Establishing structure and routine for kids during COVID-19

By Dr. Cindy S. Kim, pediatric psychologist at CHOC Children’s

During a time of crisis when so many things are unknown, creating a routine helps children in several ways. Creating a routine for kids during COVID-19 can provide structure and predictability during times of uncertainty. Structure also promotes reassurance and a sense of safety. Routines can also promote positive physical and mental health.

Children inherently turn to structure and routine for reassurance during times of uncertainty. Structure and routine help to maintain balance and normalcy. The more a child can anticipate what’s up ahead, the better they are prepared to face daily challenges and expectations.

Here are some suggestions in establishing a routine for kids during COVID-19:

  • Don’t get carried away and over-commit to an extensive schedule. Start small and slowly build into is as you see it working for your child.
  • Set aside some time to review the schedule and expectations with your child. This will ensure that they understand what is expected of them as well as when they can have free or play time.
  • For younger children, consider using a visual schedule format. This could be in the form of a chart, a clock with activities placed on it, or any other format your child can understand.
  • Start with a good wake up and bedtime routine. The goal is to stay as close to their daily school schedule as possible to allow for a smooth transition. This allows their physiological system to maintain a healthy balance between activity and rest periods. This is essential for regulating key hormones linked to our mood, hunger, and sleep to name a few.
  • Encourage your child to change out of pajamas and participate in regular grooming and hygiene activities such as brushing their teeth, washing their face, taking showers, etc.
  • Schedule time for meals and snacks, the way they would normally have them during a typical school day.
  • Set aside a quiet workspace for your child to complete schoolwork. Most schools are in the process or have already transitioned to distance learning. Get into the habit of having your child complete their daily school assignments each day.
  • Schedule harder tasks, such as classwork, to be completed earlier in the day when your child is more refreshed and rested. Save easier tasks for later in the day.
  • Allow for natural breaks or recess throughout the day. This time can be spent relaxing, listening to music, reading for fun, engaging in a hobby or exercising. During this time, be attentive to your child’s mood. When they are overly stressed or anxious, you might schedule in additional fun breaks.
  • Allow opportunities for your child to help around the house and do simple chores. This can be as simple as setting the table, folding laundry, or walking the family dog. Giving a child a simple task or job to do can help build up their sense of empowerment.
  • Encourage hobbies and other creative outlets. Your once busy child now has the gift of time to engage in creative outlets such as drawing, painting, cooking, designing, writing a short story or play, or building a fort. Hobbies are a great way to foster creativity and imagination all while giving a child something to do to break up their day.
  • Set aside time for outdoor activities, following social distancing guidelines. This is a great opportunity to go for a short family hike, bike ride or walk around the neighborhood. The goal is to remain active and physical while upholding good social distancing practices.
  • Engage in mindfulness and stress-relieving activities. Many meditation and mindfulness apps are offering free downloads or reduced subscription dues for many effective mediation, guided imagery, and stress reduction exercises or activities your child can do. CHOC offers online guided imagery.
  • Allow screen time as needed. It’s inevitable that your child will want to connect with friends online or spend some time in front of a screen. Screen time is a great way to reward your child for completing their tasks such as chores and schoolwork. As always, monitor and ensure safety measures are in place to allow for safe screen time.
  • Schedule time to connect with friends via technology. This can include video conferencing, text or social media. Social connections are important for children to continue to achieve their developmental goals. You can use video chats, for example, to have a virtual play date while children do the same activity such as creating the same craft together.
Get more information on Coronavirus (COVID-19)

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A years-long search for a diagnosis: Colton’s story

Ever since six-year-old Colton Pena was a baby, he got sick more than other kids. His parents Josh and Devon knew Colton had low immunoglobin levels and was immune-compromised, but they were determined to find more answers.

“I encourage all parents to advocate for their children,” Devon says. “If you believe there is an issue with your child, go with your gut.”

When the Pena family relocated to Orange County, Colton got horrible mouth sores. His new pediatrician ordered blood work that showed Colton was severely neutropenic. This meant that he had extremely low levels of neutrophil, a version of white blood cells, which help the body fight off infection.

His pediatrician referred him to CHOC Children’s team of pediatric hematology experts. Under the care of pediatric hematologists Dr. Loan Hsieh and Dr. David Buchbinder, Colton underwent a bone marrow biopsy to rule out leukemia, but his team still wasn’t sure why his neutrophil counts were so low.

Over the next three years, Colton’s care team worked diligently to find a diagnosis, and ultimately, a treatment plan. That time was filled with multiple bone marrow biopsies and hospitalizations for high fevers. Devon, a licensed vocational nurse, quit her job as a school nurse to care for Colton full-time.

“CHOC’s hematology team was been so great about trying to find out what was going on with Colton. There were a lot of minds working together to figure out why his immune levels would be low, then level out, then go back down,” Devon says.

Josh, a police officer, likens the doctors’ work to detectives working to find a break in a complicated investigation.

“We got to the point where we just wanted to know if it was good news or bad news. That way, we would know how to help him,” Josh says.

colton-pena
Colton during a stay at CHOC Children’s Hospital.

Colton should be in first grade, but due to health issues he missed so much school last year that he is repeating kindergarten.

“Last year, Colton was at CHOC more than he was home,” says Devon. “We came weekly to check his neutrophil count and for other appointments, anytime he spiked a low-grade fever we had to visit the Emergency Department to check his neutrophil, and he was hospitalized more than five times.”

Colton struggled emotionally with his illness, so his hematology team referred him to CHOC psychologist Dr. Cindy Kim.

“I could see his anger related to his illness, and he was having a hard time coping with the recent death of his grandfather,” Devon recalls. “I felt especially with my medical background it was important for him to talk about it. Sometimes it’s hard to talk about your feelings with a parent.”

For a few months, Colton and Devon met weekly with Dr. Kim as he learned to work through the anger and emotions.

Colton tried bone marrow stimulant injections to try and help his body make more neutrophil. When that didn’t work, his hematology team suggested genetic testing.

The results identified a rare variant mutation in Colton’s genes. This particular mutation is a recent discovery and more research is needed to fully understand its scope.

Armed with the results of Colton’s genetic testing, Dr. Buchbinder started Colton on infusions of immunoglobin—a protein in the body that plays a role in supporting the immune system. Immunoglobulin therapy is used to decrease symptoms of a number of autoimmune disorders.

Ever since starting these infusions, Colton has been like a different kid, Devon says. He’s only been hospitalized once, he’s able to attend school regularly, and he only needs to visit CHOC monthly for lab work. Since his immune system is healthier, his parents feel more comfortable letting him play outside, his favorite hobby.

colton-baseball
Now that he is much healthier, his parents feel more comfortable letting him play outside, his favorite hobby.

Dr. Buchbinder gave Colton’s family the option of coming to CHOC monthly for infusions or doing them weekly at home. Given Devon’s background in nursing and her history of caring for children with autoimmune disorders who needed similar injections, the family opted for at-home infusions. A home health nurse provided training, and now Devon administers Colton’s infusions every Sunday afternoon.

“Colton’s whole motto is ‘Be brave, show courage.’ His bravery has made my journey as a parent and caregiver so much easier. I’ve never had to deal with his fear or worry,” Devon says.

Colton, pictured here with dad Josh, has a motto: Be brave, show courage.

Throughout his journey, Colton has become an advocate for giving back to other kids at CHOC. He organized several fundraisers to purchase bright, lively hospital gowns so that other patients could wear their favorite theme or animal. He’s even participated in magic shows to spark joy among other patients.

Last Christmas, Colton told his parents he didn’t want to ask for too many gifts, so that he could donate more toys to kids at CHOC.

“Colton has the kindest heart. He loves helping other kids who are sick and helping make their day,” says Devon. “Giving back has been something that has redirected his own feelings into something positive.”

Josh’s colleagues at Huntington Beach Police Department, inspired by Colton’s bravery and commitment to help others, have supported his fundraising efforts. Officers organized fundraisers to help Colton purchase more unique hospital gowns and organized a toy drive to benefit CHOC patients hospitalized over the holiday season.

Share your own CHOC story

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