Aspecte psihosociale la copii şi adolescenţi în timpul pandemiei de COVID-19

Children are a vulnerable social group, despite improvements in the economical status and medical resources. COVID-19 pandemic has generated a general crisis in their lives whose effects have not been studied thoroughly and are still not entirely known.

The global statistics show that SARS-CoV-2 infection is spread irregularly both geographically and by age. World Health Organization’s report from October 2020 highlights the different distribution patterns of the number of cases and of the number of deaths, with the highest percentage (75%) of deaths in those aged 65 years old and above⁽¹⁾. The Centers for Disease Control and Prevention (CDC) also confirms different ratio rates of hospitalizations and deaths, with lowest rates in children and adolescents⁽²⁾. The reported case fatality rate (CFR is the ratio between the number of confirmed deaths from the disease and the number of confirmed cases) is between 0 and 0.2 in 0-19 year olds⁽³⁾.

Although children seem spared of the worst consequences of the SARS-CoV-2 infection, worldwide institutions and organizations warn about the indirect and persistent damage in children, adolescents and youths. Children from the poorest countries and communities might register the most harmful effects due to poverty and lack of access to education and healthcare services. UNICEF estimates an increase from 47% to 56% of the children lacking access to these essential services, with consistent effects on child health and survival. This could lead to an additional 2 million under-5-year-old children deaths in the next 12 months⁽⁴⁾.

Beside the medical consequences, the psychosocial domain is greatly influenced in its every aspect. Age particularities, such as reduced abilities to adapt to new or major life changes, limited understanding of theoretical and practical cues, underdeveloped verbal  skills with communication difficulties, close child-parent relationship and high family dependence, all impact the cognitive, emotional and social development of the child.

Although there is a strong interrelation between areas, the pandemic social crisis can be understood by taking into account the main children’s life domains: family, peers, school and leisure area (Figure 1).
 

What affects the family will affect the children. There is evidence that the important child-family bonding, a healthy parenting style and familial environment lead to positive outcomes for children.

During the pandemic, a high number of parents stay at home and work remotely. This leads to changes in daily schedule and pattern of family interactions, with advantages but also with many shortcomings. Children are almost permanently supervised, less autonomous, with an increased risk of hyperprotection and family dependence. In the family setting, children  are exposed to a chaotic influx of information, parental worries, restricted family visits, illness or death of close relatives, and financial problems.

Moreover, it is often difficult, especially in families with many children, for the parents to manage the e‑learning and remote school, with all the challenges involved in this new and unfamiliar schooling model. Time management, technological challenges, providing with materials necessary for education (electronic devices, prints), space management and many other factors contribute to this. Parents are exhausted, stressed, and often display a lack of patience and avalability due to the overwhelming multiple responsibilities. An increase in domestic violence against children, adolescents and women has been reported in several countries⁽⁵⁾ (China, USA, UK, Brazil, France).

Being close to family is essential. Separation caused by illness is another significant issue, and children separated from their family (isolation, quarantine, hospitalization) are prone to acute stress reaction, post-traumatic stress disorder, adjustment disorder, depression, anxiety disorders, psychosis, delinquency and even suicidal tendencies⁽⁶⁾.

School is essential in childrens’ lives and even the short and limited disruptions in children’s schooling can have long-lasting negative consequences. United Nations Educational, Scientific and Cultural Organization (UNESCO) noted the critical situation regarding global schooling and warned that prolonging school closures due to the pandemic could jeopardize the children’s right to education: “188 countries imposed school closures during the pandemic, affecting more than 1.6 billion children and youths”⁽⁷⁾. 

Digital learning isn’t available to all children, since many schools lack the necessary material resources and children from poorer households do not have internet access. UNICEF statistics underline that up to 31% of schoolchildren cannot participate in digital learning⁽⁴⁾. In addition, some children are unable to learn due to skills gaps or lack of parental support.

School has a educational role, but also offers a safe environment in which children interact with peers and adults, practise sports, arts, enhance their communication and social skills. At school, they train for adult life beyond parental supervision, in groups with rules and structure different from the familial ones.

Friendships and social interactions are strongly affected by the pandemic. Face-to-face meetings in groups at home, outside, at playgrounds or parks are replaced by remote interactions. Children are no longer allowed to share toys, food, to touch each other, they have to cover their face with a mask, they are required to disinfect frequently, to be very clean and sanitized. Children feel bored, isolated, alone, remote from peers. Distancing and frustration due to the alteration of a relationship which was previously direct, often physical, between children and adolescents, generate a disjunction, a social cleavage in the child’s life and social environment that otherwise should be rich and intense in stimuli in order to promote a harmonious development.

In teenagers, the restrain of direct interactions and daily routines, including preparations like choosing an outfit and girls’ make up in order to meet friends, lead to social disruption. There is a general suspension of social anchors that generates a lack of identification (roles, situations with which the young person identifies and that offer a position in the world) and a persistent feeling of ennui.

There is a general reduction in leisure and physical activities. Children experience few extracurricular and leisure activities in clubs, sport centers and educational institutions. The school closure changes the daily rhythm of children, the meal schedule, sleep, intellectual and physical activities, promotes a sedentary lifestyle, obesity, and orientation to activities on electronic devices and TV. The intensive use of media increases the risk of accessing inappropriate sites, being contacted by sex offenders, developing addiction to computer games and online shopping abuse etc.

Several studies have shown that children are seriously affected by the pandemic.

The most common manifestations include: irritability, frustration, increased parental adhesion, difficult concentration, fear that a family member may become ill and die, general anxiety, insecurity, depression, sleep disturbances, decreased appetite, fatigue due to excessive computer use⁽⁸⁾.

The isolated communities are at a higher risk, given the previous lack of available resources. In Romania, there are many communities in this situation, such as those of children living in rural areas or those of Roma people which live in closed and separated social groups. After a field research conducted in a Roma community near Cluj-Napoca^[1], some specific aspects have been noted, including the positive ones (Table 1).
 

Children with mental illnesses (autism, ADHD) and those with cognitive disabilities are another group severely affected by the pandemic and may contribute to the spread of infection, due to the reduced compliance with hygiene rules and social restraints. Many of these children often follow long-term therapies with daily sessions and alternative methods of therapy and interaction, such as online exercises and games that try to replace the face-to-face meetings, but these don’t compensate entirely the direct contact.

Overall preventive measures are necessary, but the excessive fear of illness has its drawbacks. It can lead to stigma and by preventing or delaying access to medical, psychological and social help, it can contribute to the onset or exacerbation of the pathological issues. Measures and strategies aimed at helping and improving the life of children and of their families are essential and entail attentive and effective communication, sensitive and careful approach, considering the child’s level of understanding, the previous knowledge and the specific life context.