How to talk to kids about disappointment during COVID-19

By Dr. Mery Taylor, pediatric psychologist at CHOC Children’s

With schools closed and the practice of social distancing in effect, it is certainly understandable for children to feel disappointed right now about missing out on birthday parties, field trips or holidays they had been looking forward to. If your child or teen feels disappointed right now, let her express her feelings, and validate them. Share your own disappointments and how you are managing your feelings.

As a parent, it is difficult to see your child experience disappointment. As adults, we have the perspective of knowing that there will be other birthday parties, field trips and celebrations in their future. During this time, children will be most comforted by parents’ words of reassurance that you will get through these challenging times together, and that life will return to normal eventually.

Remind children why things have changed

It can be helpful to remind them about why things are different right now. Remind your child that as a community, we are coming together to “flatten the curve” and prevent the spread of COVID-19.

Discuss changes in plans earlier vs. later

For most young children, it will be helpful to start to discuss changes in plans earlier than later. Start slow and return to the topic several times, each time adding a little more detail. Ask for your children’s input on how they can still honor the event though they may not be physically able to go somewhere or have in-person interactions. For example, can they create a birthday card for a friend whose party was canceled and mail it to them, and call or video chat them to wish them a happy birthday.

Limit children’s exposure to the news

At this point, most children are home from school and it is clear that something has drastically changed in their world. While it is important to keep very young children away from the daily news which can include death tolls and speculations, parents should be honest about what we are trying to accomplish by social distancing. Here’s an explanation of social distancing. It could be helpful to ask them what they already know, debunk misinformation, and provide additional information for better understanding and clarification.

Advice for older children

Older children and teens are likely more aware that there are some special occasions that they many never get back, such as school dances, play performances and graduations. Assure them that their school and teacher will do what they can to make it up to them.

Let them use their imagination

Have fun thinking about what makeup birthday parties, field trips and other gatherings with family and friends would look like. Let them use their imaginations on what decorations they would have, food they would eat and people they most want to see.

Celebrate special events in a creative way:

  • Host a virtual party — decorate a backdrop, make a music playlist and create a themed game.
  • Join friends for a virtual museum tour. Many museums and other attractions are offering free virtual visits during this time.
  • Help your child prepare a special meal or dessert for the holiday or special day.
  • Go into nature for a special adventure with those you live with.
  • Call your friend on their birthday and sing them “Happy Birthday.”
  • Share a virtual meal with friends and family.
  • Host a virtual game night.

Building resiliency

Although this pandemic is not the situation that we would have chosen for our kids to face, experiencing adverse events, with their parent’s support, will help kids build resiliency. They will be able to look back on this time and reflect on how they were creative in finding ways to connect with their friends online, how they found new ways to entertain themselves at home, and how they persevered over new challenges, such as attending school online.

Get more information on Coronavirus (COVID-19)

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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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7 ways to help kids cope with Coronavirus (COVID-19) anxiety

If the ongoing spread of Coronavirus (COVID-19) is causing anxiety, stress and uncertainty for grownups, consider how troubling it may be for children.

Depending on their age and media exposure, children may know more about the virus than grownups think. And even if unaware, children still might sense tension and anxiety from adults around them.

Here, CHOC Children’s pediatric psychologist Dr. Sabrina Stutz offers seven things parents can do to help reduce their children’s anxiety about COVID-19.

Meet children’s concerns with validation, compassion

  • Listen carefully to their concerns and learn where they heard their information. Validate their fears by saying something like, “It can be frightening when a new illness comes around that we don’t know everything about.”
  • Gently correct any misconceptions they may have heard and encourage them to continue to ask questions.
  • Maintaining a routine can provide children a sense of security. Keeping a usual schedule – including school, activities and chores – will protect mental and physical health.

Stick to developmentally appropriate facts

  • ​Avoid having adult-level conversations about COVID-19 around children. Similarly, carefully monitor children’s exposure to media reports about the virus.
  • Answer questions with brief, developmentally appropriate explanations. For example, you might tell a young child, “Coronavirus is a new type of cold/flu, and so it is important for us to wash our hands more and sneeze in our elbows to keep healthy.”
  • Remind children that doctors and other experts around the world are working hard to stop the virus. This can help kids understand that smart, capable people are taking action.

Reassure kids by empowering them

  • Telling kids how they can help provides a sense of agency and can turn anxiety into an actionable goal.
  • Reassure children that they can protect themselves and others by practicing proper hand-washing and cough etiquette and taking other healthy steps.
  • Kids can also be included in other family-wide preparations. For example, if you were preparing for the possibility of being home for a while, ask the child what they might want to snack on or what activities they might enjoy during that time.

Look for kid-friendly methods

  • Make learning about hand-washing and other preventative measures fun. Help kids learn about germs by giving them some lotion and then sprinkling glitter on their hands. Tel them the glitter is like germs, and then ask the child to try to wipe it off with a paper towel or just water. They won’t get far! Then you can explain how soap and warm water removes the glitter – and germs – best.
  • Teach kids how long to wash hands for by singing a 20- to 30-second song together. “Happy Birthday” or the “ABCs” are classics. You can also be creative and estimate 20-to-30 seconds of any song the child likes.

Emphasize kindness

  • As always, it is helpful to teach kids to continue to be kind to all people, regardless of their country of origin or their appearance. Kindness is always possible – even when they feel afraid.
  • To help children more realistically assess risk, educate children that most people who visit the doctor or wear a mask probably don’t have the virus.
  • It is important to remind children that we are all trying our best to stay healthy and it’s not anyone’s fault if they do get sick.

Remember to model positive behavior

  • Parents who show good coping skills can help reassure kids that they are safe. After all, kids learn from their parents how to react in new situations.
  • Remember that kids make mistakes. If your child accidentally does not wash their hands or doesn’t sneeze into their elbow, gently remind them. Scaring children with the potential consequences of their mistakes is not helpful.
  • Adults should model self-care behaviors: Maintain activities and sleep schedules. Eat healthfully and practice hand hygiene and cough etiquette.
  • It’s also helpful for grownups to limit their own media consumption around Coronavirus (COVID-19) and stick to a few trusted resources such as the Centers for Disease Control to prevent information overload and anxiety.

Watch for behavior changes

  • Changes in a child’s sleep, appetite, interest in being with friends or leaving the house, or levels of reassurance seeking, as well as excessive hand-washing can be signs that more help is needed.
  • If basic stress reduction techniques like deep breathing, distraction or guided imagery don’t help, reach out to your primary care provider for additional support.
Learn more about mental health services at CHOC

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How to help children cope with grief

It’s difficult for adults to make sense of a tragedy or unexpected death, so consider how difficult it can be for children to do the same. Even events that occur far away – or the unexpected death of a celebrity – can trigger a stress response in children. Here are some ways parents can help.

Monitor your child’s news and social media intake and keep their routine and schedule as normal as possible. If your child is prone to anxiety, reassure them of their safety and ensure they are not dwelling on the tragedy.

Honor your child’s connection to the deceased – even if he or she didn’t know them personally. Talk about why this person was important to them, and the qualities and values that made this person feel special to them. Ask what your child wants to do to pay their respects or process the tragedy. This can be as simple as saying a prayer for the individuals left behind or donating to an organization important to the deceased.

Parents should also consider the five E’s of helping a child navigate emotions that come with a traumatic event:

Explore what your child already knows in a gentle and calm manner. You can start with a neutral question inquiring about how their school day was.

Explain what has happened in a way that your child can understand based on their age.

  • Address any misinformation your child might have picked up at school. Help them understand that although a sad and/or scary thing did happen, adults work hard to keep children safe daily.
  • Limit information you provide to your child to the questions they ask you. This will help avoid overwhelming them with information they may not already have been exposed to.
  • Provide examples of ways you and others in your community keep your child safe every day.

Express to your child that feelings are normal, and it is OK to feel sad, mad or angry when a tragic event occurs. Remember to reduce media exposure after a traumatic event, as repeated exposure to the event has been associated with psychological distress and intensifying already heightened emotions.

Emotionally model for your child healthy expression of feelings because children take their cues from their parents. Describe how you cope with your distressing emotions (e.g., “When I feel sad, I talk about it with someone who makes me feel safe or I take three deep breaths.”).

Ensure stability by continuing to adhere to your child’s daily routine. This will provide them with a sense of reassurance and safety during a chaotic time. Engaging in a daily routine is not meant to ignore what has happened, rather to continue to provide the child with structure, stability and predictability.

Additional resources

In the wake of a tragic event, it can be difficult for parents to find the words to talk with children and teens. Below are resources and suggestions for parents on how to discuss difficult topics with their children:

When to get help

Grief and shock are common after a loss or community tragedy. When this lasts longer than two to four weeks and is constant and begins to affect everyday life (schoolwork, interactions with family and friends), then therapy might be appropriate.

If you are struggling to help your child process a traumatic event, or if you feel your child could benefit from additional support, ask your pediatrician for a referral to a pediatric psychologist or psychiatrist.

Below are a few resources in Orange County with expertise in children:

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative and to receive tips and education from mental health experts.

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Three gifts support mental health, research and neonatal care

CHOC Children’s is so grateful to recently have received three very generous gifts that will help CHOC continue to care for more than 185,000 babies, kids and teens each year. CHOC believes that all children deserve a chance at a happy, healthy childhood.

Transformational gift to benefit the pediatric mental health system of care

CHOC received a transformational gift from the Cherese Mari Laulhere Foundation to enhance and expand its pediatric mental health system of care. The announcement comes on the heels of the Conditions of Children in Orange County report, which highlights alarming increase in the number of children hospitalized in the county for mental illness.

The gift from the Cherese Mari Laulhere Foundation will:

  • Endow CHOC’s mental health inpatient center. Opened in April 2018 for children ages 3 to 17, the center is the only inpatient facility in Orange County that offers specialized programs for kids younger than 12. The center will now be named the Cherese Mari Laulhere Mental Health Inpatient Cente
  • Establish the Cherese Mari Laulhere Young Child Clinic for children ages 3 to 18 who are experiencing behavioral and emotional challenges, mental health issues and school readiness challenges.
  • Expand CHOC’s Intensive Outpatient Program, a mental health treatment program for high schoolers with moderate to severe symptoms of anxiety, depression or other symptoms related to mental health conditions. The program will be expanded to middle school-aged children.
  • Advance trauma-informed care, including providing tools to pediatricians to help in identifying adverse childhood experiences, and connecting patients and families with resources.
cherese
Cherese Mari Laulhere

“Our donations are gifts from our daughter, who brought so much light and love into this world. As someone who advocated for the underserved, Cherese would be very proud of her role in supporting CHOC’s mental health efforts and helping change the trajectory of thousands of young lives,” says Cherese’s parents, Chris and Larry.

Learn more about this gift to CHOC Children’s.

$8 million to advance research for rare disorder

An $8 million gift from the Foundation of Caring will help CHOC advance research for a rare lysosomal storage disease, ultimately leading to an improved understanding and more effective treatments.

The gift will support CHOC researchers working to develop next-generation therapies for Pompe disease, a lysosomal storage disease wherein glycogen builds up in the body’s cells and causes life-threatening heart failure and muscle weakness in affected babies. In honor of the gift, the program will be named the Foundation of Caring Lysosomal Storage Disorder Program at CHOC Children’s.

The work of Dr. Raymond Wang, a CHOC metabolic disorders specialist and director of the Foundation of Caring Lysosomal Storage Disorder Program, drew the attention of the Foundation of Caring several years ago when Dr. Wang began treating the great-granddaughter of the Foundation’s founder after she was diagnosed with Pompe disease.

raymond-wang-md
Dr. Raymond Wang, a CHOC metabolic disorders specialist and director of the Foundation of Caring Lysosomal Storage Disorder Program

With previous support from the Foundation of Caring, Dr. Wang and his team have already made significant strides in its study of Pompe disease, having built a growing research team that’s used CRISPR/Cas9 technology to edit the genome to create animal models of Pompe disease. The Foundation of Caring’s gift will allow Dr. Wang and his team to expand upon this work and use CRISPR to cure Pompe disease and lysosomal storage disorders.

“We are so pleased to support the important work of Dr. Wang and his team at CHOC to help find better treatment or, even better, a cure for Pompe disease for patients affected by the condition worldwide,” says the Foundation of Caring Board of Directors.

Learn more about this gift to CHOC Children’s.

$2 million to CHOC’s neonatal intensive care unit

Newborn babies requiring critical care have gained a big ally in the William, Jeff and Jennifer Gross Foundation. A recent $2 million gift to the neonatal intensive care unit (NICU) on CHOC’s main campus in Orange rounds the Foundation’s support of CHOC’s neonatal services to $7 million in the past year.

choc nicu

Many hospitals offer intensive care units but only a select few are rated by the American Academy of Pediatrics as Level 4 – the highest rating available – and even fewer are ranked among the best in the nation, according to U.S. News & World Report. CHOC’s program features three NICUs, a team of board-certified neonatologists and special units for the smallest preemies, infants who need complex surgery, and babies who have neurological and cardiac concerns.

“CHOC’s neonatal services are unlike anything else offered on the West Coast, providing the highest levels of care and tremendous hope to families in the region. We are honored to continue our commitment to CHOC and the care of newborn babies,” says Jeff Gross.

Learn more about this gift to CHOC Children’s.

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