Communicating to children about the COVID-19 pandemic
The end of 2019 ushered in a new decade and the spread of a novel coronavirus causing respiratory symptoms and disease confirmed as an outbreak by the World Health Organization (WHO) in January 2020. The International Committee on Taxonomy of Viruses (ICTV) declared on 11 February 2020 that “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2) was the name of this new virus due to its genetic similarity to the coronavirus responsible for the SARS outbreak of 2003. The disease caused by this virus was designated the name coronavirus disease of 2019 (COVID-19) by the WHO for purposes of risk communication to the general public  and see pXXX
The first cases of COVID-19 were identified in Wuhan City, China and more cases were reported worldwide leading to the determination that the disease had now reached pandemic levels as declared by the WHO in March 2020 . As of 15th April 2020, there were four confirmed cases of COVID-19 in South Sudan with zero deaths and no reported recoveries from the affected individuals who were placed in quarantine .
Epidemiology of COVID-19 and disease burden in children
Current evidence suggests that COVID-19 affects mainly adults and individuals with weak immune systems, the elderly and those with underlying chronic diseases like diabetes, cancer and chronic lung disease.
There have been few reported cases of COVID-19 in children. As of February 20, 2020, only 2.4% of the 75,465 reported cases in China were in persons less than 19 years of age, mostly as a result of exposure through household members with COVID-19. This picture is similar to that seen during the 2002-2003 nSARS epidemic where, less than 5% of cases were in persons younger than 18.
Children manifest a milder form of COVID-19 and their symptoms such as fever, cough and difficulty in breathing are also seen when they have viral respiratory infections. Clinical management of COVID-19 includes prompt use of infection prevention measures like use of a respirator or facemask, gloves, gowning and shielding in healthcare settings and supportive management of the respiratory complications .
Risk communication and community engagement on COVID-19
Past experiences with disease outbreaks such as Ebola and SARS, have shown that risk communication and community engagement are important tools in outbreak management and response. Risk communication, in any disease outbreak, is defined by the WHO as ‘the real-time exchange of information, advice and opinions between experts, community leaders or officials and the people who are at risk’ . Timely messages avoid confusion and prevent misinformation about the disease spread and enable individuals at risk to make informed decisions to prevent them from further risk .
Maintaining public trust is key in risk communication because without it the public will not believe or act on information provided by public health officials to minimize their personal risk. Regular communication also allows the government to respond rapidly to specific concerns and information needs of the public and healthcare workers .
Importance of communicating to children about the COVID-19 pandemic
Children may play a role in the spread of SARS-CoV-2 in the community. Most risk communication and community engagement strategies are always focused on adults as opposed to children for obvious reasons. However, this does not mean that children cannot be informed about diseases especially of a public health nature such as the current COVID-19 disease. Failure to engage children in risk communication and prevention strategies for COVID-19 means that they can be the weak link in the spread of the disease.
Children all over the world have been affected by measures to curb the spread of COVID-19 such as physical distancing, quarantines and school closures . Schools have remained widely closed while churches and community gatherings are not permitted in South Sudan since a government directive effective from the 24th of March of 2020. Restriction of movement of children and disruption of daily activities such as school and play may cause feelings of isolation, disappointment and boredom . These changes may also affect their temperaments and result in behavioural problems.
Ongoing conversations about COVID-19 may cause worry and anxiety among children depending on the information they hear and their interpretation of it. Feelings of fear over the health of family members and loved ones may result in anxiety and worry. Unlike adults, children are unable to effectively communicate feelings of anxiety or worry. Anxiety in children can manifest as physical symptoms such as stomach aches, poor feeding and sleeping .
The Centers for Disease Control and Prevention highlights some common stress induced behaviour changes that parents can watch out for in their children during this period . Figure 1 highlights some of these behavioural changes.
Figure 1. Common stress induced behaviour changes in children. Source: Grace J. Soma (Author).
During these uncertain times when both parents and children are unexpectedly at home, parents may find it challenging to support children who are struggling to cope with the current changes in their lives. The presence of a trusted adult who is able to check with children to find out what they are hearing and how they are feeling about all that is going on is important during this period. This article shares some useful tips for parents, guardians and caregivers on how to communicate to children about the COVID-19 pandemic.
Tips on communicating to children about the COVID-19 pandemic
Children need to be made aware of what is going on in the world around them but this should be done in a child friendly manner. Below is a compilation of general principles and tips on communicating to children about COVID-19 from UNICEF , WHO , CDC  and the Child Mind Institute :
1. Be available and take the lead
- Take the lead in opening up the discussion on COVID-19 by being available to listen and talk.
- Start by finding out how much they already know, ask open questions, listen and build up on existing knowledge.
- Close conversations with care ensuring that you have not caused more anxiety or introduced new fears.
- Let the child know that you are available to talk and that you will continue to keep informing them on any new updates that they need to know.
2. Be tactful
- It is not necessary to volunteer a lot of information to very young children as this may be overwhelming, what is important is to continue reinforcing good hygiene practices.
- Use age-appropriate language, watch for reactions, and be sensitive to the level of anxiety and understanding.
- Give information that is truthful and appropriate for the age and developmental level of the child.
3. Be calm and reassuring
- Deal with your own anxiety first in order to be calm and reassuring.
- Acknowledge any concerns the child may have, address them as best as possible and offer reassurance.
- Pay attention to what children see or hear on television or radio and limit their exposure in order to avoid anxiety due to too much information on the topic.
- Remind children that everyone is working hard to contain the virus and that they can play their part in this by following the rules and practicing good hygiene as advised.
- Reassure the child that not many children are getting COVID-19 and that those who get it seem to have milder symptoms.
4. Don’t use language that can lead to stigma
- Anyone can get sick with any virus including COVID-19 and it is important to avoid language that might blame others and lead to stigma.
- Check if they are experiencing or spreading stigma.
5. Be an example
- Communication is not only about talking, but also about actions that match the words.
- Teach and show children how to reduce the spread of germs by everyday actions like hand washing.
- Remind children not to get too close to people who are coughing or sneezing or sick.
- Remind children to cough or sneeze into a tissue or their elbow, then throw the tissue into the trash.
6. Stick to the facts!
- Let your children know that there may be many stories out there about COVID-19 which may not be true and that they should always come and confirm these stories with you.
- Do not make any guesses, if you are not sure of anything, take the opportunity to learn more on the topic by referring to official public health communications either on radio, TV or mass messaging.
COVID-19 facts for discussions with children.
The CDC suggests some useful COVID-19 facts for discussion with children shown in Table 1.
Table 1. COVID-19 facts for discussion with children
What is COVID-19?
How is COVID-19 spread?
What happens if someone gets COVID-19?
What can I do so that I do not get COVID-19?
How can I keep my hands clean?
What should I do if I am coughing or other people are coughing around me?
What should I do if I feel sick
A simple way to remember how to communicate to children about COVID-19 is through the acronym ABCDEs! as in Figure 2.
Figure 2. The ABCDEs! for communicating to children about COVID-19. Source: Grace J. Soma (Author).
Physical distancing does not mean emotional distancing and children should be allowed a safe environment to express feelings of fear, anxiety or sadness. Children will best thrive during this period if they are kept close to their family members and caregivers as long as it is considered safe . Maintaining structure and familiarity of daily routine life is important as children continue to stay at home, this means that learning should continue, inclusion in house chores, play and socialization with members of the same household should be encouraged .
Communicating with children about COVID-19 through regular family or household updates in honest and developmentally appropriate ways may ease their anxiety. Children always observe adults’ behaviours and emotions for cues on how to manage their own emotions during difficult times. A balance of learning, play and involvement in household activities will go a long way in keeping children happy and healthy during this period .
- World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. World Health Organization Website. [Internet]. 2020.
- Emergency PH, Concern I, Health M, Use S. Mental Health and Psychosocial Considerations During COVID-19 Outbreak. World Health Organization. 2020;(January):1–6.
- Tamazuj R. South Sudan ’ s coronavirus cases rise to four. 2020;8–9. Radio Tamazuj Website.
- Centers for Disease Control and Prevention C. Coronavirus Disease 2019 (COVID-19): Information for Pediatric Healthcare Providers. 2020;2019:4–7.
- World Health Organization. Communicating Risk in Public Health Emergencies. A WHO guideline for emergency risk communication (ERC) policy and practice. 2017. p 57.
- Pan American Health Organization. Guidelines for communicating about coronavirus disease 2019. 2019.
- World Health Organization. # HealthyAtHome - Healthy parenting Read the World Listen to stories. 2020;4–7.
- The East African Newspaper. South Sudan on a lockdown over coronavirus fears.The East African Newspaper Website. 2020.
- Miller C. Anxious Stomach Aches and Headaches.Child Mind Institute 2020;1–10.
- Centers for Disease Control and Prevention. CDC. Mental health and coping during COVID-19.
- Centers for Disease Control and Prevention CDC. Talking with children about Coronavirus Disease 2019. 2020;1–11.
- UNICEF. How to talk to your child about coronavirus disease 2019. 2020.
- Ehmke R. Talking To Kids About the Coronavirus. Child Mind Institute 2020;84(84):1–7.