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August 31, 2020

Considerations for Young Children and Those With Special Needs as COVID-19 Continues

Author Affiliations
  • 1Pediatric Critical Care Medicine, University of Alabama at Birmingham, Birmingham
  • 2Department of Pediatrics, University of Florida, Gainesville
  • 3Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville
JAMA Pediatr. 2020;174(10):1012. doi:10.1001/jamapediatrics.2020.2478

The coronavirus disease 2019 (COVID-19) pandemic continues to affect children and their families.

While the country navigates reopening of the economy, many child-friendly places such as schools, libraries, parks, museums, and zoos remain closed. Social distancing continues to be one of the primary methods used to slow the spread and transmission of the infection. All of these important measures affect young children and children with special needs immensely.

Adjusting to the new reality caused by the COVID-19 outbreak is difficult for children, particularly those who are younger or have additional challenges related to developmental delay or medical diagnoses such as autism spectrum disorder. For many, it can be difficult to fully understand the changes that are happening in the world, even in their homes. Disruptions in their schedule conflict with the stability of routines and, when coupled with any communication difficulty, can lead to anxiety, frustration, and negative behaviors. Even attending to a familiar task in an unfamiliar setting can be challenging, and with time, these children are at risk for losing these skills.

It is important that parents use clear, simple, and concrete language when explaining the COVID-19 pandemic. For instance, phrases such as “they caught the bug causing COVID-19” or “they are under the weather” can be confusing to children. Using direct and concrete language such as “they are sick” can be easier to understand. Parents can also use story boards to explain the situation. In these short stories or narratives, parents can describe new situations or activities using literal language and pictures. This can be a useful tool to teach important concepts such as hand washing, putting on a mask, or social distancing.

Parents need to establish a home routine for their children. Keeping a similar daily schedule can be comforting as the child becomes familiar with a new routine. Parents should set the same wake and sleep time, as well as specific times for meals, schoolwork, play time, and exercise. A visual of the daily schedule can be particularly helpful. Children can preview the calendar the day before so that they can anticipate events before they happen. Furthermore, these visual cues can also help note the passing of time. Otherwise, without the typical school and weekend schedule, days and weeks merge together, which can be disorienting. Having a child mark the calendar can be a concrete way to track time and to feel in control. Transition periods can also cause a lot of anxiety for these children. Use of visual timers allow the child to see how much time is remaining for a particular activity before transitioning to the next activity compared with using phrases like “in just a second.”

Young children and children with special needs may have difficulty expressing their emotions, whether it is fear, anxiety, or frustration with the unknown. It is important for parents to recognize that difficult behaviors may be an expression of these feelings and for them to be proactive in providing alternate expressive opportunities via music, art, or by using augmentative devices such as a tablet. Finally, it is essential that children stay connected with their social support system, including other family members, teachers, therapist, and friends via scheduling of regular check-ins.

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Article Information

Published Online: August 31, 2020. doi:10.1001/jamapediatrics.2020.2478

Conflict of Interest Disclosures: None reported.