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February 07, 2020
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Q&A: Managing pediatric anxiety in an outbreak environment

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Robin Gurwitch

Last week, WHO officially declared the novel coronavirus outbreak a Public Health Emergency of International Concern. Although few cases have been reported thus far in the United States, the virus’ impact may be reaching beyond the physical scope and affecting the mental health of children and adolescents by stoking anxiety, according to Robin Gurwitch, PhD, psychologist at Duke University Medical Center.

Healio spoke with Gurwitch about how clinicians should recognize and manage the anxiety of pediatric patients during this current outbreak environment. by Kate Burba

Question: What is the relationship between disease outbreak environments and mental health?

Answer: I think any time there's a health scare, just as people can contract a virus or another illness, they can catch emotions, too. If there is anxiety present, particularly for young children feeding off their parents, they can become anxious without really understanding what it's all about. As older children talk among themselves, anxiety, worry and concerns sometimes begin to take on a life of their own. We have seen anxiety become contagious many times before, in other outbreaks and health scares. Parents and caregivers can play an important role in reducing our children's anxiety by being straightforward with them and starting a conversation about the outbreak.

Q: Is there any data available regarding mental health effects from the coronavirus outbreak thus far in either pediatric or adult patients?

A: Although there may not yet be information related to the coronavirus, we do know how other health emergencies like H1N1, Zika and SARS have impacted mental health. Because of the growing uncertainty, there is often accompanying increases in anxiety, stress and worry. Increases in depression, insomnia and somatic complaints have been seen. Poor coping strategies may include increased drug or alcohol use. Health care professionals, both pediatric and adult, may see an increase in demand. As flu this year seems to be touching so many families and coronavirus has some overlapping symptoms, this will likely further increase anxiety and more appointments for health care treatment.

Q: How do you suggest clinicians help mitigate anxiety surrounding the epidemic, and how worried should the general public really be?

A: Communication is key. I think it's important we have this conversation with children to help them understand a couple of things. First, it is possible to contract coronavirus, but the probability is very low at this point in time. It’s highly unlikely that it will come to a patient’s neighborhood or town, unless they’re living in areas of higher risk. It's also important to share with our children what needs to be done to make sure we stay healthy.

Second, this is a phenomenal opportunity that we have as parents, caregivers and clinicians to talk to our children and teenagers about health and protecting themselves during cold and flu season. It is an opportunity for us to talk to them about hand washing and the importance of covering their mouths when they sneeze, getting rest and eating healthy.

Concerning mental health, it's a really good time to let kids know that if they are worried about it, they can talk to a parent or other caregiver, or their doctor. If they hear something about the virus and are not sure whether it’s true, they should feel comfortable asking parents and other caregivers in their lives. Adults need to stay informed in order to better answer their children’s and teen’s questions.

We all have anxieties about different things, and just telling a child “don't feel that way” is probably the least helpful thing we can do. Clinicians can acknowledge and validate a patient’s concerns by saying, “I know you're worried and I know you're anxious; here's what we know about the virus.” Talking to kids and correcting their misperceptions and being patient with them is important. We must recognize that many children are feeling a little bit more anxious right now because conversations surrounding the virus seem to be everywhere. Parents and clinicians should work to lessen this anxiety when it arises because this anxiety is real.

Q: How susceptible to this ‘outbreak anxiety’ are children?

A: Children can be more susceptible than adults because they fill in gaps in knowledge with information that they don't understand. They might even fill these gaps with misinformation and assume the situation is far worse than it really is, making them further susceptible to anxiety. If a child is in a home where the parents are calm, cool and collected, and their clinician is reinforcing behavior that will help them stay healthy, this child is probably not going to get too anxious. However, if family members are saying, “Remember not to touch anything because you might get coronavirus, and don't hold hands with your friends because they might have coronavirus,” that child is probably going to be more anxious because they’re picking up and feeding off of the anxiety of their caregivers. The home environment has a lot to do with the spread of anxiety, which is something clinicians can help families understand and address.

Q: How should clinicians treat the mental health of pediatric patients amid this outbreak?

A: If a parent or child is worried about the outbreak , it’s important that clinicians and parents align to have a conversation about coronavirus. It’s important to stay informed about public health messages and recommendations, It’s important that clinicians and parents are both giving the same message: It is highly unlikely that you're going to contract it and doctors are doing everything they can to find a way to treat it. Further, parents and clinicians can watch to make sure that their children stay as healthy as possible and informed about the risks, however small, regarding coronavirus.

Disclosure: Gurwitch reports no relevant financial disclosures.