The effect of the COVID19 pandemic on infant and toddler’s development and maintaining the well-being of children and parents

The COVID19 pandemic that started in March 2020 is still lingering. Although COVID vaccines are slowly being distributed, many families and their children are still practicing social isolation in order to stay safe. The pandemic has created unprecedented challenges for parents who are caring for their children.

There has been a concern amongst parents and caregivers of infants and young children that the many months of social isolation may lead to a lasting negative impact on their children. Several of my patients have remarked that they are concerned that their infants around 9 months to 12 months of age may have greater stranger anxiety then their older siblings because their infants have not had a chance to interact with peers and other people outside the immediate family. There is a concern that the pandemic may cause a delay in infant and toddlers’ development of speech and social skills.

Fortunately, the evidence seems to show that a finite period of social isolation from the COVID pandemic in itself does not lead to significant developmental threats to the mental health of infants and toddlers as long as the families and caregivers are able to handle and withstand the impact of the pandemic such as social isolation or financial setbacks. Dr. Rahil Briggs, PsyD, a national director of the ZERO TO THREE’S Healthy Steps program and clinical professor of pediatrics and psychiatry at the Albert Einstein College of Medicine in Bronx, NY states that so much of infant and toddler’s development is dependent on the caregiver’s state of mind. During the pandemic, many toddlers did not have a chance to go to preschool or playgroups. The concern is that these children are not learning to navigate social relationships with peers such as learning to share and work in groups. Evidence shows that once the children will be able to go back to preschool and social groups with other children, they will slowly gain the social skills that they may not been able to learn from their peers during the pandemic. These social skills such as sharing develop over many months and years and therefore even a year long period of social isolation will be unlikely to make long term impacts1.

If the caregiver is in a good, healthy state of mind, infants will be exposed to appropriate language and stimulation within their home environment and any long-term mental health impacts on infants and toddlers should be minimal. Evidence shows that young infants can gain enough social stimulation and language input from their parents alone as long as the parents are engaging with the infants. In fact, evidence shows that a positive effect of the pandemic is that infants and young children are benefitting from having their siblings and parents work from home. This benefit can be obtained if the family members are willing and able to take the time to engage and communicate with their infants and toddlers. However, many studies in pediatrics are showing that there has been a climb in parents mental health issues during the pandemic such as postpartum depression, anxiety, stress and also significant stress due to financial losses from job loss. There is evidence that shows that depressed parents may be less likely to talk to their infants and interact with their infants. In addition, many parents who are working from home are overworked and have little time to spend with their children. Such impact could affect infants and language development. The most significant predictor of language development is the amount of language spoken to a child in the first year of life. Parental depression and anxiety can also cause toddler’s own depressed mood2.

What may be more concerning about the effect of the pandemic is not so much a direct impact on development in infants and toddlers but the increasing evidence that shows that the pandemic has caused an increase in depression, stress and anxiety amongst parents. According to Megan Smith, PhD, co-director of the Parenting Center at the Yale Medicine Child Study Center and director of the New Haven Mental Health Outreach for Mothers (MOMS) Partnership, parental depression shapes not only a parent’s perception of the world, but also a child’s experience of the world internally and externally, Smith says. Depressed parents have been found to interact with their children differently, in ways that affect child development. For example, Smith says, “Depressed mothers have been found in some studies to use less emotion and expressivity in their language with their babies. And they make less eye contact.”

According to Dr. Smith, parental depression can negatively affect many daily activities of parenting. For example, when a depressed parent talks to a child or reads to a child, the parent may not be as lively or may tend to make poor eye contact and interact less. These changes in parental behavior can negatively impact infants and toddlers3.

Fortunately, it does not appear that the pandemic and social isolation in itself will lead to long term developmental issues in infants and young children. However, parental mental health can greatly impact the child’s health. Therefore, it is very important that parents try to maintain their mental health during this challenging, unprecedented time.

What can parents do to support their own mental health?

What can parents do to support their own mental health?

Partners and spouses should be aware that many people are suffering from mental health challenges during the pandemic and try to be sensitive to the needs of their partners. Some figures state that over 40% of people are experiencing some kind of anxiety or depression due to the effects of the pandemic4. Try to recognize when a partner seems more withdrawn, anxious, irritable, not sleeping or eating normally. If a partner seems to not be in his or her usual state, he or she should be encouraged to connect with their primary care doctor as the first step to uncovering any mental or physical issues.

Instead of staying indoors, parents should try venture outside in a safe fashion by wearing a mask and trying to maintain social distancing. As the weather becomes warmer outside, parents with young children can feel comfortable to mask and to meet neighbors and friends in a socially distanced manner outside in a park or playground. Toddlers who are over 2 years old should wear masks when in public but not under 2 years of age. Other activities that will promote relaxation include yoga or stretching at home. Simple yoga and stretches can be done together with young children and the parents. Parents can search for appropriate exercises on YouTube and online.

It is important for parents and caregivers to try to connect with other parents- even in a virtual format. Parents should try to establish chat groups or virtual networks with friends: a zoom session can be done amongst several people where they can communicate and talk to each other on line.

What can parents do with their infants, toddlers and young children to promote their healthy development?

What can parents do with their infants, toddlers and young children to promote their healthy development?

On a daily basis, make eye contact with your infant and talk to them. It is important for infants to hear conversations amongst members of the family.

An important activity to do with infants and young children is to read to them. Reading encourages language, literacy and communication across all ages and offers ways for your child to join in, such as turning the page, helping to tell the story and predicting what will happen next. Show colorful pictures and images. Make comments as you show the images. For infants, just hearing the parents’ voices as they read out loud can be very stimulating.

Interactive games and activities are important. For infants and toddlers, games involving back-and-forth play such as "peek-a-boo" can boost cognitive growth. Older children need access to activities they can participate in—such as puzzles and building blocks for problem-solving, and coloring and art for creativity.

Parents should try to encourage their older children to write letters to grandparents or schedule skype sessions with relatives such as grandparents who they cannot see readily or safely. It is important to connect with others even if it’s by letters or virtually.

Try to limit screen time or to break it up. Engage the children with short bursts of creative play. For toddlers and older children, consider leaving the screen and going outside and taking walks. I If possible, safe interaction with members outside the immediate family can aid social and emotional growth. Therefore, keep a social distance with others but interact and connect with friends outdoors. Socializing through video chats and online is also a safe way to introduce your young children to faces and voices of non-family members.

Fear of COVID-19 transmission has been linked to decreases in overall medical care. It is important to not delay your infant and children’s well child visits so that your child does not fall behind with vaccines. These checkups will allow parents to interact with their pediatrician and to ask about issues that may be concerning to them. Parents can refer to check lists of expected developmental milestones prior to the doctor’s visit to see if their child seems to be on track for development. Refer to the milestone checklist to see if your child seems to be developing appropriately5. It is also important for parents and caregivers to not delay annual checkups and to address their own health issues. The physical and mental health of the caregivers greatly impacts the healthy development and growth of the children.

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Maki Kano-Lueckerath, MD, FAAP

Maki Kano-Lueckerath has been in practice as a pediatrician and internist for over 20 years and has been a physician at the Mount Sinai Japanese Medical Practice in Hartsdale NY since finishing her Med-Peds residency at Mount Sinai Medical Center. Dr. Kano-Lueckerath is board certified in pediatrics as well as internal medicine. She enjoys providing evidence based medical care to patients while always considering and incorporating the patients psychosocial issues and taking a holistic approach. Dr. Kano-Lueckerath went to Mount Sinai Medical School and Cornell University for her undergraduate studies. Her special interest is to provide the highest level of primary care to the Japanese population from newborns to the elderly. She is the Vice President of the Japanese Medical Society of America and the chairperson of the Community Outreach Program (JCOP) which supports Japanese community groups that provide medical, mental and social support to the community with grants. She is the President of New York Sukusuku-kai, an NPO that provides health related information to promote wellness amongst the Japanese community in the New York Tristate area and beyond. In addition, she has served as the school doctor for the Keio Academy of New York.

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