Early identification and treatment is vital to avoid long-term mental health consequences from COVID-19 among children and young people, say researchers.
Writing in the Behavioural and Cognitive Psychotherapy Journal, the psychologists from the University of Bath highlight how health anxieties can be triggered by changes like returning to school and argue that young people need time to readjust to routine and to deal with emotions after such a prolonged period at home.
For some, they say, ongoing concerns about health, triggered by the invisible threat posed by COVID-19, could interfere with life and parents and teachers need to be aware of signs such as excessive hand washing, and reassurance-seeking about health-related worries.
Crucially not all children and young people will experience or develop health anxiety, and many have shown remarkable resilience in the face of an unprecedented health crisis. Yet for some, particularly those who are already vulnerable to worrying and anxiety, this year's tumultuous events are likely to have significantly and negatively impacted them.
Dr Jo Daniels clinical psychologist within the Department of Psychology at the University of Bath, who throughout the pandemic has been active in advising and guiding individuals and organisations on responding to COVID-19-related health anxieties, explains: "Children are not immune to worries about their health, or the health of those around them. It is essential that we are able to recognise when normal concerns around covid become more problematic.
"Signs of stress in children may include tummy ache, sleeping problems and not engaging in normally enjoyable activities; for those particularly affected by health related anxiety, you might expect to see excessive hand-washing, exaggerated avoidance of touching objects for fear of picking up the virus, or repeated reassurance seeking from adults in addition to the usual signs of stress and worry.
"Children may not always be able to describe or verbalise their concerns clearly, so we are looking for marked changes in behaviour or worries that get in the way of living life to the full. Teachers also now have a role in this when children return back to school, as they tend to know the children well and school is where they will be spending a large part of their day."
The team behind the study suggest health anxieties in children might be triggered by an immediate family member becoming ill, a shielding member of the household, or perhaps because of raised family tensions due to parental health-related worries. In these scenarios they advise parents and teachers to seek professional help where needed.
Their guidance offers suggestions about how cognitive behavioural therapy (CBT), including CBT conducted online or by phone, can be an effective treatment option to address children and young people's health anxieties.
During the pandemic, the team have previously highlighted mental health vulnerabilities including health anxiety in adults, and loneliness in children and young people.
Dr Maria Loades, also from Bath's Department of Psychology and who earlier this year published findings about the potential long-term mental health challenges for children and young people as a result of lockdown and loneliness, added: "As children and young people return to school, they need to have the opportunity to catch up, not just academically, but also socially and emotionally.
"A big part of this is having the time and space to connect with one another, through play, which gives them a chance to process the emotions and to share their experiences with others. It will take time for children and young people to adjust. While we want to avoid pathologizing normal responses to the pandemic, in children and young people especially, it is vital to spot the signs and intervene early."
They recommend that parents or teachers who notice that a child or young person is worried about health should offer them the opportunity to talk about their worries by gently listening to their concerns, and then encouraging them to find ways to gradually face and overcome their fears.
Where a child or young person is seeking excessive reassurance from others, it's important to remember that although this may help them in the short-term, it can keep their worries going over time. It is understandable to worry about health at this time and they say it is important to work with young people to find ways to resolve and understand their worries. Simple interventions that may be helpful could include correcting misunderstandings surrounding covid and the necessary precautions.
Although most will overcome their fears without specialist help, for some, their anxiety may get in the way of functioning and cause distress; in this instance, additional help should be sought via health care professionals or teachers.
Dr Loades adds: "We all need to work together to ensure children and young people are able to live their lives to the fullest."
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