Children’s Health and Well Being During the Coronavirus PandemicThe debate over school openings has highlighted the implications of the coronavirus pandemic for children and their families. While experts continue to gather data on children’s risk for contracting and transmitting coronavirus, current research suggests that though children are more likely to be asymptomatic and less likely to experience severe disease than adults, they are capable of transmitting to both other children and adults. In addition to the risk of disease and illness, COVID-19 has led to changes in schooling, health services delivery, and other disruptions of normal routines that will likely affect children’s health and well-being, regardless of whether they are infected.This brief examines how a range of economic and societal disruptions stemming from COVID-19 may affect the health and well-being of children and families. It draws on published literature as well as pre-pandemic data from the National Survey of Children’s Health and the National School-Based Health Care Census, recent survey data on experiences during the pandemic, data tracking the number of cases resulting from school openings, and preliminary reports based on claims data evaluating service utilization among Medicaid and CHIP child beneficiaries. It finds that school openings/closures, social distancing, loss of health coverage, and disruptions in medical care could negatively impact the health and well-being children in the US (Figure 1).1 Key findings include:Students who attend in person school face direct risks of contracting coronavirus, with early tracking documenting nearly 12,400 cases across 3,900 schools. Risks due to school attendance may be higher for low-income children or children of color, whose families may be less likely to afford alternative schooling arrangements or private transportation to school. A July KFF poll found that parents of color were significantly more likely than White parents to say they were worried about their child contracting coronavirus due to school attendance and that their school lacked adequate resources to safely reopen.Students who do not attend school in person also face health risks, including difficulty accessing health care services typically provided through school, social isolation, and limited physical activity. Millions of children access health services through school-based health clinics, school screening and early intervention programs, and on-site counseling, and these services may be suspended in schools that are not open for in person instruction. Children also may be missing opportunities for social connections or exercise, as three-quarters of school-age children take part in a sport, club, or other organized activity or lesson, many of which may be suspended. A quarter of children do not live in a neighborhood with access to sidewalks or walking paths, which could limit physical activity. KFF polls show high rates (67%) of parent concern for their children’s social and emotional health due to school closures.Both students attending and not attending in-person school may face emotional or behavioral challenges due to disruptions to routines as well as increases in parent stress and family hardship. Early research has documented high rates of rates of clinginess, distraction, irritability, and fear among children, particularly younger children, as well as increases in some substance use among adolescents, and one survey found that nearly a third of parents said their child had experienced harm to their emotional or mental health. Parent stress due to childcare, schooling, lost income, or other pandemic-related pressures can negatively affect children’s emotional and mental health, harm the parent-child bond and have long-term behavioral implications, and have serious implications for children at risk of abuse or neglect. Exposure to adverse childhood experiences have documented effects of lifelong physical and mental health problems.Children are also experiencing consequences of the economic fallout of the pandemic, with at least 20 million children living in a household in which someone lost a job. Though the large majority of children who lose access to employer-sponsored insurance due to job loss are eligible for Medicaid or CHIP, some parents may not enroll children in coverage due to challenges completing the application, lack of knowledge or understanding of eligibility, or other reasons. Many families experiencing loss of income, food insufficiency, or problems paying rent since the pandemic have children, and school closures may make it challenging for the 20 million students who receive free or reduced price lunch to access those meals.Parents may be delaying preventative and ongoing care for their children due to social distancing policies as well as concerns about exposure. Reports based on health care claims show declines in rates of vaccinations, child screenings, dental services, and outpatient mental health services among Medicaid/CHIP child beneficiaries (Figure 3). Other administrative data show declines in vaccine orders and administration, particularly among children older than 24 months. It is likely that parents may be delaying care due to concerns about contracting illness or cost concerns, and providers may have limited capacity due to changes in operations to safely treat patients. These delays in care may disproportionately impact the 13 million children with special health care needs who require ongoing care to address their complex needs.Children’s lower risk of serious illness due to COVID-19 has led most discussion and policy debate over the pandemic to focus on adults at high risk, though the recent debate over school openings has shifted focus to children’s health and well being. Many children are currently facing substantial access barriers, emotional strain, and financial hardship that could have long-term repercussions for their lives. Policies to ensure access to needed health services, particularly behavioral health services, as well as facilitate access to social services to support families with children, can help address some of the consequences children are currently facing.Coronavirus: Practicing Wellness While You Stay at HomeIn light of the COVID-19 pandemic, many people are working from home these days. Under normal circumstances, telecommuting can offer a pleasant break from your daily routine. You can enjoy freedom from a long commute and the luxury of working in your sweats.But this situation is far from normal. Harpreet Gujral, program director of integrative medicine at Johns Hopkins’ Sibley Memorial Hospital, offers the following suggestions on staying centered and healthy when you’re working at home during the pandemic.Greeting the DayIf you’re waking in the morning and feeling uncertain because your routine is so different, Gujral suggests a 15-minute ritual to get prepared for your day.“First thing in the morning, I recommend spending 10 to 15 minutes on self-care. I take a moment to think about three things I’m grateful for. They can be simple things, such as a comfy blanket, a safe home, warmth, spring trees, blue sky or blossoming trees.”Many of us lunge for our cellphones as soon as we’re conscious, but Gujral says she makes a point not to pick up her phone for at least 15 minutes.Breathing for Stress ReliefBefore the day’s demands take over, Gujral recommends becoming centered with some stress-relieving breaths.“Take a few minutes to really focus on your breathing. There is a technique called 4-7-8 breathing, or relaxing breath, which helps you concentrate on deep breaths. The practice is simple: Breathe in for a count of 4, hold for a count of 7 and breathe out for a count of 8. Practicing this for four breaths four times each day or more can help relieve anxiety and reset the autonomic nervous system,” Gujral says.Here’s how to do it:Moving and Stretching, Indoors and OutStaying active can increase immunity and boost mental health. It's common for people to focus on stress rather than physical health. Try 10 minutes of qi gong — movements that help you practice mindfulness — or use stretches and yoga poses to bring your awareness back into your body.Even if you don’t know how to practice these disciplines, she says, you can simply close your eyes and move your awareness into your feet to feel more grounded.Physical distancing doesn’t mean you have to isolate yourself or to stay inside. Activities like gardening and hiking outdoors, and taking notice of the natural world, helps alleviate anxiety and improve well-being.Going outside each day for 15 minutes of fresh air and sunshine helps the body make vitamin D. Vitamin D deficiency can create vulnerability to the common cold.Eating WellGood nutrition is essential in stressful times however trying to boost your immunity with supplements may not be as helpful as simply eating whole foods.Eating meals rich in plant-based foods, especially leafy vegetables and fruit is beneficial for your health. Increase your consumption of diverse produce to gain more phytonutrients.Taking steps to cut out inflammatory foods such as sugar and bad fats is a good idea. These foods might be more tempting when you’re feeling tense or worried. Cook homemade foods with ginger and turmeric. Adding a little rosemary to your meals can help you focus. Drink plenty of water, and consider green or black tea.At Your Home OfficeBring in something from outdoors for your at-home desk. Rocks, branches, flowers, even a picture, photograph or screen saver depicting a beautiful, calming scene can help remind you of nature.Listening to music that inspires you can help you focus and improve your mood.Staying FocusedIt can be hard to concentrate on work when your daily routine is off-kilter and the future is uncertain. Consume social media conservatively.Aromatherapy can make your home office more conducive to calm productivity. It’s important to remember that essential oils are not effective treatments for disease, but they can help uplift mood or create a more relaxing environment.Practicing MindfulnessIt’s also important to keep in touch with friends, especially the ones who uplift you, and give people the benefit of the doubt during this challenging time.Practicing mindfulness and gratitude are also beneficial for your well-being. Spending time each day to say positive affirmations for yourself can improve your mental health and mood.“This is something that affects everyone, because either you have someone in your family who may be affected, a friend, or you yourself.”