The impact of COVID -19 confinement on children study

The Impact of COVID-19 on Children’s Lives:  a cross sectional study carried out by a team of doctors lead by Dr. Sam Hassan at Mediclinic City Hospital, Dubai.

Since the COVID – 19 pandemic started in November 2019, more than 40 million people have been infected and more than 1 million have died according to official figures.  

Measures to try to stop the spread of the virus included school closures and online teaching to keep education going on.  This occured for most of the year 2020 and is expected to partially continue beyond.   It affected more than one billion children and adolescents world-wide. 

Home confinement and online schooling resulted had an unprecedented impact on children and adults.   As children are developing individuals and so sensitive to environmental and social changes, the confinement significantly affected their quality of life.  For them, schools are considered as a life place, not only for education and learning but for social and sensory brain development and interaction. Therefore the impact may even be worse and last for a long time.   

To study the impact of COVID-19 home confinement on children’s lives and schooling, Dr. Sam Hassan, Consultant Paediatrican at Mediclinic City Hospital and Adjunct Associate Professor at Mohammed Bin Rashid University Of Medicine and Health Sciences led a team of paediatricians to conduct a cross sectional study about the impact of COVID-19 confinement on children.  More than 650 parents were included in the study the first of its kind in literature and was recently published in the American Journal of Paediatrics:  

http://www.sciencepublishinggroup.com/journal/paperinfo?journalid=380&doi=10.11648/j.ajp.20200604.14

The study showed significant results due to the impact of COVID-19 home confinement on the life of children, their parents and schooling.   Presenting such unprecedented impact due to the pandemic in a statistically significant study is important to all professionals involved with children’s care.   The study showed the following impacts.

1. Behaviour, mental and financial difficulties:  More than 72% of children were reported to have behavioural problems which were not shown before the lockdown.  More than half (57%) of the children were reported to have new mental distress such as anxiety while 14% were affected financially due to one or both parents losing a job or being on reduced pay. 

2. Hyperactivity, inattentiveness, loneliness and depression:  Both hyperactivity and lonely feelings were equally reported in 36% of children.  Inattentiveness and depression were reported in 18% of children.

3. Impact on physical activity:  The majority of parents (72%) reported significant impact on children’s physical activities, mainly in due to lack of space at home (around 50%) and others due to cessation of outside sport. 

4. Sleep difficulties:  At least 41% of children suffered from sleep difficulties that did not exist before the lockdown.  Most reported difficulties are related to disrupted sleep, sleeping and awaking late, sleeping more, sleeping less, having insecurity, talking during sleep, having nightmares, irregular pattern of sleep and worry about parents’ jobs. Sleeping late and waking late were the most commonly reported difficulties.

5. Eating problems: Altered eating habits are one of the most important newly reported impacts of lockdown. Around half of parents (48%) reported eating difficulties in their children that emerged during lockdown. Some of the children have more than one eating problem. The most commonly reported were junk food, food refusal and picky eating.

6. Lack of psychological support: Despite mental, behavioural, sleep, eating problems and other impacts, 82% of parents reported no psychological support from professionals such as a psychologist, educational counsellor or others.

7. Missing schools and friends: More than 75% of children verbalised they were missing school frequently to their parents irrespective of age, gender and culture.

8. COVID-19 infection in family and the impacts: About 9% of surveyed parents reported COVID-19 infection in one or more of immediate family living in the same house.  Negative effects on children were reported more when there was COVID-19 infection in family.  Taking in consideration COVID infection (COVID% v No-COVID%), the results were: behaviour (72% v 52%), sleep (72% v 38%), eating (72% v 45%) and depression (37% v 16%). Mental impacts, parents’ feelings about long-term impacts beyond lockdown and fear of sending children to public places are more or less same in the two groups (COVID-19 in family compared to no COVID-19 in family).

9. Vaccinations difficulties during lockdown: One of the most affected aspects during the lockdown was bringing children for vaccination in the health centres or hospitals and clinics. We assessed this issue by asking parents a direct question if the lockdown interfered with vaccinations and development assessment. A third of the parents (31%) answered that fear of infection made them to postpone children’s vaccinations and or other health assessment. In addition to the fear of infection, other parents reported that the clinics were closed, the mother was pregnant, and some lost their insurance. Interestingly, when parents were asked if they are confident to visit clinics and health facilities for vaccinations and assessment after lockdown lifted, still one third of them (32%) answered that the fear of infection was still the main cause for their lack of confidence to visit clinics.

According to the WHO and UNICEF data of 15 July 2020,  COVID-19 confinement and fear of attending for vaccinations or closure of clinics resulted in an alarming decline in the number of children receiving lifesaving vaccines around the world. There is a substantial drop in the number of children completing three doses of the vaccine against diphtheria, tetanus and pertussis (DTP3). This is the first time in 28 years that the world could see a reduction in DTP3 coverage which is the marker for immunisation coverage within and across countries. There was serious drop in MMR vaccinations added to the decline noticed over many years, and increased spread of measles, whopping cough and mumps across the world. According to the report 75% of 82 countries reported disruption of their vaccination programme due to covid-19. It is therefore very important for health professionals and maybe schools to monitor childrens’ vaccinations.

10. Visiting public places with children: More than 70% of parents were reluctant to visit public places and shopping centres with their children and/ or sending children for sports or to centres for children including schools.

11. Online virtual schooling: During the confinement, schools became virtual, and education was provided online from homes. We asked parents about their experience with online teaching and to score such experience between 1 and 5 where 1 is very poor and 5 is excellent.  Most parents were satisfied with the level of online schooling as 65% scored it 3-5 and only 35% scored it less than 3. Some parents commented that online schooling produced more work for parents, parents took the role of the teacher, parents were tired, had difficulties when having more than one child, depending on the teacher online cannot replace coaching in school, do not know how to teach and difficult to keep the young child concentrated. Quite a few parents felt that the whole online learning susyem was introduced in a rush leaving a large burden on parents. A few parents reported that learning at home offered one to one teaching which gave positive outcome.

12. Long-term impacts: When asked if the home confinement due to COVID-19 may lead to long term impacts such as boredom, fear of infection and or stress, 63% of parents believe it may cause long term impact that may continue beyond the lockdown period.

This study adds important and significant information and answers many questions about the impact of home confinement due to COVID-19 pandemic.  This information is important to all professionals and schools in dealing with children of school age, particularly when the return back is still not as normal as before the pandemic and most of schools are on partial online teaching.  It will also provide an answer for parents about these impacts and vaccination, in particular this season the influenza vaccine.  Moreover, it laid the basis for more research in the same area. 

Lastly, we acknowledge all parents who joined the study and resulted in its success and the management of the Mediclinic Middle East and Mediclinic City Hospital who supported the research studies, and of course the team led by Dr. Sam Hassan.