Q&A with Rachel Klein, Ph.D. Fascitelli Family Professor Emerita of Child and Adolescent Psychiatry Department of Child and Adolescent Psychiatry NYU Grossman School of Medicine BBRF Scientific Council Member 2004 BBRF Ruane Prize for Outstanding Achievement in Child and Adolescent Psychiatric Research 1995 BBRF Distinguished Investigator
Dr. Klein, there is uncertainty about the degree to which society will return to “normal” in the coming months. With this in mind, we note that the lockdown brought on by the spread of COVID-19 has caused psychological stresses that have been felt by both parents and children. What advice do you have for parents who are working from home while also managing kids who are learning remotely or can no longer go to daycare? This problem is all the more urgent, I would think, when the living space is limited, as it is, for instance, in urban apartments.
It’s reasonable for parents to be wondering how they can maintain their professional lives or work activities while the children are with them, at home. There is also the question of how to deal with particular problems associated with living together as a family under lockdown conditions.
I would say, first, that it depends on what else is going on in the home. Who else is there? And what are the living circumstances? If it’s a small apartment with limited space, it is very different than if you live in a house where there’s a back yard and other people around, with access to outdoor space.
Let’s assume the children and their parents are together, they can’t be separated, and that the children are young, in daycare or elementary school but not currently attending because of the coronavirus.
I think it is very important for parents in this situation to communicate with children and to do so early, in very simple terms. Why are we doing this? Why are we home? Why does mom or dad have to work? These things have to be articulated very clearly to the child, and not all at once. Of course, how and whether one does this depends on the children’s ages. In general, young children do not require special considerations. Typically, they are happy as long as they are with their family.
Messages have to be repeated. How often to repeat also depends upon the child and how well he or she absorbs and identifies with the information. But it has to be understood well by the child “why we are doing this.” Otherwise, it’s confusing, and resentment develops on both sides.
As part of this process, parents should also ask questions of the child. “If this is what we need to do, how do you think we can get there?” “We are trying to be safe. How do you suggest we do that?” It’s important to let the child think and talk, not just lecture them. Often parents forget that. At the same time, parents tread a fine line because we do not want to alarm the child. Therefore, there should not be an emphasis on “being safe.”
Would it be a good idea to assign chores or tasks to children to occupy them and give them a sense of purpose?
Yes, but again, it’s how you do it. Unfortunately, some parents give arbitrary commands and often don’t communicate enough with their kids. I’m not saying you have to explain everything, but you want to foster a spirit of collaboration rather than just say, “You have to do this.” It’s very tempting to behave that way, but if you want to be effective, it’s better to say “We need to do this…” and ask the child for their suggestions. Since this is a prolonged situation and not a one-off thing, it’s especially important to develop a dialogue with your child.
What would that dialogue sound like?
“We’re all going to be together in this house for a long time. We don’t know for how long, and we have to do A,B,C,D. How do you think we should manage it among us?” “We have Dad, we have you, we have your brother, your sister. What do you think each of us should try to do?”
Of course, as I noted above, this conversation depends on the age of the child. If the child cannot come up with an answer, you should make suggestions; the child is more likely to respond to suggestions. But you want to give the child the illusion of control. It empowers children to make them think that they contributed to the solution. And this can happen at almost any age. I’m not just talking about chores necessarily, but about simple household issues. It is obvious that children cannot be in control, but this doesn’t mean that there aren’t different means of giving commands. It can facilitate compliance and limit conflict if parents are able to instill a sense of participation in the child, by giving him/her the illusion of control.
So what you are saying is that there is a sense of involvement; the child feels as if he or she has some say in deciding how to proceed.
Exactly, yes. They participated, they contributed to what happened. They’re not just being told what to do.
What happens if the child comes back with: “I’m bored, I’m bored,” and they’re testing your patience because they have run out of things to do.
You have to find things that the child may enjoy. Each child is different, but we are very fortunate in this generation to have iPads and almost endless video entertainment. You can have some leeway in allowing entertainment that you might not under other circumstances. You have to be creative and find things that the kid likes and allow them to do it even if it’s not exactly what you would prefer. You have to be flexible.
You’re saying that this might not be the best time to obsess about screen time.
Exactly. This also brings to mind something else that is important: plan exercise with the kids. You are promoting a state of better health by stressing regular exercise. This can be done very easily at home and parents should schedule time for it. It won’t just happen if you wait for everyone to feel the inspiration to be physically active.
Let’s say the kids who live in private homes want to have their friends come by the house—to wave and talk at a distance in the front yard, say. But the parent worries: “Now I have to monitor them, how close they are, and can’t do anything until the visit ends.” It’s not so easy for a small child to understand why they have to stay distant from people.
I don’t think it’s realistic to expect a young child to understand distancing and to practice it. But by now COVID has been around for a while. And, if you know that a child has been confined for weeks, I don’t see anything that suggests the kids should not get together, provided that they come from one home directly to the other. That is, if you can reasonably make the assumption at that time that no one in your household or that of the visitors is infected.
On the subject of friends, how would you judge the importance of the child not being able to interact with friends? How much of a hardship is this likely to be?
Small children are much more parent-oriented than, say, teenagers. As long as within the family they feel safe, they may miss their friends but it doesn’t have the same salience for them. The family is much more critical to them. Very young children are happy as long as they are with the family. In elementary school their friends become much more important but they’re not the most important, if the family is a reasonably happy one. Typically, young kids won’t get dismally miserable unless the parental relationship is really problematic and they’re suffering.
Let’s talk about anxiety for a bit. With the coronavirus you have something that is objectively terrifying. Wouldn’t it be normal for children to feel and express fear? What does the parent do when this happens?
It’s a little ironic. Children who are anxious are typically anxious about unreasonable events like monsters under the bed and rarely worry about something that an adult might think one should worry about, for instance, living though a pandemic.
The pandemic is something “rational” and it’s a little bit beyond them intellectually, especially young children. Is this what you are saying?
Yes, and if the family expresses fear and it’s palpable in the home, the child is very likely to pick that up. But on their own, young children do not get very anxious about realistic dangers.
For parents who are caretakers—let’s say a woman who works in a nursing home or a hospital—I could easily imagine such a person coming home from work and obsessing about it with her husband. In other words, there might be quite a bit of this kind of discussion in certain households, given the jobs parents do.
At the same time many people try to escape and may avoid talking about it completely. However, if you’re the kind of person who relives the work day or goes over it in detail, worries included, when you come home, then you may indeed be communicating to your children—whether you mean to do so or not—that you’re in this bind and you are very worried about it. This is not a good situation.
What would you say to a parent in that situation?
Try to not bring home your stress. If you do, don’t express it where the child can see, hear or feel it. It doesn’t mean you have to be completely fake. You can acknowledge that you’re doing something difficult. I’m talking more about a feeling and a mood in the home. If the parent works with patients who have COVID-19, then they are in a very difficult and possibly tragic situation. But it doesn’t help the small child to be aware of it.
You don’t want to be untruthful or false with your children, who will pick up on that. But perhaps, in a situation where there is real danger at work, Daddy could say that Mommy is a hero because she works with people who need help?
Yes, you have to essentially slant it in the positive. You could say that she’s helping people. I also think that parents have to accept that they’re going to lose it once in a while. The expectation that you’re going to be upbeat and do the right thing all the time is wishful thinking.
For this reason, you have to anticipate that it’s going to get unbearably hard and plan to take breaks. The idea is to know your limits well enough to acknowledge them, and try to take steps to avoid losing your temper. Knowing your limits, if you have opportunities to get outside, then do so. If you can go into another room, do so deliberately, even when you feel okay. You know your own tolerance. If it’s every two hours, that’s it. If it’s every four hours, that’s fine. But it’s important to know that you have limits.
Should we be worried about any long-term impact on children from the stress of this pandemic?
Children are highly resilient. Should your child develop anxiety, or other difficulties, during this stressful crisis, it does not indicate that there will be long-term negative consequences for the child. If anything, dealing with stressful situations facilitates appropriate, constructive, means of problem solving later on.
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