Professor emeritus, dr. philos
Spesialist i klinisk psykologi
Klinikk for krisepsykologi, Bergen, Norge
Psykologspesialist, Foredragsholder, Prosjektleder, Sakkyndig
Since we made the first and second edition of these guidelines, much has happened. A new update is needed. In several countries schools and kindergartens are now closed. Adults and children in these countries are taking a collective responsibility to ensure that the infection does not affect too many people at one time. This, so that our health care systems have the capacity to treat those who are most ill.
This development has the consequence that children throughout the world are becoming more and more affected by what is occuring. Many families may have close relatives and friends who are infected, quarantined, have temporarily been laid off or are at risk of losing their job. This means that, in addition to the danger of virus infection, we have a situation that causes major mental upheaval for millions of families. It is a situation that leads to increased worry and anxiety, i.e. a form of mental contagion that we should also try to limit. As a consequence of many schools and kindergartens being closed, these expanded guidelines are most of all directed to parents.
The guide covers the following topics:
– Facts about the corona virus
– What can we say to the children
– For parents with young children
– General advice for conversations with children
– Family life in a ‘new’ world
Advice for parents
The corona epidemic has been declared an international public health crisis and a pandemic by the World Health Organization. It has spread to almost every country in the world. All news broadcasts and very much of what is on web pages deal with this situation. It is also the most dominant topic of conversation among all adults and young people. The situation is unique, and we recommend all parents to have a conversation with their children, including the older kindergarten children. There is constantly scary news being presented, from deaths to worst-case scenarios. If kindergartens and schools are closed and children must be refraining from meeting in groups (such as sport), if they cannot play as before, travel as before, be with extended family as before, there is fear and anxiety. Children lack the experience to grasp the information they receive. This poses major challenges for parents who themselves struggle to understand what is happening.
In this situation, children need to be taken seriously, facts need to be communicated and their thoughts and fantasies about viruses and disease must be met by adult caretakers. When we as adults fear the consequences of the epidemic, it is understandable that children fear for example what happens if my mother or father do not make money anymore.
«Children lack the experience to grasp the information they receive
Currently, the experts do not know enough. Based on figures from China and other countries, health authorities must plan based on different scenarios. When they have initiated serious measures such as shutting down large parts of our society, it is to ensure that the number of seriously ill persons does not exceed the treatment capacity that the health care system has. Most people have seen the curves that experts show to illustrate how much better the capacity will be if we can create a flat curve as opposed to a high ‘wave’. But this also means that it will take a long time for the infection to ‘die’ and we can say that the danger is over. Now, most people understand how important these measures are and the prime minister, government and health authorities want us all to take part in an effort to protect those who belong to the at-risk groups who are the old and those who have diseases, especially lung diseases. When you as a parent talk to your children about their concerns and thoughts, and explain and instruct in infection control, you are contributing in this effort.
The health authorities must plan for the worst to happen. Although most people do not become seriously ill, many can be. But because we are unfamiliar with the serious nature of this new illness. We cannot see the virus and so we are uncertain about it, and this increases people’s fears about it. Fears and worries will increase as more and people get infected and more deaths are reported. This is especially true as we hear/read of this in our own country where people living near us and our own family may be affected. To stop the spread of this disease all of us are being asked to avoid physical contact with other people — so most cafes, restaurants and meeting places will be closed, with only food stores and pharmacies kept open. Children as well as adults may take this as signals for feeling fear.
Facts about the Coronavirus
(official sources in Norway including the Norwegian Institute of Public Health and the World Health Organization, see https://www.who.int/emergencies/diseases/novel-coronavirus-2019)
Below are some facts about the disease that you can explain to children. The older the child is, the more details it will need.
- The outbreak of what is called coronavirus can cause respiratory tract infection in humans. For many, it causes mild illness, but death rates worldwide have risen because so many are infected. Although only a few of those infected die, there are large numbers worldwide. It is believed that the infection is originally from animals, but it can be transmitted between humans.
- The virus was discovered in a major city in China (Wuhan) during December 2019, but cases have now been reported in most countries in the world.
- From the very beginning, doctors and other experts have shared information about the virus, so that we gradually learn more about the issues below:
- Where does the virus come from?
- How serious is it? Who gets ill and how and how ill are they?
- How does it spread?
- Can someone who does not (yet) show signs of illness infect others even if they are not ill?
- How can they be best treated? What measures can be taken to limit the reach of the virus.
- As with all infections, it is important with good hand hygiene, hand washing with soap and water – or with Antibac or similar. Then we must keep a distance – at least one meter – from other people and not hand greet or hug each other. “High fives” and “fist bumps” should be avoided.
- There is currently no vaccine or preventative medicine for the disease. Scientists work around the clock to find countermeasures to the disease.
Since the virus has spread throughout the world, this is very much discussed in newspapers, on TV and the Internet. It’s almost like everything is about the virus. It is important to remember that children read the front pages of the newspapers, they are active on the Internet and they talk to each other about what they see and read. In addition, they get to know what the adults are talking about, and they realize that something is dangerous or scary when they cannot attend kindergarten or school as usual. We cannot protect or prevent the children from seeing what is happening. Even small children in kindergarten age get this. Pictures and reports, e.g. from hospitals or from closed kindergartens, schools, businesses, etc. can seem daunting and must be explained to children. It does not help the children that the information is nuanced in reports, this information may only be seen by adults. Children take in a lot of information, and they need safe adults who can explain and interpret this information with them.
Children needs adult to help the understand what is going on, so that misunderstandings can be cleared away and they can get a better understanding of what is going on. The reason we talk to children about the Coronavirus is to help them feel safer. It is not fair that children should be more scared of the virus than us adults, if there is no need for this. One example is that it is difficult for children to understand distances. When they hear of many dead in China, they do not realize how far away this is. With disease outbreaks that takes place in their own country, they realize that it can also happen close. However, they do not know what an emergency response or quarantine is. When authorities say they are prepared, or that a city or ship is in quarantine, it must be explained to children.
The children need adult assistance so that misunderstandings can be cleared away and they can understand what is happening.
Our goal in explaining to the children about Coronavirus and the measures taken to limit the spread is that they should feel more secure than if they have to process the information on their own. It is unfair for children to walk around being much scarier than us adults, if they do not have to. For example, it is difficult for children to understand why school or kindergarten closes. Then we have to explain how a virus spreads and that it is when many are together that it spreads most. Then they must be told that just as football matches and other activities are closed down, the closure of schools is to prevent the virus from spreading. It does not mean that no one will get ill, but fewer will be ill at one time. Then the hospitals can manage to treat those who become so ill that they need to go to the hospital. Then they need to hear that most of those who get ill only get a little ill, and that is not dangerous. Therefore, they do not need to be very afraid of mom and dad (or those living in the home). They can also be told that they help others when they do not go to school or are good at washing hands etc.
There are many new and unknown concepts that children need to be explained. Children do not know what readiness or quarantine is. Many know what a home office is, but hygiene, infection control, etc. and other words that they hear or see must be explained in a simple but truthful way. They may hear that equipment is missing and then they must be explained what is being done to make or obtain more equipment. When authorities or media use the concepts of quarantine and isolation this needs explaining, including why those who come from abroad must be in quarantine for 14 days and that those who are ill are isolated.
What can you tell children?
We recommend that you as a parent talk to your child. Ask about what he or she have heard about the virus and the situation so that you can correct possible misconceptions and provide a comprehensible explanation that acts as a platform for understanding new information they receive. Also give them hope: tell them that now many people are working to curb the viral disease and that even though it is serious, everyone is doing their best to make it successful. Many people work to develop a vaccine, which means that you get a syringe that causes the body to stop the virus from developing into disease.
In the following we provide examples of how you can talk to children about what is currently going on.
What is Coronavirus?
The news is filled with items about Coronavirus. I don’t know how much you think about it but thought we could talk about it. First, let me say a little about what I know (here, as a parent, you may want to supplement with new information coming from secure sources (official health websites).
It started in China where several people were infected with the disease. They think it was first transmitted from animals to humans, but we do not know how the first humans were infected. Because the disease transmits through contact between people and many did not know how it transmitted, more people got the disease. Then it has spread to other countries and many people have received it from someone who has been abroad. The disease spreads only through contact from an ill person to a healthy person, through hand contact or through a healthy person coming into contact with body fluid from the ill person. Body fluids are saliva, sweat, blood, vomiting, urine (tissues), and stool (poop). If an ill person touches a handle, table or sink, the infection can stay there for many hours. That is why it is so important that we keep at least one meter away from others and avoid touching surfaces with our bare hands. When we come in to the house, we should wash our hands with soap and warm water, rubbing them together for at least 20 seconds. When you cough or sneeze, do it into a tissue and then put the tissue into a bin. Don’t cough into your hand – use your elbow if you cannot get a tissue in time.
Many are working to find out more about the virus so that vaccines can be created to protect against it, but it takes many months to do so. Those who get ill get what is called a respiratory infection, they cough and can get pneumonia. Most get mild ailments, called symptoms, others severe. In the world, many have died, but very few of those who are infected die. This is a little difficult to understand. But imagine that everyone in a big city is gathered in one place, maybe as many as 100,000 people. If all these were infected, almost all would become well again, but some could become so ill that they died. If you have learned about percentages, the experts do not know how many percent die, but it is less than 5 percent. This means that over 95,000 of the city’s inhabitants would become well. We know that the virus is most dangerous for those who already have a serious illness, especially those with lung disease and who are old with weaker bodies. It is the adults who are responsible for your contact with grandparents and other elderly or ill in your family.
Is Coronavirus dangerous?
Yes, it is dangerous for those who are ill and old. For most of us it is not dangerous, but we can get ill when in contact with a sick person. All those who are going to help the ill know this and want to protect themselves. Now all of us protect ourselves by being careful and washing hands and keeping distance. Most people who get infected do not get serious symptoms, but we must say that the disease is dangerous because it is deadly to some people. But fortunately, they are very, very few. Healthcare professionals who meet ill patients can be infected, and some have. This has mostly happened because they have been traveling and got the virus where they were. Now they have become even more careful to avoid infection from the ill. From previous outbreaks of infectious diseases, they have learned to be careful and protect themselves, so it is rare for health professionals to become infected.
If you are wondering if the Coronavirus is dangerous for children it seldomly is, but may be for children who have a serious illness. Children are usually only slightly ill, and many are not infected at all. And most adults who are healthy have bodies that can handle well if they get ill, if you are scared of your mom or dad getting ill.
Why do so many talk about this virus?
When adults are so concerned about this, it is because there are so many infected in countries all over the world. Anything that is threatening to us and that we don’t know much about is scary and gives us turmoil and uncertainty. Now that so much in our daily life is not as it used to be, it is something we talk about a lot. That is why there is a lot of reporting in the media and this makes both adults and young people more worried. And although those who are leading our health care systems do not believe that the disease is very dangerous for most Norway, they must prepare for more people getting the disease.
Will it pass?
We do not know how long this will take. If your kindergarten and school are closed, we know that it will open again. We just don’t know when, because the most important thing now is to slow the spread so that we can help those who get ill. In China, where many people were first infected, most are now healthy again. It shows that what we do together now works. As soon as we know more about this, we will tell you about it, but it will probably take weeks and maybe months before we know exactly what is happening. Then we have to live with the situation as it is and listen to what those who lead the country and the Health Service say.
What can children do?
It is the adults who are responsible for working with diseases. It is in hospitals that the ill are taken care of and therefore you do not have to worry. If your mom or dad works in a hospital or in the health care system, then you should know that they are well prepared if they are going to treat any ill person where they work. And those who work there will be careful to protect themselves. Remember that your family are doing something to keep the virus from spreading to others. By following what you have been told about how to wash your hands and keep distance to others you are helping to prevent more people from getting ill.
However, there are still things you can do:
- Take care not to spread rumors or or sensational stories that you do not know are true, be that telling directly to someone or online
- Try not to frighten younger children (young siblings).
- Play and have fun as much as you can and try to think as little as possible about what’s happening.
- Keep busy; contact friends by ‘phone; use the internet; do homework set by school if school is closed; keep in touch with grandparents by internet.
- Talk to adults and ask them to explain what is happening and what is new, if you are thinking about the disease. Having a fixed ‘talk time’ every day can be good.
- If you think about this very much, then ask your parents if they have good advice for thinking less. A good method is to set aside a time to think about your worries (worry time of, say, 10 minutes) and if they should appear in your mind outside the worry time, you always say to yourself, “I postpone this worry until my worry time”. Doing this every time will make it happen automatically.
Advice for parents with young children
Children are scientists, they hear, see, read and draw conclusions based on this. They are scientists in a new and different way than just ten years ago. The internet has become part of everyday life. A grandfather said that his grandson of four years asked if he had learned how to search the web. It was part of the family’s daily life. It is absolutely relevant to listen to the oldest children in the kindergarten, on what they have «researched» when it comes to the Coronavirus.
We know that the kindergarten children can become aware of frightening news stories. This may derive from fragments uncovered via TV and radio or from overhearing adult conversations. Often their older siblings or friends will talk about the disease or retell news, and this in inaccurate ways. Children pick up that what is going on is scary, but they lack the understand the extent to which this should be of concern to them.
We recommend that parents of the oldest toddlers (4-6 years) take the initiative to check out what the children have heard or taken in of the situation. Ask your children about what is in the news or what they have heard about the virus / disease so you can correct misconceptions. If the children do not show interest in the topic, it is okay to leave it – but you do not know that until after you check out what they are thinking. When parent is explaining something to a child – especially young ones – keep it short and then ask the child to explain it back. This will soon show any misunderstandings.
The young children lack experience, so they can be unnecessarily scared and confused. It can be helpful to think that children need hooks from us adults. These hooks can help them with information to understand what they take in from others and the media. With facts and explanations, they are able to relinquish undue fear, and reduce unnecessary confusion.
General advice for conversation with children
1 Don’t wait to see what is happening – go to see
As an adult you should actively check out what the children have understood about the situation if you think they might be unnecessarily frightened by what is happening. Constant ‘dangerous’ news and changes in everyday life, as well as recognizing that adults are concerned, are felt by children and adolescents. Remember that all newspapers have a children’s page – that’s the front page. All children who can read get it right in the face from the newsstand or the breakfast table. In fact, the worst front pages should not be there.
2 Children need to understand
Think about how to approach a conversation when your child has taken in big headlines in the newspaper or on websites. While we cannot protect them from media exposure, we must help them understand, so that they can be calmed. You may also discuss what you plan to say to children with other adults – use Facetime, Skype etc.
3 Kids need mental hooks
Good mental hooks are words and concepts that allow the child to understand at their level. With good hooks a child can dampen a lot of unnecessary fear and worry, and they can talk about what is worrying them. For young children, insurances of the type «I am not afraid, mum or dad cannot get the disease”, “Now everyone is working to stop others from getting the disease” may be necessary. Older children need you to explain why you feel safe.
Do not be afraid to ask if the children have questions and provide them with honest answers. If you do not know the answer, say so, or say that you will try to find out. Children build up their experience through questions and often ask about the same thing several times to get a better grip on the information.
4 Our Best Adult Explanations
If there are strong emotions involved, the children might not store the explanation properly in their memory. They have to hear it several times. They will be confused if there are significant variations in these explanations. Explanations must be consistent. Also, the worst part of the information should be in the first part of the conversation. «It is a disease that many people in the world have become ill with and many have died. But only a few of the many people who fall ill die. Therefore, the ill people must not be together with others whom they can infect. Also, the people who are helping the ill needs to protect themselves (mouthwash, wash hands, antiseptic etc.). If you have to be away from school and leisure activities that means you are helping too. Then the disease cannot spread to others so easily”. Children want, and they deserve, our best adult explanations. Tell them that the authorities are doing everything they can to prevent the disease from spreading more and therefore many must live differently from usual to prevent many from becoming ill at the same time. Then doctors and hospitals have enough capacity to help. They know what to do.
5 Open to help understanding – close to help calm down
Conversations with children aim to make children understand what is going on and feel safe. We have to make sure this happens. When we start the conversation and talk about their fears, we must explain to the child that we are doing so to help them gain control over the troublesome thoughts. It is not a goal to evoke strong emotions, it is a goal to reduce those who are already there.
6 Stick to the facts
The coronavirus first was discovered in a Chinese city. Since then, many people all over the world have fallen ill. Scientists believe it has transmitted from animals (bats are often mentioned) to humans, but they do not know for sure. Now the disease is spreading between people (see more facts earlier).
7 What can children do for themselves?
Repeat that they all do something for others by being careful (and being home from school if that is the case). They help prevent the virus from spreading. Emphasize that good hand washing many times a day, especially before eating and after having been to the toilet is important The same applies to close contact with friends: do not hug friends, do not shake hands or be so close that they may become infected by sneezing or coughing. And if they have a cold, they can cough or brush their noses into paper handkerchiefs and, if they do not have this available, cough or sneeze into the elbow. Then they prevent infection because diseases such as the flu and colds are transmitted through body fluids.
Adults can also use the situation to teach children about the body, to tell what happens when we get ill and how the different parts of the body interact to keep us alive. Children who ask about death must receive simple explanations of what happens in the body when we die; that all life functions stop, that one can no longer feel pain and that the dead cannot return.
Family life in a ‘new’ world
In many countries closing kindergartens, schools and leisure activities has created a new situation for parents. More countries will probably follow suit. It is worst where members of the family are quarantined. While being together is great at weekends and holidays, being together all the time without school and leisure activities and regular socializing with friends can be tiring. Maybe not the first few days, but over time. It can cause irritability and wear and tear between adults and between children. We share some advice about this situation.
1 Establish regular routines in everyday life
Solid, well-known routines in everyday life provide security and stability. It works well in an uncertain situation. Strive to have communal meals at regular times, carry out bedding routines as usual and keep to the rules children usually have for what they are allowed and not. If greater irritability is experienced, it is a good thing to do something together that is nice.
2 Do enjoyable things together
Involve the kids in coming up with ideas for what you can do the next week. Make a plan and suggest some regular family times where you can play games, play, go for a walk together or do other things that you know most of you like. Think about what catches your children’s interest when you are on vacations. Many of the interactive games that exist, adults can join. Here is a chance for adults to learn from children.
3 Internet can be very helpful, but it is not a babysitter
Tablets and cell phones are great to use when there is a lot of free time that is not filled by organized activities. Both playing alone and interaction are engaging and provide good distraction. It is perfectly understandable that children are allowed to spend more time on mobile and tablets than usual. But children also need direct interaction with adults. They develop social competence in interaction with others. Young children in particular need language stimulation through conversations and interaction with adults. Try to find a good balance between direct interaction and play, and children’s use of mobile and tablets.
4 Keep in good contact with family and friends
Include your children in conversations with grandparents, friends, and other important family members. Use the internet solutions you usually keep in touch through (Facetime, Skype, Messenger etc.). It makes the children feel less alone and emphasizes how important we are to each other. Probably preadolescents and adolescents already meet both close and distant friends through games. Adults can encourage such contact and perhaps stimulate them to make contact with someone in their class or group of friends that they know are lonely or do not have many people they have contact with.
5 Discuss how you can stop unnecessary worries
Worries are natural when the world suddenly changes so much. Children’s worry should be addressed by adults, so the kids know they can talk to you about them. But it is easy to worry too much. When the family practice good hand washing, reduce close contact with others, etc., most extra worrying only bring about an upset mind and body. They may need some tools to reduce unneccessary worry. Explain to the children that if they become very worried, it may be good to distract themselves with something that takes their mind off the worries. Teach them to ease their worries. Let them set aside 15-20 minutes in the afternoon where they can think about the worries. If the worrying thoughts come in before or after this time, they can say to themselves without being annoyed at themselves; “I notice that this worry came into my mind, but I will postpone it to my ‘worrytime’. ” If they do this every time, the association will become automatic. It is necessary to practice this method, so it is important that they do not give up right away. Adults can benefit as much from this method as children.
6 Do not leave radio / TV news on in the background – limit news updates
Both adults and children will be more worried if they are exposed to constant news about illness, death and other the consequences of the virus. Stay tuned for a few updates every day from trusted sources. It reduces worries and anxiety. Follow some daily news with children. If news made especially for children are available and can be trusted, or pages are written for children in the newspapers, use these. A fixed daily talk time can be good for children.
7 Take care of yourself
The unique situation the world now is in may cause great concern in you as an adult. If you have to stay home and mostly indoors for a long period, it is a tiring situation and it is good for you to find occasional breaks. If you are two parents, you can divide time for being responsible for children, and both have time to relax or do something for yourself. As a single parent do not hesitate to ask others if that is an option. This may be like a long-distance race where you don’t know how many laps to run. Then it is important to economize with your energy. If possible, do what has worked well for you during stressful periods in your life. Stressed parents result in stressed children. If the stress level can be kept down, it is good for all parties. At the same time, it is important that one recognizes that it is perfectly normal that when life changes as much as now, it is natural that it is stressful, and it may take time to find new routines that work.