic. As much as I want to be an optimist, I believe there have been more disadvantages than advantages with everything that has happened.

# data[].attributes.body
Covid and mental health is a subject that I haven't seen many people discuss. Many people were obliged to interrupt their daily routines and stay at home due of the pandemic. While many others may have enjoyed this personally during this time brought on a lot of anxiety and depression through the whole year. Many Americans lost their jobs and social relationships during this time, and their mental health suffered as a result. During the pandemic, many of my family and friends suffered from mental health concerns, and I still have people who struggle to go out and be social.

# data[].attributes.body
For many of us, vaccination is a current hot topic. While some people recognize the value of vaccinations, others refuse to do so. Personally, I feel that we should all be able to choose what is best for our bodies. It is crucial for others' and our own health, which is why so many people are being vaccinated. I believe that no one should be forced to take the vaccine against their choice, but I also believe that we should educate others so that they can make informed decisions.

# data[].attributes.body
Opposing Viewpoints

CQ Researcher

Gale eBooks

# data[].attributes.attachment_link.readable_text
Skip to Main Content

It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. If you continue with this browser, you may see unexpected results.

# data[].attributes.attachment_link.title
LibGuides: VVC Library: Article Databases

# data[].attributes.attachment_link.description
Skip to Main Content It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. If you continue with this browser, you may see unexpected results.

# data[].attributes.body
Covid-19 has started in Wuhan, China and began spreading from there to other countries. It is a deadly contagious virus that infects hosts, it can make you feel nausea, fever or chills, make you have fatigue, headaches, sore throat, and etc. It has brought down many business's and family's and is bringing the economy down since no one has been working and multiple people have been getting sick.

# data[].attributes.body
Ever since the pandemic hit many people died from it at the beginning, but since a vaccine was produced less people died then before. The health of people is also not good since many places were closed due to the virus and left many unhealthy. The virus is a huge threat to children besides older people because since children don't have an effective immune system they can die much easier than adults or teens.

# data[].attributes.body
For children it can be hard for them to learn since most schools are closed so schools improvised and stuck with online schooling which can still be difficult for them to learn since they will be stuck looking at a screen most of the day which can have an effect on their health and all they do is sit and listen to what their teachers says. When this virus got worse and started to mutate everyone was ordered to wear a mask every time they went out. Health care is available for people to get but will have to wait long hours because the doctor's and nurses are overwhelmed by how many people are sick and need help. Many people stay away from each other because they do not want to be at risk of getting sick and thus the reason everyone is getting less social and getting into depression and anxiety.

# data[].attributes.body
COVID-19 affects different people in different ways. Infected people have had a wide range of symptoms reported – from mild symptoms to severe illness.

Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:

Fever or chills

Cough

Shortness of breath or difficulty breathing

Fatigue

Muscle or body aches

Headache

New loss of taste or smell

Sore throat

Congestion or runny nose

Nausea or vomiting

Diarrhea

Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:

Trouble breathing

Persistent pain or pressure in the chest

New confusion

Inability to wake or stay awake

Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

The best way to prevent illness is to avoid being exposed to this virus. Learn how COVID-19 spreads and practice these actions to help prevent the spread of this illness.

To help prevent the spread of COVID-19:

Wear a mask to protect yourself and others and stop the spread of COVID-19.

Stay at least 6 feet (about 2 arm lengths) from others who don’t live with you.

Avoid crowds and poorly ventilated spaces. The more people you are in contact with, the more likely you are to be exposed to COVID-19.

Get a COVID-19 vaccine when it’s available to you.

Clean your hands often, either with soap and water for 20 seconds or a hand sanitizer that contains at least 60% alcohol.

Avoid close contact with people who are sick.

Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean frequently touched objects and surfaces daily. If someone is sick or has tested positive for COVID-19, disinfect frequently touched surfaces.

Monitor your health daily.

Self care

If you have possible or confirmed COVID-19

Stay home except to get medical care.

Monitor your symptoms carefully. If your symptoms get worse, call your healthcare provider immediately.

Get rest and stay hydrated. Take over-the-counter medicines, such as acetaminophen, to help you feel better.

If you have a medical appointment, notify your healthcare provider ahead of time that you have or may have COVID-19.

Stay in a specific room and away from other people in your home. If possible, use a separate bathroom. If you must be around others, wear a mask.

Medical treatments

Treatments used for COVID-19 should be prescribed by your healthcare provider. People have been seriously harmed and even died after taking products not approved for COVID-19, even products approved or prescribed for other uses. Your healthcare provider will decide on what approach to take for your treatment.

Your healthcare provider also may recommend the following to relieve symptoms and support your body’s natural defenses.

Taking medications, like acetaminophen or ibuprofen, to reduce fever.

Drinking water or receiving intravenous fluids to stay hydrated.

Getting plenty of rest to help the body fight the virus.

If someone is showing emergency warning signs, get medical care immediately. Emergency warning signs include:

Trouble breathing

Persistent pain or pressure in the chest

New confusion

Inability to wake or stay awake

Bluish lips or face

# data[].attributes.body
The COVID-19 pandemic has had a major effect on our lives. Many of us are facing challenges that can be stressful, overwhelming, and cause strong emotions in adults and children. Public health actions, such as social distancing, are necessary to reduce the spread of COVID-19, but they can make us feel isolated and lonely and can increase stress and anxiety. Learning to cope with stress in a healthy way will make you, the people you care about, and those around you become more resilient.

Stress can cause the following:

Feelings of fear, anger, sadness, worry, numbness, or frustrationChanges in appetite, energy, desires, and interestsDifficulty concentrating and making decisionsDifficulty sleeping or nightmaresPhysical reactions, such as headaches, body pains, stomach problems, and skin rashesWorsening of chronic health problemsWorsening of mental health conditionsIncreased use of tobacco, alcohol, and other substances,  depression

It is natural to feel stress, anxiety, grief, and worry during the COVID-19 pandemic.

Healthy Ways to Cope with Stress

Take breaks from watching, reading, or listening to news stories, including those on social media. It’s good to be informed, but hearing about the pandemic constantly can be upsetting. Consider limiting news to just a couple times a day and disconnecting from phone, tv, and computer screens for a while.Take care of your bodyTake deep breaths, stretch, or meditateexternal iconTry to eat healthy, well-balanced mealsExercise regularlyGet plenty of sleepAvoid excessive alcohol, tobacco, and substance useContinue with routine preventive measures (such as vaccinations, cancer screenings, etc.) as recommended by your healthcare providerGet vaccinated with a COVID-19 vaccineMake time to unwind — Try to do some other activities you enjoyConnect with others — Talk with people you trust about your concerns and how you are feelingConnect with your community- or faith-based organizations — While social distancing measures are in place, try connecting online, through social media, or by phone or mail
During times of extreme stress, people may have thoughts of suicide. Suicide is preventable and help is available. The risk of suicide, signs to watch for, and how to respond if you notice these signs in yourself or a friend or a loved one.

Widespread economic losses

The economic crisis unleashed by the outbreak of COVID-19 is hurting economies, regardless of income level. The most recent data from UNIDO’s seasonally adjusted Index of Industrial Production (April 2020 vs December 2019) indicate that both lower- and upper middle-income countries have been significantly impacted by COVID-19 .
There are  studie  which examined the experiences of families with school-aged children during the first three months of the 2020 pandemic of COVID-19 in the United States, while focusing on the roles of income level and race/ethnicity in their experiences. Two hundred and twenty-three parents of school-aged children participated in this study by completing an online survey. The results revealed that low-income and lower-middle class parents, as well as parents of color, experienced more instrumental and financial hardships due to the pandemic, when compared to their higher income, White counterparts. In contrast, parents with higher income and White parents were more likely to feel stressed over structuring home learning environments and planning educational and physical activities at home for their children. The overall findings suggest that family income level and race/ethnicity play a significant role in the lives of families coping with a variety of challenges due to the pandemic

Recent data from Centers for Disease Control and Prevention (CDC, 2020a) indicated that COVID-19 disease burden, including acquisition of illness, hospitalization, and mortality, is disproportionately higher among racial and ethnic groups (e.g., Black/African American, Latinx, American Indian or Alaska Native, and Asian American). Persistent systemic inequities, such as structural racism and discrimination, overcrowded housing, occupational segregation, and inadequate health access and utilization, play a large role in contributing to disparities in health outcomes among minoritized populations (cited in Brown et al., 2020; CDC, 2020b). Evidence has suggested that Black and Hispanic workers face much more economic and health insecurity as a result of the COVID-19 outbreak than White workers (Gould & Wilson, 2020). Being that racial and ethnic minority groups (e.g., Black and Latino people) are overrepresented in low-wage jobs and in jobs that cannot transition to remote work, they have been hit the hardest by stay-at home and other public health measures that put in place to control the spread of the virus. Recent data suggest that people of color and low-income families, when compared to their White and higher-income counterparts, have been affected much more by spiking unemployment and job insecurity (Gould & Wilson, 2020), as well as increased housing instability (Greens & McCargo, 2020), since the COVID-19 outbreak. These economic and social inequities may in turn place minoritized families at greater risk for increased stress and disparate outcomes during the COVID-19 pandemic.

School closures due to the COVID-19 outbreak have added extra challenges for parents of schooling children. Moreover, prolonged school closures can further exacerbate preexisting educational disparities. Reports have shown that lower-income parents are more concerned about their children potentially falling behind amid COVID-19 school closures than higher-income parents (Horowitz, 2020). While many schools have abruptly adopted remote learning to continue students’ schooling in response to the outbreak, students from lower-income households experience a “digital gap” due to the lack of reliable access to the Internet and other digital resources (e.g., computers) at home, potentially affecting their learning. Data reported by Pew Research Center further suggest that the digital gaps are particularly notable in Black and Hispanic households of low incomes (Auxier & Anderson, 2020), suggesting race and family income contribute to the complexity of widening educational inequities as a result of the COVID-19 outbreak.

According to Prime et al.’s (2020) conceptual framework, the impact of social disruption due to COVID-19 (e.g., job loss, financial hardship, social distancing, confinement) needs to be considered in the context of preexisting vulnerabilities in families (e.g., racism and marginalization, economic hardship, history of adversity). Although the current strain of the COVID-19 outbreak is unprecedented and affects all people globally, the impact of the virus can be rooted in historic and persistent social, economic, and educational disparities, resulting in greater vulnerabilities and difficulties in people of color and low-income families. This study further examined the roles of income level and race/ethnicity in families’ experiences coping with the COVID-19 pandemic, focusing on those with school-aged children. We expected to observe greater social, economic, and educational challenges and problems experienced by families of color and low-income households.

# data[].attributes.body
Great job on getting your topic and your padlet together. I think there is some confusion about what you are doing for the padlet. What I would like is for you to use the databases that I provided and you need to add to the padlet are the keywords: like Covid-19, pandemic, vaccine, etc and related terms like face mask, remote learning etc... hope that makes sense.

# data[].attributes.body
The COVID-19 pandemic forced an unprecedented, massive school closure across the United States in the Spring of 2020. The majority of PreK–12 students across races and income levels continued their education through long-distance learning (e.g., web-based instructional methods, video conferencing, etc.) provided by their schools. However, we observed that students from low-income and lower-middle class households, compared to those from upper-middle and high-income families, appeared to have a lower rate of engagement in long-distance learning through school. Lack of resources, such as computers and Internet accessibility and stability, might have partially prevented students in low-income and lower-middle households from engaging in long-distance learning. To ensure equitable educational opportunities, schools need to further assess the barriers for students from low-income households to engage in long-distance learning and to provide needed equipment and support for them.

In addition, school meal programs are essential to many American families. We observed that low-income and lower-middle class families were more likely to be affected by their children missing free and reduced-price school meals due to the pandemic, when compared to higher income families. Communities and school need to work collaboratively to provide meals to students in need during school closures through different practices (e.g., curbside grab-and-go, delivery routes, mobile food pantries, etc.).

While students stayed home due to school closures in response to the pandemic, we observed that about one-third of families did not have a clear structure and schedule at home to support their children’s learning. Particularly, more middle-class parents appeared to struggle to create and maintain a clear structure and routines at home. It is possible that middle-class parents were cognizant of the importance of having a clear structure and routines at home but did not have the means for implementation. Schools may provide support through consultation to help parents design and implement customized structure and schedule plans for their children, while taking account of family structure, parent’s work schedule, and life circumstances.

Even though low-income and lower-middle class parents, as well as parents of color, experienced more instrumental and economic challenges, we observed that upper-middle and high-income parents were more likely to report that school closure had been a major problem for them. Particularly, parents of higher incomes and White parents were more likely to feel stressed over structuring home learning environments, and planning educational and physical activities at home for their children. The gap is most significant between parents of upper-middle and high-income class and those of low-income and lower-middle class. It is possible that upper-middle and high-income parents were more likely to work from home during the pandemic than low-income and lower-middle class parents; therefore, their immediate exposure to and association with their children’s learning at home resulted in additional responsibilities and perceived stress. It is also possible that low-income and lower-middle class parents were more likely to be overwhelmed by immediate financial challenges. They were more concerned about their family’s basic needs, such as food, clothes, and shelter, than structuring their children’s days and planning educational and physical activities at home for their children. Schools can play a pivotal role in providing needed psychological and instrumental support based on families’ specific needs. Children lost that connection of social interaction with each other.

# data[].attributes.body
https://doi.org/10.1177%2F0192513X21994153

Cdc.gov

# data[].attributes.attachment_link.readable_text
Abstract

This study examined the experiences of families with school-aged children during the first three months of the 2020 pandemic of COVID-19 in the United States, while focusing on the roles of income level and race/ethnicity in their experiences. Two hundred and twenty-three parents of school-aged children participated in this study by completing an online survey. The results revealed that low-income and lower-middle class parents, as well as parents of color, experienced more instrumental and financial hardships due to the pandemic, when compared to their higher income, White counterparts. In contrast, parents with higher income and White parents were more likely to feel stressed over structuring home learning environments and planning educational and physical activities at home for their children. The overall findings suggest that family income level and race/ethnicity play a significant role in the lives of families coping with a variety of challenges due to the pandemic.

On March 13, 2020, the United States declared a national emergency over the outbreak of Coronavirus Disease (COVID-19) as the novel, highly transmissible Coronavirus (SARS-CoV-2) started rapidly spreading across the country. Due to the nature of the virus, by the end of March 2020, more than half of the U.S. population was ordered to stay home under shelter-in-place orders issued by many states and cities across the county in an attempt to minimize close contact between people in order to reduce the spread of the virus. As a result, more than 124,000 schools in the United States were closed, affecting at least 55 million students ( Education Week, 2020). Although some cities/states gradually lifted their shelter-in-place orders and prepared for reopening in phases in late May or early June of 2020, the majority of schools remained closed for the rest of the 2019-2020 school year.

A pandemic outbreak can have a pervasive impact on social order and the economy ( Qui et al., 2016-2017). For instance, schooling and the economy were significantly disrupted during the Ebola pandemic in 2013 and 2015 in West Africa in order to contain the virus ( Nabarro & Wannous, 2016). During the H1N1 outbreak in 2009, large scale school dismissals/closures were found to lead to a greater reduction rate of infected cases (German et al., 2019). Araz et al. (2013) found that preventive closing was best to decrease unnecessary infection; however, it is important to consider issues of distance learning, school meals, and dealing with pandemic waves. With the United States being the hardest-hit country by the COVID-19 pandemic in terms of numbers of COVID-19 infected cases and deaths ( Johns Hopkins University and Medicine, 2020), many families with school-aged children experience various challenges due to the outbreak and subsequent lockdowns and life disruptions.

In addition to worries and anxieties related to the COVID-19 outbreak, the economic situation has suddenly worsened with unprecedented rising levels of unemployment in the first three months of COVID-19 in the U.S. ( Kochhar, 2018), resulting in financial hardship for many families. Moreover, external support by other family members may be disrupted and social support systems may fade away due to social distancing measures. Many parents, while working from home, have to take care of their children with restricted caregiver resources (e.g., grandparents, daycare settings), as well as support their children's education through home schooling or remote learning provided by their schools ( Fegert et al., 2020). This has suddenly created a lot of challenges and put a lot of pressure on parents of schooling children. This study explored the consequences and problems associated with the COVID-19 outbreak as experienced by families with school-aged children during the acute phase of COVID-19 in the U.S.

Past research has suggested that a pandemic may affect different demographics differently, leading to social, economic, and health disparities ( Kumar et al., 2012). As times of crisis often reinforce and exacerbate these disparities because resources are limited and people are fearful, traditionally minoritized and marginalized populations (e.g., racial/ethnic minorities, low-income families, women) may encounter more challenges ( Kantamneni, 2020). As part of the long history of racial bias and discrimination in the U.S., national disasters and crises have often become racialized and scapegoated minority groups are targeted and blamed ( Chen et al., 2020). Evidently, racial discrimination against Asians and Asian Americans has increased significantly since the outbreak of the COVID-19 in the U.S. (e.g., Chen et al., 2020; Lee & Waters, 2020). According to a Pew Research Center survey, Black and Asian Americans have shared the experiences of racial discrimination amid the COVID-19 pandemic. Approximately 40% of Black and Asian Americans reported that since the COVID-19 outbreak people have acted as if they were uncomfortable around them due to their race or ethnicity ( Ruiz et al., 2020).

Recent data from Centers for Disease Control and Prevention ( CDC, 2020a) indicated that COVID-19 disease burden, including acquisition of illness, hospitalization, and mortality, is disproportionately higher among racial and ethnic groups (e.g., Black/African American, Latinx, American Indian or Alaska Native, and Asian American). Persistent systemic inequities, such as structural racism and discrimination, overcrowded housing, occupational segregation, and inadequate health access and utilization, play a large role in contributing to disparities in health outcomes among minoritized populations (cited in Brown et al., 2020; CDC, 2020b). Evidence has suggested that Black and Hispanic workers face much more economic and health insecurity as a result of the COVID-19 outbreak than White workers ( Gould & Wilson, 2020). Being that racial and ethnic minority groups (e.g., Black and Latino people) are overrepresented in low-wage jobs and in jobs that cannot transition to remote work, they have been hit the hardest by stay-at home and other public health measures that put in place to control the spread of the virus. Recent data suggest that people of color and low-income families, when compared to their White and higher-income counterparts, have been affected much more by spiking unemployment and job insecurity ( Gould & Wilson, 2020), as well as increased housing instability (Greens & McCargo, 2020), since the COVID-19 outbreak. These economic and social inequities may in turn place minoritized families at greater risk for increased stress and disparate outcomes during the COVID-19 pandemic.

School closures due to the COVID-19 outbreak have added extra challenges for parents of schooling children. Moreover, prolonged school closures can further exacerbate preexisting educational disparities. Reports have shown that lower-income parents are more concerned about their children potentially falling behind amid COVID-19 school closures than higher-income parents ( Horowitz, 2020). While many schools have abruptly adopted remote learning to continue students' schooling in response to the outbreak, students from lower-income households experience a "digital gap" due to the lack of reliable access to the Internet and other digital resources (e.g., computers) at home, potentially affecting their learning. Data reported by Pew Research Center further suggest that the digital gaps are particularly notable in Black and Hispanic households of low incomes ( Auxier & Anderson, 2020), suggesting race and family income contribute to the complexity of widening educational inequities as a result of the COVID-19 outbreak.

According to Prime et al.'s (2020) conceptual framework, the impact of social disruption due to COVID-19 (e.g., job loss, financial hardship, social distancing, confinement) needs to be considered in the context of preexisting vulnerabilities in families (e.g., racism and marginalization, economic hardship, history of adversity). Although the current strain of the COVID-19 outbreak is unprecedented and affects all people globally, the impact of the virus can be rooted in historic and persistent social, economic, and educational disparities, resulting in greater vulnerabilities and difficulties in people of color and low-income families. This study further examined the roles of income level and race/ethnicity in families' experiences coping with the COVID-19 pandemic, focusing on those with school-aged children. We expected to observe greater social, economic, and educational challenges and problems experienced by families of color and low-income households.

Method

After obtaining permission from the university institutional review board in early April of 2020, we used a variety of online recruitment methods, including online postings on social media (e.g., Facebook and Twitter), discussion forums (e.g., Reddit), websites (e.g., Psychological Research on the Net), and emails, to recruit parents of school-aged children (PreK-12th grade) in the United States as our research participants. Parents completed an online survey via the SurveyMonkey platform. Participants were given an opportunity to enter a drawing for one of ten $15 gift cards. Data were collected during a period of 2.5 months between April 8, 2020, and June 15, 2020.

The sample included 223 parents of school-aged children, with a mean age of 41.31 years ( SD = 8.54). The vast majority ( n = 202, 91%) of our participants were female, and nearly two-thirds were White/Caucasian ( n =145, 65%). More than half of the participants resided in New York State ( n = 127, 57%), with 25 other states ( ns = 1-14) representing the rest of the sample. Half ( n = 112, 50%) of the participants had two or more ( M = 1.74, SD = 0.97) school-aged children across PreK-12 grade levels in their household. Eighteen percent of the participants had at least one child in preschool, 8% had at least one child in kindergarten, 43% had at least one child in elementary school, 26% had at least one child in middle school, and 29% had at least one child in high school. See Table 1 for the demographic information of our participants.

Demographic Data of Sample.

Demographic information (e.g., age, gender, race/ethnicity, household income, family structure, etc.) was collected.

For the purpose of this study, we categorized participants into three income classes based on their reported annual household incomes (US Dollar): (a) low-income and lower-middle class (≤ $50,000), (b) middle class ($50,001-$100,000), and (c) upper-middle and high-income (> $100,000; Kochhar, 2018). Fifty-four percent of our participants were from upper-middle class or high-income households, 23% from middle-class households, and 18% lower-middle or low-income households.

Due to a small number of participants representing each of the racial/ethnic minority groups in our sample, we dummy coded race/ethnicity into 0 (White) and 1 (people of color; POC), with POC representing those who identified as Asian/Pacific Islander, American Indian/Alaska Native, Black/Africian American, Latinx/Hispanic, or mixed/biricial/multiracial.

Chi-square tests were conducted to compare group differences in measures of consequences/problems associated with the COVID-19 pandemic by income class and race/ethnicity. We performed all statistical analysis using IBM SPSS version 26. Cramer's V (φc) values were calculated to determine the effect sizes of chi-squared tests, taking the degree of freedom into consideration ( Cohen, 1988).

Results

Income class was associated with family structure, χ ²(6, N=212) = 61.56, p<.001, φc=.38 (large effect size). There was a higher rate of single-parent households within the low-income and lower-middle class (62.5%) than those in the middle class (19.2%), as well as the upper-middle and high-income class (3.3%). There was a moderate relationship between income class and race/ethnicity, χ ²(2, N=213) = 14.47, p=.001, φc=.26 (median effect size); White families were more likely to be in the higher income class than their POC counterparts. Families of color represented 56% of the low-income and lower-middle class, 42% of the middle class, and 25% of the upper-middle and high-income class in this sample.

Discussion

As the COVID-19 pandemic continued to be a global concern when this manuscript was being prepared in June 2020, the results of this study reflected the impact of the pandemic on families with school-aged children within the first three months of a rapid outbreak in the United States. Although the COVID-19 virus itself is supposed to be nondiscriminatory, our findings revealed inequitable consequences of the pandemic for low-income families and families of color. We observed that parents of low-income and lower-middle class households (≤US$50,000), as well as parents of color, experienced more adverse instrumental and financial hardships, such as reduced pay or income, furlough, and job loss or potential job loss. The findings are consistent with a recent report from the U.S. Department of Labor revealing that the historical layoffs due to the COVID-19 pandemic took the biggest toll on traditionally minoritized groups, including women, Blacks, Latinos, and the low-income workers (cited in Jones, 2020). In addition, we observed that low-income and lower-middle class parents, as well as parents of color, were less likely to have the privilege to work remotely from home, increasing their risk of exposure to the COVID-19 virus. A recent study ( Hawkins, 2020) suggested that people of color are more vulnerable to COVID-19 infection due to the nature of their occupation and employment, as they are more likely to be considered "essential" or "frontline" workers in occupations with more exposure to infections and close proximity to others (e.g., food service, cleaning and building maintenance, retail and hospitality, warehouse work, public transit work, etc.).

The COVID-19 pandemic forced an unprecedented, massive school closure across the United States in the Spring of 2020. The majority of PreK-12 students across races and income levels continued their education through long-distance learning (e.g., web-based instructional methods, video conferencing, etc.) provided by their schools. However, we observed that students from low-income and lower-middle class households, compared to those from upper-middle and high-income families, appeared to have a lower rate of engagement in long-distance learning through school. Lack of resources, such as computers and Internet accessibility and stability, might have partially prevented students in low-income and lower-middle households from engaging in long-distance learning. To ensure equitable educational opportunities, schools need to further assess the barriers for students from low-income households to engage in long-distance learning and to provide needed equipment and support for them.

In addition, school meal programs are essential to many American families. We observed that low-income and lower-middle class families were more likely to be affected by their children missing free and reduced-price school meals due to the pandemic, when compared to higher income families. Communities and school need to work collaboratively to provide meals to students in need during school closures through different practices (e.g., curbside grab-and-go, delivery routes, mobile food pantries, etc.).

While students stayed home due to school closures in response to the pandemic, we observed that about one-third of families did not have a clear structure and schedule at home to support their children's learning. Particularly, more middle-class parents appeared to struggle to create and maintain a clear structure and routines at home. It is possible that middle-class parents were cognizant of the importance of having a clear structure and routines at home but did not have the means for implementation. Schools may provide support through consultation to help parents design and implement customized structure and schedule plans for their children, while taking account of family structure, parent's work schedule, and life circumstances.

Even though low-income and lower-middle class parents, as well as parents of color, experienced more instrumental and economic challenges, we observed that upper-middle and high-income parents were more likely to report that school closure had been a major problem for them. Particularly, parents of higher incomes and White parents were more likely to feel stressed over structuring home learning environments, and planning educational and physical activities at home for their children. The gap is most significant between parents of upper-middle and high-income class and those of low-income and lower-middle class. It is possible that upper-middle and high-income parents were more likely to work from home during the pandemic than low-income and lower-middle class parents; therefore, their immediate exposure to and association with their children's learning at home resulted in additional responsibilities and perceived stress. It is also possible that low-income and lower-middle class parents were more likely to be overwhelmed by immediate financial challenges. They were more concerned about their family's basic needs, such as food, clothes, and shelter, than structuring their children's days and planning educational and physical activities at home for their children. Schools can play a pivotal role in providing needed psychological and instrumental support based on families' specific needs.

This study has some limitations. Because of the cross-sectional nature of this observational study, causation can never be exactly known. It is possible that the racial and income differences observed in this study might be partially attributed to other social and political events and conflicts (e.g., police brutality, racism, Black Lives Matter Movement) that were simultaneously occurring in the U.S. in the era of the COVID-19 pandemic ( Thomeer et al., 2020). More research is needed to understand the complexity of the dynamic interplay of social, political, and economic factors in families' lives during a pandemic. The majority of the participants were White females from higher income clusters. Parents from low-income and middle classes were disproportionately underrepresented in the sample. Although participants resided in 26 states in the United States, more than half majority were from New York State. Our online recruitment efforts might not reach families that had zero or limited access to the Internet or the sites where our online messages were posted. Therefore, the sample might not represent the entire U.S. population. However, we did not intend to conduct this study as a population research to understand the overall impact of the COVID-19 on families, but to focus on the roles of income level and race/ethnicity in the experiences of families with school-aged children during the pandemic. Our findings highlight the importance of evaluating the instrumental and psychosocial impact of the pandemic on families. Moreover, as we observed inequitable outcomes of the pandemic for low-income and racially minority families, schools and communities should further assess and address the specific challenges and difficulties facing diverse families in order to provide needed support for them.

ORCID iD
Cliff Yung-Chi Chen https://orcid.org/0000-0001-8659-5305

References

Centers for Disease Control and Prevention (2010, September 10). Parental attitudes and experiences during school dismissals related to 2009 influenza A (H1N1)-United States, 2009. Morbidity and Mortality Weekly Report (MMWR), 59(35), 1131-1134. |
Google Scholar Medline

Cohen, J. (1998). Statistical power and analysis for the behavioral sciences (2nd ed., pp. 79-80). Lawrence Erlbaum Associates.
Google Scholar

Horowitz, J. M. (2020). Lower-income parents most concerned about their children falling behind amid COVID-19 school closures. https://pewrsr.ch/2K72Oc3
Google Scholar

Johns Hopkins University and Medicine . (2020). COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University and Medicine. Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html
Google Scholar

Qui, W., Rutherford, S., Mao, A., Chu, C. (2016-2017). The pandemic and its impacts. Health, Culture and Society, 9-10, 3-11. https://doi.org/10.5195/hcs.2017.221
Google Scholar

Thomeer, M. B., Yahirun, J., Colón-López, A. (2020). How families matter for health inequality during the COVID-19 pandemic. Journal of Family Theory & Review, 12(4), 448-463. https://doi.org/10.1111/jftr.12398
Google Scholar

# data[].attributes.attachment_link.title
Impact of the 2020 pandemic of COVID-19 on Families with School-aged Children in the United States: Roles of Income Level and Race - Cliff Yung-Chi Chen, Elena Byrne, Tanya Vélez, 2021

# data[].attributes.attachment_link.description
Abstract This study examined the experiences of families with school-aged children during the first three months of the 2020 pandemic of COVID-19 in the United States, while focusing on the roles of income level and race/ethnicity in their experiences. Two hundred and twenty-three parents of school-aged children participated in this study by completing an online survey.

# data[].attributes.headline
-Travel and Covid                                    -Covid travel in U.S.                                 -Covid travel international                     -Effects of Covid onCalifornia             -Effects of Covid on Families              -Travel restrictions/requirements 

# data[].attributes.subject
-Travel and Covid                                    -Covid travel in U.S.                                 -Covid travel international                     -Effects of Covid onCalifornia             -Effects of Covid on Families              -Travel restrictions/requirements 

# data[].attributes.body
Cheri Caplinger

# data[].attributes.headline
-Covid effects on California’s jobs.    -Covid vaccination passport   requirements                                            -Vaccination and restriction debate  -Mental health during Covid.               -Mental Health of adolescents during Covid     

# data[].attributes.subject
-Covid effects on California’s jobs.    -Covid vaccination passport   requirements                                            -Vaccination and restriction debate  -Mental health during Covid.               -Mental Health of adolescents during Covid     

# data[].attributes.body
Cheri Caplinger

# data[].attributes.headline
Increased anxiety psychological distress  depression. Travel restrictions. Vaccination passports Mental health effectsJob loss,Financial hardship. Fear, anxiety and depression

# data[].attributes.subject
Increased anxiety psychological distress  depression. Travel restrictions. Vaccination passports Mental health effectsJob loss,Financial hardship. Fear, anxiety and depression

# data[].attributes.body
cheri caplinger

# data[].attributes.headline
               https://library-cqpress-com.vvc.idm.oclc.org/cqresearcher/document.php?id=cqresrre2021092400.                     https://go-gale-com.vvc.idm.oclc.org/ps/retrieve.do?tabID=Reference&resultListType=RESULT_LIST&searchResultsType=MultiTab&hitCount=1&searchType=BasicSearchForm&currentPosition=1&docId=GALE%7CLJKRYR317953259&docType=Topic+overview&sort=Relevance&contentSegment=ZXAY-MOD1&prodId=OVIC&pageNum=1&contentSet=GALE%7CLJKRYR317953259&searchId=R2&userGroupName=victorvcl&inPS=true                      

# data[].attributes.subject
               https://library-cqpress-com.vvc.idm.oclc.org/cqresearcher/document.php?id=cqresrre2021092400.                     https://go-gale-com.vvc.idm.oclc.org/ps/retrieve.do?tabID=Reference&resultListType=RESULT_LIST&searchResultsType=MultiTab&hitCount=1&searchType=BasicSearchForm&currentPosition=1&docId=GALE%7CLJKRYR317953259&docType=Topic+overview&sort=Relevance&contentSegment=ZXAY-MOD1&prodId=OVIC&pageNum=1&contentSet=GALE%7CLJKRYR317953259&searchId=R2&userGroupName=victorvcl&inPS=true                      

# data[].attributes.body
Cheri Caplinger

\

# data[].attributes.body
Opposing Viewpoints

CQ Researcher

Gale eBooks

I used CQ researcher. for families and covid.

# data[].attributes.body
Families and COVID

Many families lost their jobs, couldn't pay their rent and at the same time owners of the rented home couldn't pay their mortgage. Some families had to move out and live either with some one else or in motels or on the streets. Others stayed and just couldn't pay rent. The moratorium  helped and didn't at the same time. Depended on what side you were on. The COVID virus and its affects on families was being compared to the Great Depression. Yet, this was something entirely different.
now as Covid is less than before , people who have started working again can pay future rent but the back rent is a loss.
There is a lack of agreement from the policy makers on what to do.
I just don't understand how the majority of these families made it through the most difficult times with just 2 stimulus payments and no job. But then again at the same time there are many who don't even want to work and keep getting unemployment, etc. It just seems like a never ending crisis sometimes in this life, and then Covid came and dropped a bomb.

# data[].attributes.body
In response to where the virus came from, Its just awful. There are so many stories about how the virus started or who was involved. Its sad how so many people have lost their lives, and are still dying from this COVID virus

# data[].attributes.body
Covid Effects, Mental health, Children, public, business, mandate, insanity, vaccination.

# data[].attributes.body
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444649/

# data[].attributes.attachment_link.readable_text
Abstract

Background

COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe. This phenomenon has led to short term as well as long term psychosocial and mental health implications for children and adolescents. The quality and magnitude of impact on minors is determined by many vulnerability factors like developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection or fear of infection.

Aims

This paper is aimed at narratively reviewing various articles related to mental-health aspects of children and adolescents impacted by COVID-19 pandemic and enforcement of nationwide or regional lockdowns to prevent further spread of infection.

Methodology

We conducted a review and collected articles and advisories on mental health aspects of children and adolescents during the COVID-19 pandemic. We selected articles and thematically organized them. We put up their major findings under the thematic areas of impact on young children, school and college going students, children and adolescents with mental health challenges, economically underprivileged children, impact due to quarantine and separation from parents and the advisories of international organizations. We have also provided recommendations to the above.

Conclusion

There is a pressing need for planning longitudinal and developmental studies, and implementing evidence based elaborative plan of action to cater to the psycho social and mental health needs of the vulnerable children and adolescents during pandemic as well as post pandemic. There is a need to ameliorate children and adolescents' access to mental health support services geared towards providing measures for developing healthy coping mechanisms during the current crisis. For this innovative child and adolescent mental health policies policies with direct and digital collaborative networks of psychiatrists, psychologists, paediatricians, and community volunteers are deemed necessary.

Keywords: COVID-19, Lockdown, Mental health, Children, Adolescents

1. Introduction

There are more than 2.2 billion children in the world who constitute approximately 28% of the world's population. Those aged between 10 to 19 years make up 16 % of the world's population ( UNICEF, 2019). COVID-19 has impacted the lives of people around the world including children and adolescents in an unprecedented manner. Throughout the world, an essential modus of prevention from COVID- 19 infection has been isolation and social distancing strategies to protect from the risk of infection ( Shen et al., 2020). On these grounds, since January, 2020, various countries started implementing regional and national containment measures or lockdowns. In this backdrop one of the principal measures taken during lockdown has been closure of schools, educational institutes and activity areas. These inexorable circumstances which are beyond normal experience, lead to stress, anxiety and a feeling of helplessness in all.

It has been indicated that compared to adults, this pandemic may continue to have increased long term adverse consequences on children and adolescents ( Shen et al., 2020). The nature and extent of impact on this age group depend on many vulnerability factors such as the developmental age, current educational status, having special needs, pre-existing mental health condition, being economically under privileged and child/ parent being quarantined due to infection or fear of infection. The following sections discuss about findings of studies on mental-health aspects of children and adolescents impacted by COVID-19 pandemic and lockdowns being implemented at national or regional levels to prevent further spread of infection.

2. Material and methods

We searched the electronic data bases of MEDLINE through PubMed, Cochrane Library, Science-direct and Google Scholar databases, from January,2020 till June,2020. We carried out the search with the following methods like, MeSH or free text terms and Boolean operators were employed for PubMed; COVID-19 and Children [All Fields] OR (Children and COVID-19 effects [Terms] OR & Psychological effects of COVID-19 on children &Quot;[All Fields] OR (&Quot; COVID effects on children &Quot;[All Fields] AND &quot; &Quot;[All Fields]) OR effects on Children of COVID-19 &quot; Psychological effects of COVID, Children &quot;[All Fields]) OR (&quot;COVID-19 and children &quot;[MeSH Terms] OR &quot; Psychological effects of COVID-19, Children &quot;[All Fields]. This search strategy and terms were modified for other databases as appropriate. The searches were done by five independent reviewers. A manual search was also conducted of the references of the related articles to gather information about the relevant studies. Initial PubMed search with the term with " COVID-19 in children" showed only 12 results. Among these, only four articles were related to "Psychological effects of COVID in children". Therefore in order to make the review more comprehensive and informative, we also included studies that reported the effect on older children and impact of COVID1-19 on their lives. This was done keeping in mind the varied terminologies used to describe the phenomenon of 'Children and COVID-19". After using the above strategy, our search showed 112 results. Only articles in English language peer reviewed journals were included. Grey literature such as conference proceedings were not included due to possibility of insufficient information. We included case studies and review articles and Advisories by the WHO (World Health Organization), APA (American Psychiatric Association) and NHS (National Health Services) and Government of India Ministry of Health. Based on these inclusion criteria we included 22 articles. Three independent authors participated in study selection and all authors reached a consensus on the studies to be included. Being a narrative review, we did not attempt computation of effect sizes or do a risk of bias assessment for included papers.

The studies included were categorized under eight headings divided in various thematic sections and discussed with studies and reports found. The data is qualitatively analysed and reported in the paper. A summary of the papers included in this narrative review is presented in Table 1 .

Table 1

Sl.

Thematic area

Author and Year

Articles

Findings

Conclusions

1

School closures during COVID-19

Viner, R.M et al. (2020).

School closure and management practices during coronavirus outbreaks including COVID-19: A rapid systematic review
Lancet Child Adolescent Health

This systematic review included 16 articles on Closure of schools in China and its impact on transmission on COVID-19.
Studies using modelling method showed that closing the schools in itself contributes to 2-4% additional prevention of deaths due to COVID-19, which is quite less than using other methods of social distancing.

For academic social and psychological reasons, Policy makers need to consider combinations of social distancing measures which are less disrupting if restrictive social distancing policies are needed for long periods.

2

Mental health effects of School Closures

Lee, J. (2020)

Mental health effects of school closures during COVID-19. Lancet Child & Adolescent Health.

School routines are crucial for young people with mental health challenges as schools help them to cope and structure their behavior.
Children with special education needs are at high risk.
Also since the pandemic and lockdown has caused economic distress, there are indications of increased abuse towards children.

Since the pandemic is ongoing it is crucial to provide psycho social support to the minors who are highly vulnerable and are exposed to various economic and social stressors.

3

Mental health considerations for children quarantined

Liu.J.,Bao Y.,Huang X.,&Lu Lin.(2020).

Mental health considerations for children quarantined because of COVID-19. Short review

A large number of children have been quarantined in addition to the adult population.
Quarantine policies have been developed keeping in mind the impact of quarantine on mental health aspects of children

Paediatric health care workers need to focus on the emerging mental health issues of children. Recommendations should be made for early identification of mental health issues and appropriate referrals and management.

4

Impact on Young People with Mental Health Needs

The mental health charity Young Minds, 2020

Coronavirus: Impact on Young People with Mental Health Needs: 2020. Survey

Survey of 2111 individuals [age<=25 years] with history of mental health conditions in UK. The current pandemic and lockdown worsened their condition. About 26% of then were unable to access the mental health services. Since support groups and 'face to face services' were stopped.
Certain activities and routines were important coping mechanisms. Support by tele or online services was found challenging by some youth.

It was recommended that maintenance of social contact with families and friends by tele services or social platforms would help to reduce stress. However, excessive social media use should be under check.

5
Stress in students due to postponement of exams
Ng Kang chug, 5 April 2020

Coronavirus: stress over university entrance exams has skyrocketed amid Hong Kong school closures, study finds. (survey) South China morning post

The March poll, which interviewed 757 students before the first postponement of the Diploma of Secondary Education (DSE) exam - showed that over 20 per cent reported that the level of stress faced by them was maximum (10 / 10). The students reported feeling 'helpless' in this condition.

Authorities to be more transparent in their negotiations and to allow candidates sufficient notice to prepare emotionally as well. Students to be timely provided counselling.

6

Behavioral and Emotional Disorders in Children

Jiao, W. Y., Wang, L. N., Liu, J., Fang, S. F., Jiao, F. Y., Pettoello-Mantovani, M., & Somekh, E. (2020)

Behavioral and Emotional Disorders in Children during the COVID-19 Epidemic. The Journal of Paediatrics. Commentory

A collaborative working group of China-EPA-UNEPSA found
clinginess, difficulty in attention, and being irritable as commonest psychological conditions shown by all minors. Media entertainment was largely successfully used by families as a means to relieve their children's distress.

The measures suggested to the parents and their families were to increase communication with minors, playing collaborative games, encouraging physical activity, and music therapy . Moreover, parents need to focus on sleep problems and nightmares in children, and forbid augmented sleep during the daytime

7

Associations of social distancing with Mental and Social Health in adolescent.

Oosterhoff.B,et al (2020)
Adolescents' Motivations to Engage in Social Distancing during the COVID-19 Pandemic: Associations with Mental and Social Health.
98.1% respondent adolescents shared that they engaged in at least some method of maintaining social distancing. they found that different motivations for social distancing were related with the symptoms of anxiety and depression and feeling of burdensomeness and belongingness.

Among youth it is found that social distancing is viewed primarily as a social responsibility and is followed more sincerely if it is motivated by prosocial reasons to prevent others from getting sick, hence prosocial motivation for this cause should be encouraged.

8

Children and adolescents with eating disorders

David.C et al (2020).

Caring for children and adolescents with eating disorders in the current COVID-19 pandemic: A Singapore perspective. Journal of Adolescent Health.

Services for paediatric disorders related to eating habits care had made major adaptations in terms of the service delivery. This was done in response to the changing psychological and social requirements of the needs of people in Singapore during containment phase. Partnerships were established with school counselling and community services. They showed that "Coronaphobia" effected the patients' visits and increased existing health anxiety in some people.

The experience of the study provides suggestions to deal with stress and provide support for children and adolescents with eating disorders
in the present during periods of crisis.

9

Diagnosis, treatment, and prevention COVID 19 infection in children

Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, et al.

Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement. World J Pediatr 2020.

An expert committee was called to gather consensus and standardize COVID 19 prevention and management in children. It was found that psychological counselling improves rate of recovery. If children have complaint of mood swings, fear or psychological disorder timely psychological management is warranted.

Methods of promotion of healthy and balanced diet, maintaining oral health, physical exercise, proper rest, avoidance of fatigue, and enhancing immunity are prescribed measures to preventi infection, and improving mental health

2.1. Impact on young children

Stress starts showing its adverse effect on a child even before he or she is born. During stress, parents particularly pregnant mothers are in a psychologically vulnerable state to experience anxiety and depression which is biologically linked to the wellbeing of the foetus ( Biaggi et al., 2016; Kinsella and Monk, 2009). In young children and adolescents the pandemic and lockdown have a greater impact on emotional and social development compared to that in the grown-ups. In one of the preliminary studies during the on-going pandemic, it was found younger children (3-6years old) were more likely to manifest symptoms of clinginess and the fear of family members being infected than older children (6-18 years old). Whereas, the older children were more likely to experience inattention and were persistently inquiring regarding COVID-19. Although, severe psychological conditions of increased irritability, inattention and clinging behaviour were revealed by all children irrespective of their age groups ( Viner et al., 2020a). Based on the questionnaires completed by the parents, findings reveal that children felt uncertain, fearful and isolated during current times. It was also shown that children experienced disturbed sleep, nightmares, poor appetite, agitation, inattention and separation related anxiety ( Jiao et al., 2020).

2.2. Impact on school and college going students

Globally, the pre-lockdown learning of children and adolescents predominantly involved one-to-one interaction with their mentors and peer groups. Unfortunately, the nationwide closures of schools and colleges have negatively impacted over 91% of the world's student population ( Lee, 2020). The home confinement of children and adolescents is associated with uncertainty and anxiety which is attributable to disruption in their education, physical activities and opportunities for socialization ( Jiao et al., 2020). Absence of structured setting of the school for a long duration result in disruption in routine, boredom and lack of innovative ideas for engaging in various academic and extracurricular activities. Some children have expressed lower levels of affect for not being able to play outdoors, not meeting friends and not engaging in the in-person school activities ( Lee, 2020; Liu et al., 2020; Zhai and Du, 2020). These children have become more clingy, attention seeking and more dependent on their parents due to the long term shift in their routine. It is presumed that children might resist going to school after the lockdown gets over and may face difficulty in establishing rapport with their mentors after the schools reopen. Consequently, the constraint of movement imposed on them can have a long term negative effect on their overall psychological wellbeing ( Lee, 2020).

A study found that older adolescents and youth are anxious regarding cancellation of examinations, exchange programs and academic events ( Lee, 2020). Current studies related to COVID-19 demonstrate that school shut downs in isolation prevent about 2-4% additional deaths which is quite less if compared to usage of other measures of social distancing. Moreover, they suggest to the policy makers that other less disrupting social distancing strategies should be followed by schools if social distancing is recommended for a long duration ( Lee, 2020; Sahu, 2020; Viner et al., 2020a). However, in current circumstances, it is controversial whether complete closure of school and colleges is warranted for a prolonged period.

It has been reported that panic buying in times of distress indicate an instinctual survival behaviour ( Arafat et al., 2020). In present pandemic era there has been a rise in the hoarding behaviour among the teenagers ( Oosterhoff et al., 2020a). It is also found that among youth social distancing is viewed primarily as a social responsibility and it is followed more sincerely if motivated by prosocial reasons to prevent others from getting sick (Oosterhoff et al., 2020a). Further, due to prolonged confinement at home children's increased use of internet and social media predisposes them to use internet compulsively, access objectionable content and also increases their vulnerability for getting bullied or abused ( Cooper, 2020; UNICEF, 2020b). Worst of all, during lockdown when schools, when legal and preventative services do not functioning fully, children are rarely in a position to report violence, abuse and harm if they themselves have abusive homes.

2.3. Impact on children and adolescents having special needs

There are about 1 in every 6 children within the age group of 2-8 years who have some or the other neurodevelopmental, behavioural or emotional difficulty ( CDC, 2019). These children with special needs [autism, attention deficit hyperactivity disorder, cerebral palsy, learning disability, developmental delays and other behavioural and emotional difficulties] encounter challenges during the current pandemic and lockdown ( CDC, 2019). They have intolerance for uncertainty and there is an aggravation in the symptoms due to the enforced restrictions and unfriendly environment which does not correspond with their regular routine. Also, they face difficulties in following instructions, understanding the complexity of the pandemic situation and doing their own work independently. With the closure of special schools and day care centres these children lack access to resource material, peer group interactions and opportunities of learning and developing important social and behavioural skills in due time may lead to regression to the past behavior as they lose anchor in life, as a result of this their symptoms could relapse ( Lee, 2020). These conditions also trigger outburst of temper tantrums, and conflict between parents and adolescents. Although prior to the pandemic, these children had been facing difficulties even while attending special schools, but in due course they had learnt to develop a schedule to adhere to for most of the time of the day ( APA, 2020; Cortese et al., 2020; UNICEF, 2020a). To cater to these challenges, it is difficult for parents to handle the challenged children and adolescents on their own, as they lack professional expertise and they mostly relied on schools and therapists to help them out ( Dalton et al., 2020).

Since every disorder is different, every child has different needs to be met. The children with autism find it very difficult to adapt to the changing environment. They become agitated and exasperated when anything is rearranged or shifted from its existing setup. They might show an increase in their behavioral problems and acts of self-harm. It is a huge challenge for parents to handle autistic children due to lockdown. The suspension of speech therapy and occupational therapy sessions could have a negative impact on their skill development and the achievement of the next milestone, as it is difficult for them to learn through online sessions ( UNICEF, 2020a). The children with Attention Deficit Hyperactivity Disorder (ADHD), struggle to make meaning of what is going around them from the cues they get from their caregivers. It is difficult for them to remain confined to a place and not to touch things, which might infect them. Due to being confined to one place the chances of their hyperactivity increases along with heightened impulses and it becomes difficult for the caregivers to engage these children in meaningful activities ( Cortese et al., 2020).

Obsessive compulsive disorder (OCD) among the children and adolescents is estimated to be of 0.25%-4% among children and adolescents ( CDC, 2019). Children with OCD are suspected to be one of the most affected ones by this pandemic. Due to obsessions and compulsions related to contamination, hoarding, and somatic preoccupation, they are expected to experience heightened distress. Cleanliness is one key protective measure against the spread of COVID-19. According to United Nations' policy guidelines to fight the infection one has to be careful about washing their hands six times a day, and whenever they touch anything ( APA, 2020; United Nations, 2020). The lockdown, which has made the healthy population distressed about possessing enough food and prevention related resources like masks and sanitizers, has made it worse for people with hoarding disorder ( APA, 2020; Mukherjee et al., 2020)

2.4. Impact of lockdown on underprivileged children

Social inequality has been associated with the risk of developing mental health challenges. The pandemic and lockdown world has experienced global economic turn-down which has directly worsened the pre-existing social inequality. In developing countries, with the imposed lockdown, the underprivileged children face acute deprivation of nutrition and overall protection. The prolonged period of stress could have a long term negative impact on their development. For instance, in India, which has the largest child population in the world with 472 million children, the lockdown has significantly impacted 40 million children from poor families. These include children working on farms, fields in rural areas, children of migrants and street children ( Dalton et al., 2020; Rosenthal et al., 2020). An increasing number of poor and street children now have no source of income, making them a high risk population to face abuse and mental health issues with greater vulnerability and exposure to unfavorable economic, social and environmental circumstances ( Birla, 2019).

A home represents a source of security and safety in most families. However, for the poor and the underprivileged it is just the opposite. With the restriction of movement due to lockdown, these children have increased risk of being exploited and become victims of violence and abuse ( Cooper, 2020; United Nations, 2020). The Deputy Director of 'CHILDLINE 1098' India, announced that India saw a 50 per cent increase in the calls received on helpline for children since the lockdown began ( PTI, 2020). This increase in rate is alarming and has made an increasing number of child victims in their own homes.

During the time of lockdown an increasing number of poor families have no source of daily wages which lead to frustration and feelings of helplessness. By the reason of displacement, the frustration and family conflict may manifest itself in the form of violence towards children. This can make the child more vulnerable to depression, anxiety and suicide ( Jiao et al., 2020; Petito et al., 2020; Solantaus et al., 2020) School closure coupled with economic adversity may force children and adolescents into child labour. Likewise, children without parents or guardians are more prone to exploitation ( United Nations, 2020).

In order to cover up the loss of education during lockdown, many schools have offered distance learning or online courses to students. However, this opportunity is not available to underprivileged children as a result of which they face a lack of stimulation and have no access to online resource material to study. A study pointed out that in underprivileged families, in comparison to boys, girls have decreased access to gadgets, this may diminish their involvement in digital platforms of education ( McQuillan and Neill, 2009). Due to this gender inequality, increasing number of girls are prone to bear the consequences of school dropouts once the lockdown is lifted ( Cooper, 2020; PTI, 2020).

2.5. Impact due to quarantine and separation from parents

COVID-19 infection is expressed differently in children and adolescents. Yet the incidents of infection in the minors have been reported worldwide, which result in children being quarantined. Moreover, in many cases a single parent or both the parents are infected and quarantined. In either condition children are separated from their parents. Many countries have laid down strict quarantine policies as a measure to fight COVID-19 pandemic. Such as in China several adults, adolescents and children have been put in complete isolation to control the spread of infection. Although quarantining measures are for the benefit of the community at large, its psychological effects cannot be ignored ( Liu et al., 2020). The children who are in isolation require special attention as these children might be at risk of developing mental health problems due to grief caused by of parental separation. As during the formative years of life, the role of parents is very crucial, any disruption in the form of isolation from parents can have long term effects of perceived attachment of the child. It is found that separation from the primary caregivers can make a child more vulnerable and can pose a threat to a child's mental health ( Cooper, 2020; Jiao et al., 2020; Liu et al., 2020). The children may develop feelings of sadness, anxiety, fear of death, fear of parents' death and fear of being isolated in the hospital which may have a very detrimental effect on their psychological development ( APA, 2020; CDC, 2019; Dalton et al., 2020). Children have emotionally pent up feelings of distress which may turn inwards into emotional fear or outwards towards acting out behavior ( Liu et al., 2020). They might feel separated or alone as they have limited knowledge and level of maturity to understand the implications of the current pandemic situation in their limited world.

2.6. Advisories of international organizations

With the objective of universal prevention and mental health promotion, the International organizations and advisory bodies have issued various guidelines taking into account the mental health needs of children during the COVID-19. They have suggested parents to interact constructively with the children by communicating with them about the current pandemic, according to their maturity level and their ability to comprehend the crisis. Parents should plan their children's tasks one at a time, involve them in various home activities, educate them about following hygiene habits and social distancing, engage in indoor play and creative activities. In addition to these activities, adolescents are advised to be involved in household chores and understand their social responsibilities ( WHO, 2020b). Interventions supervised by adults can help them in understanding their concerns. The activities of children and adolescents should include more structure in home schooling activities. Children should be encouraged to socialize with their friends and classmates through digital forums under adult supervision ( WHO, 2020a).

The advisory committees have also provided guidelines for managing children with special needs and neurodevelopmental disorders ( UNICEF, 2020a, 2020b; WHO, 2020a). The children prone to risk for trauma and heightened anxiety. The children need early identification prompt management involving the parents and experts to prevent long term mental health morbidity.

2.7. Recommendations

It is imperative to plan strategies to enhance children and adolescent's access to mental health services during and after the current crisis. For this direct and digital collaborative network of various stakeholders is required. Recommendations for ensuring mental well-being of children and adolescents during the COVID-19 pandemic and lockdown and the role of parents, teachers, pediatricians, community volunteers, the health system and policy makers are being discussed. In addition a brief summary of the roles is given in Table 2 .

Table 2

S. no.

Target Group/Support System

Primary Roles

1
Young Children

2
School going children and adolescents

3
Children with special needs

4
Underprivileged/vulnerable children

5
Quarantined parents/children

2.8. Role of Parents

In the times of paramount stress and uncertainty, a secure family environment which the parents can provide is a strong protective factor ( Schofield et al., 2013). There is evidence to show that parental practices and coping measures affect the children's post disaster mental health ( Cobham et al., 2016). Parents need to respond to the needs of their children based on the developmental phase of the child is being discussed below:

2.12. Role of pediatricians

During a child's formative years when their personalities are shaped, parents are in regular touch with pediatricians, as parents reach out to their local pediatricians whenever they encounter health/ behavioral complaints associated with their children. Parents expect answers from them as they trust them. Hence a pediatrician's role is paramount in promoting mental health, developing resilience, recognizing mental health problems, and coordinate with the mental health care providers when it comes to mental health care of children. In the backdrop of COVID 19 specific roles of pediatricians are enlisted below:

2.15. Critical appraisal of the studies included

The studies included in the review were collected after setting criteria to have a comprehensive view of the global vision in managing the crisis of children in the COVID-19 pandemic. The majority of the studies included in the review were based on online self-reports( Bhat et al., 2020; Jiao et al., 2020; Oosterhoff et al., 2020b). The adults and older children were the respondents of the study( Lee, 2020; Liu et al., 2020; Viner et al., 2020b; Wang et al., 2020). The studies are mainly carried out in the developed nations and the East Asian countries. Studies have reported the concerns may not be generalizable throughout the globe. There are variations in the number of samples as well, thus they make it difficult to generalize the findings of their study alone.

The cross sectional studies are useful in understanding the immediate or short term impact apparent at a certain point of time. However the limitations of these cross sectional studies are that these studies cannot conclude about the long term impact of COVID-19, given that certain pre-existing vulnerabilities, high risk factors and stressors could be multiple, ongoing or recurrent and also the manner through which they work may vary. Consequently, there is a pressing need for carrying out longitudinal and developmental studies to be able to apprehend multiple layers of dynamic determinants playing role during this time of global crisis ( Holmes et al., 2020).The literature suggests the need for evidence based elaborative strategies and plan of action to cater to the mental health needs of children and adolescents during the period of pandemic ( Wade et al., 2020).

3. Limitations

The review articles for this review have been selected during the time of global lockdown, where the issues and challenges were new and the global crisis was at peak times. In our review, we were unable to track the measures of management targeted towards the children. The strategies reported in the studies were isolated to geopolitical conditions. The recommendations provided in this review can be modified to suit the needs of the places according to their local resources and geopolitical scenarios. Due to strict selection criteria and the short period of data collection and the only use of electronic databases for our research, there is a possibility of missing studies relevant to the care of children and adolescents.

4. Conclusion

Although the rate of COVID-19 infection among young children and adolescents is low, the stress confronted by them poses their condition as highly vulnerable. Many cross-sectional studies have been conducted to analyze the impact of COVID-19 and lock down on children and youth. The results of these studies show that the nature and extent of this impact depend on several vulnerability factors such as the developmental age, educational status, pre-existing mental health condition, being economically underprivileged or being quarantined due to infection /fear of infection. Studies show that young children show more clinginess, disturbed sleep, nightmares, poor appetite, inattentiveness, and significant separation problems.

The containment measures like school and activity centers closures for long periods together expose the children and youth to the debilitating effects on educational, psychological, and developmental attainment as they experience loneliness, anxiety, and uncertainty. Compulsive use of internet gaming and social media puts them at higher risk. Children and adolescents with mental health conditions are not used to variation in the environment. Hence there could be an exacerbation in symptoms and behavioral problems.

The children who receive training, therapy, and other treatments are at high risk of being derailed from therapy and special educations. Economically underprivileged children are particularly prone to exploitation and abuse. Children quarantined are at high risk for developing higher risk for mental health-related challenges.

There is a need to ameliorate children and adolescent's access to mental health services by using both face to face as well as digital platforms. For this collaborative network of parents, psychiatrists, psychologists, pediatricians, community volunteers, and NGOs are required. There is a need for 'tele mental health compatibility' and be accessible to the public at large. This would be crucial to prevent during and post-pandemic mental challenges in the most vulnerable and underprivileged section of the society. The focal point of the health care system and policymaking should be prevention, promotion, and interventions corresponding to the public mental health system to meet the mental health needs of the population at large by taking the regional contextual parameters into account.

Disclosure of prior presentation of study data

This paper has not been submitted in full or part in any conference and is not being considered for publication elsewhere.

Financial disclosure

This is a completely researcher initiated study without any external funding whatsoever.

CRediT authorship contribution statement

Shweta Singh: Writing - review & editing, Software, Validation, Supervision, Data curation, Writing - original draft, Conceptualization, Methodology. Deblina Roy: Validation, Visualization, Investigation, Data curation, Writing - original draft, Software. Krittika Sinha: Visualization, Investigation, Data curation, Writing - original draft. Sheeba Parveen: Visualization, Investigation. Ginni Sharma: Visualization, Investigation, Data curation, Writing - original draft. Gunjan Joshi: Visualization, Investigation, Data curation, Writing - original draft.

Declaration of Competing Interest

There is no known conflict of interest.The authors whose names are listed below certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants, participation in spakers' bureaus arrangements, consultancies, memberships, stock ownerships, or other equity interest, or expert testimony and patent licencing arangements) or non financial interests such as ( personal or professional relationships, affiliations, knowledge or beliefs)in the subject matter or materials discussed in this manuscript. All the authors confirm that, all of them has contributed in the conception of design; analysis, interpretation of data; drafting the article; critically revisiting the article for important intellectual inputs; and approval of the final version. This paper has not been submitted elsewhere or is under review at another journal or publishing venue. The authors have no affiliation with any organization, with a direct or indirect financial interest in the subject matter discussed in the manuscript.

Acknowldegment

We would like to Acknowldge the efforts of Mrs. Meenakshi Seth and Mr. Prakhar Bhanu, who were involved in improving the language of the manuscript. Additionally the authors are gratefull to the CORONA Warriers i.e. the Health Care Workers for their selfless and tremendous service to the mankind.

Footnotes

☆ This paper is aimed at reviewing articles related to mental-health aspects of children and adolescents impacted by COVID-19 pandemic and lockdowns. There is a need to carry out longitudinal and developmental studies and plan strategies to enhance children's and adolescent's access to mental health services during and after the current crisis. For this direct and digital collaborative network of psychiatrists, psychologists, pediatricians, and community volunteers are of vital importance.

Supplementary material associated with this article can be found, in the online version, at doi: 10.1016/j.psychres.2020.113429.

Appendix. Supplementary materials

References

Arafat S.Y., Kar S.K., Marthoenis M., Sharma P., Apu E.H., Kabir R. Psychiatry Research. PMC; 2020. Psychological underpinning of panic buying during pandemic (COVID-19) [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

Cobham V., McDermott B., Haslam D., Sanders M. The role of parents, parenting and the family environment in children's post-disaster mental health. Curr. Psychiatry Rep. 2016:18. doi: 10.1007/s11920-016-0691-4. [[ PubMed] [ CrossRef] Google Scholar]

McQuillan H., Neill B.O. Gender differences in children's internet use: key findings from Europe. J. Child. Media. 2009;3(4):366-378. doi: 10.1080/17482790903233408. [[ CrossRef] Google Scholar]

Petito A., Pop T.L., Namazova-Baranova L., Mestrovic J., Nigri L., Vural M., Sacco M., Giardino I., Ferrara P., Pettoello-Mantovani M. The burden of depression in adolescents and the importance of early recognition. J. Pediatr. 2020;218:265-267. doi: 10.1016/j.jpeds.2019.12.003. [[ PubMed] [ CrossRef] Google Scholar]

Schofield G., Beek M., Ward E., Biggart L. Professional foster carer and committed parent: Role conflict and role enrichment at the interface between work and family in long-term foster care. Child Fam. Soc. Work. 2013;18(1):46-56. doi: 10.1111/cfs.12034. [[ CrossRef] Google Scholar]

Shen K., Yang Y., Wang T., Zhao D., Jiang Y., Jin R., Zheng Y., Xu B., Xie Z., Lin L., Shang Y., Lu X., Shu S., Bai Y., Deng J., Lu M., Ye L., Wang X., Wang Y.... . Diagnosis, Treatment, And Prevention Of 2019 Novel Coronavirus Infection In Children: Experts' Consensus Statement. World Journal of Pediatrics : WJP; 2020. Global Pediatric Pulmonology Alliance; pp. 1-9. PubMed. [[ PMC free article] [ PubMed] [ CrossRef] Google Scholar]

26. Solantaus, Leinonen, T., Punamäki, J., & Raija-Leena. (200 C.E.). Children's mental health in times of economic recession: replication and extension of the family economic stress model in Finland. Dev. Psychol., 404,(3), 412-429. [ PubMed]

United Nations Policy brief: the impact of COVID-19 on children. United Nations. 2020:1-17. Policy breif] [ Google Scholar]

Articles from Psychiatry Research are provided here courtesy of Elsevier

# data[].attributes.attachment_link.title
Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations

# data[].attributes.attachment_link.description
COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe. This phenomenon has led to short term as well as long term psychosocial and mental health implications for children and adolescents. The quality and magnitude ...