Are the kids okay? How the pandemic spiked mental health issues in children, and how to help them

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  • The pandemic and consequent lockdowns disrupted the lives of children in many different ways.
  • The mental health of many children has been impacted.
  • It is important that they receive the support they need, a Cape Town-based clinical psychologist says.

The Covid-19 pandemic has taken a major mental health toll on millions of adults all over the world. This year, the World Health Organization (WHO) noted that the pandemic triggered a 25% increase in the prevalence of anxiety and depression worldwide. Sadly, children have also not come out unscathed.

In an op-ed for Spotlight, Kholofelo Mphahlele highlighted that, "... if not adequately addressed, the mental health consequences for a generation of children and young people could far surpass the immediate health and economic impact of the pandemic, with harmful long-term social and economic consequences".

Living under severe restrictions during the first months of the pandemic, dramatically upended the lives of the majority of children worldwide. School closures and imposed social isolation with little scope for outside movement caused a major loss of social interaction and dramatically increased their anxiety levels.

For others, it has also meant toxic stress and violence in their domestic environment.

Lending a helping hand

"If the child is growing up in a home where there's a bit of toxic relationship or family dysfunction, and they don't have any escape from that, it's really a lot worse than if they were in a dysfunctional family but they had an escape every day – they could get out and be with friends, learn new things, play sport – it gives them a welcome relief from the stress or tension that might be happening at home," says Jenny Perkel, a Cape Town-based clinical psychologist.

Perkel is also the author of a recently published book, Children in Mind, which centres on children's mental health in today's world and offers tips on what we can do to lend them a helping hand.  

But even in non-conflict, emotionally healthy households, lockdown measures impacted kids. Perkel, who called a chapter in her book "Children of the pandemic", explains: "The other, more everyday experience is that the outside world brings so much opportunity for growth, adventure and positive experience, so even if their own home is safe, relaxing, comfortable and stimulating, they still need the outside world. 

"They still need to go out and explore different territories, meet new people, learn new things. Being at home too much has perhaps interfered with their development a little bit."

In fact, missing out on normal experiences may have somewhat stunted the development of younger children, she adds.

Different experiences

Importantly, the pandemic hasn't affected all children the same way: "It definitely has impacted them but each child's experience has been different, depending on their particular circumstances and their particular lockdown home and how their school managed it, for example."

Some schools managed better than others at continuing the curriculum and pivoting to online learning. "Of course, the socio-economic gap came into play because those children whose families could afford education and went to every extreme measure to continue educating children, they obviously did better," says Perkel.

Unfortunately, children from poorer areas suffered a lot more, particularly academically, because they couldn't get educated in the same way. The poorest children were the least likely to live in good home-learning environments with an internet connection.

"It just reinforces the same old problem of the socio-economic divide and how unjust that really is," said Perkel.

Some children also didn't know anybody who was sick or died due to Covid, while others lost a parent or a loved one; in what Perkel describes as, "... a horror beyond description". A report in The Lancet this year indicates that 5.2 million children have been orphaned by Covid.

Mphahlele wrote, "In South Africa – where many grandparents assume the role of primary caregivers – the loss of older family members to Covid-19 has been particularly devastating." The loss or separation from a primary caregiver, she writes, has a profound impact on a child's mental health in terms of loss of attachment figures.

Then there were children whose parents were healthcare workers and worked directly with Covid patients. "That was very difficult for those children – they were very directly affected because their parents were quite badly traumatised," says Perkel. "Because working in a Covid ward has been very traumatic for healthcare workers."

Parents taking care of themselves

Dealing with restrictions and lockdown has been a stressful experience for parents who have had to meet numerous demands simultaneously, including balancing their personal life, work, and raising their children, often without help or resources.

Research has shown that increased and long-term parental stress caused high levels of parental burnout globally, while, another study found that parents who reported more difficulties dealing with quarantine showed more stress and that that, in turn, increased the problems experienced by their children.

Perkel advises that if you, as a parent or caregiver, are carrying fear about Covid, or carrying any sort of distress that you're being troubled by that you shouldn't feel guilty or beat yourself up about it, but should instead reach out and get help.

"Children rely on the mental stability of their parents, so prioritise your mental health and take care of yourself first so that you are strong enough to take care of your children," she says, and draws on the analogy of the "oxygen mask", where, when a flight attendant gives their pre-flight safety instructions, they advise you to put your oxygen mask on first before helping others.

And different parents may need different things in order to address their mental health. For example, some may benefit from being on medication for anxiety or depression, while others may benefit from psychotherapy, making lifestyle changes, working away from home, or incorporating relaxation techniques or sport into their weekly routine, but the bottom line is that, "... they need to find their own way into a more positive frame or relaxed frame of mind", Perkel suggests.

Lack of mental health support in SA schools

Mental health support is something few schools have in South Africa, particularly government schools in low-income areas.

Says Perkel:

There's a huge gap in mental health service delivery for children whose families can't afford mental health consultation, and the schools would be a good place to offer that. But it’s not available.

Children who are exposed to adversity and poverty are more likely to experience mental health difficulties. This is especially relevant in South Africa where more than six out of 10 children (62%) are identified as multidimensionally poor, according to a 2020 report

"We need more counsellors, social workers and educational psychologists who work with children at these schools," says Perkel.

How does a parent know their child needs therapy?  

There is a string of different symptoms that indicate a child might need mental health support. Children won't tell us through words that they are unhappy, anxious or distressed – instead, it is expressed through their behaviour, says Perkel.

These symptoms include:

  • Peer relationship difficulties (like having no friends)
  • Nightmares and poor sleeping patterns
  • Separation anxiety
  • Aggressive behaviour
  • Nervousness and shyness, or a lack of confidence
  • Being sad and emotionally withdrawn
  • Temper tantrums
  • Bed-wetting (enuresis)
  • Concentration and attention difficulties

Screen time vs playing outside

In her book, Perkel dedicates a chapter to the importance of outdoor play for children. A common theme is that, "... there is a lot of indoor time and much of it is spent in front of a screen" – and the pandemic has led to an unprecedented rise in this phenomenon.

A sedentary, indoor, digital lifestyle can negatively affect a child's development, so much so that their gross motor development can be affected, she explains in her book.

"When children are too often in front of their screens, it becomes a bit hard for them to manage in everyday life," Perkel adds. "The outside world is more challenging than being on your bed behind a screen where it's safe and comfortable, but it's also more exciting; it's more of an adventure, and children really need that excitement and the challenges one can get outside the home."

Being outdoors is also safer because the Covid virus is less likely to be transmitted due to good ventilation. "So outdoor time is actually beneficial; as long as it's in a safe environment and there isn't a risk from gang violence or crime," says Perkel.

She adds: "Children need that scaffolding that the outside world provides: being in school, partaking in extra murals, being at other people's houses – just all the things that the outside world brings in terms of helping a child to develop that they're not really going to necessarily find at home."

Children in Mind is available at major retail book stores and can be purchased online on Takealot and

READ | Children who play adventurously have better mental health, study finds

READ | OPINION | Covid-19 has been hard on kids, more support is needed

READ | Antidepressants during pregnancy not linked to epilepsy in children

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