The COVID-19 pandemic is making us flex our 24-hour parenting muscles, and our children have been with us throughout it all. They, too, are missing their schools and day care, feeling household tensions, experiencing grief and struggling with their own anxieties.
As adults, we are able to focus on anxiety management techniques as well as the possibility of recovery in the future, both of which can help us through tough times. Children, however, may need a little more help from us to manage their stress and be resilient.
Psychological First Aid (PFA) is an approach used by response workers during and immediately after a disaster. PFA suggests guidelines for identifying people who are distressed, intervening to reduce initial stress and moving that person toward improved functioning and coping.
PFA methods can help parents provide the compassionate and supportive presence our kids need right now—and best of all, you don't need to have a formal mental health background for this approach to be useful. In fact, the RAPID-PFA model, created by Johns Hopkins University, is encouraged for use by non-clinicians when mental health practitioners may be overwhelmed or otherwise inaccessible.
A friendly word of advice and caution—PFA is not therapy. But it is a system parents can use to support our children during crises, now and in the future.
Here's how to respond to your child's mental health needs right now using psychological first aid:
The RAPID in the RAPID-PFA model stands for:
● Reflective Listening
Here's what each of those components mean:
1. Reflective listening
It's easy to become distracted and miss the important things children are saying. Reflective listening is a way to really focus on what is being said.
When children act out their feelings, express their emotions and fears, or even just mention something they saw on the news, respond in a way that acknowledges what they're going through. For example:
"It sounds like you're having a tough time. How does all of this make you feel?"
"People can be mad/angry/sad in different ways. Tell me what it feels like for you."
"What scares you most about [family member or friend] being sick?"
"I can understand that you are worried. It's scary when that happens."
The best responses are nonjudgmental and non-intrusive. Reflective listening in PFA is not about telling the child how they should feel, making assumptions or minimizing their perception. Rather, it's about reflecting the child's feelings back to them. This helps build and maintain trust, which is critical for assessment, the next step in the process.
It's normal to expect some behavioral changes as a result of disruption as widespread and long-lasting as this pandemic. But have your child's eating habits dramatically changed? Are they more withdrawn than usual, or perhaps extremely clingy these days (beyond needing some extra cuddles for comfort)? Are there sleeping or bedwetting issues beyond a reasonable regression?
You know your child best. Based on what you hear from your child in conversation, and what you know of their typical behaviors pre-pandemic, your own parental assessment can tell you whether the stress of the pandemic is affecting your child's daily functioning.
If the stress from the current crisis has actually interfered with a child's daily living skills, prioritization and intervention can help.
In crisis and disaster scenarios, this stage urges the RAPID-PFA user to determine which individuals are most in need of immediate care and assist them first. As parents it's common to prioritize our children anytime they are distressed—even during normal times, it's rare for moms to follow the advice to "put your own oxygen mask on first."
But parents of multiple children might observe that one of their children seems more impacted by the pandemic. Your toddler might be showing more signs of stress than your third-grader, or vice versa. Is there a child in the family who needs a little more reflective discussion, more private time and more frequent intervention to help handle their stress?
Here's what parental interventions might look like for a child who appears to be very impacted by pandemic-related stress:
- Create a visual support board to help your child focus on the future and recovery. Grab a poster board or paper and create a collage together, adding images of places they'd like to visit, names of friends they want to reconnect with, anything that helps them look toward the future with a sense of hope.
- Normalize feelings. Reassure them that they are not alone in feeling the way that they do, and that their feelings are accepted and normal. You can say, "A lot of children feel the same way you do," or "It is common to feel what you are feeling."
- Help them understand what to expect. Help your child understand that while things have changed, they won't always be this way. You can say, "You may feel afraid, and sometimes you might worry about getting sick. Doctors say most people who get sick will eventually get better, and people are working hard to help people stay well."
- Stress management techniques such as deep breathing may help children learn how to create a sense of calmness in themselves. Grounding is also a useful coping strategy to guide children to connect with their environment: Ask them, What do they see, smell and hear around them?
Try making rituals of these intervention techniques—adding a new element to the visual support board every night, or doing a breathing or grounding exercise together at bedtime.
This is the stage in the process where you observe your child's behavior for changes in response to the intervention. How is your child doing? Are they displaying more abilities to cope and less anxiety? Have the behaviors you observed in the assessment stage decreased?
If not, and if the child continues to display a decline in their daily functioning, reach out for additional care. Follow up with your pediatrician or a mental health provider depending on the child's needs. And stay connected to social supports that can help emotionally sustain your family.
No one knows what tomorrow, next month, or even next year will bring. The truth is the novel coronavirus pandemic is just that—novel. These are never before experienced times—unprecedented unemployment, heightened anxiety, distance between social connections and support and at times unexpected loss of loved ones. We will be changed. Our children will be changed.
As a child advocate and parent, it is comforting to know we have the power to support children, in the face of this crisis and others.