Talking with Children During Infectious Disease Outbreaks

This article provides parents, caregivers, and teachers with strategies for helping children manage their stress during an infectious disease outbreak. It describes potential reactions among youth and the support adults can provide to help them.

What You Should Know

When children and youth watch the news on TV about an infectious disease outbreak, read about it, or overhear others discussing it, they can feel scared, confused, or anxious—as much as adults. This is true even if they live far from where the outbreak is taking place and are at little to no actual risk of getting sick.

Young people react to anxiety and stress differently than adults. Some may react right away; others may show signs that they are having a difficult time much later. As such, adults do not always know when a child needs help. This tip sheet will help parents, caregivers, and teachers learn some common reactions, respond in a helpful way, and know when to seek support.

Possible Reactions to an Infectious Disease Outbreak

Many of the reactions noted below are normal when children and youth are handling stress. If any of these behaviors lasts for more than two to four weeks, or if they suddenly appear later on, then children may need more help coping. Information about where to find help is in the Helpful Resources section of this tip sheet.

Preschool Children, 0–5 Years Old

Very young children may express anxiety and stress by going back to thumb sucking or wetting the bed at night. They may fear sickness, strangers, darkness, or monsters. It is fairly common for preschool children to become clingy with a parent, caregiver, or teacher or to want to stay in a place where they feel safe. They may express their understanding of the outbreak repeatedly in their play or tell exaggerated stories about it. Some children's eating and sleeping habits may change. They also may have aches and pains that cannot be explained. Other symptoms to watch for are aggressive or withdrawn behavior, hyperactivity, speech difficulties, and disobedience:

• Infants and toddlers, 0–2 years old, cannot understand that something bad in the world is happening, but they know when their caregiver is upset. They may start to show the same emotions as their caregivers, or they may act differently, like crying for no reason or withdrawing from people and not playing with their toys.
• Children, 3–5 years old, may be able to understand the effects of an outbreak. If they are very upset by news of the outbreak, they may have trouble adjusting to change and loss. They may depend on the adults around them to help them feel better.

Early Childhood to Adolescence, 6–19 Years Old

Children and adolescents in this age range may have some of the same reactions to anxiety and stress linked to infectious disease outbreaks as younger children. Often younger children within this age range want much more attention from parents or caregivers. They may stop doing their schoolwork or chores at home. Some youth may feel helpless and guilty because they are in a part of the world currently unaffected by the outbreak, or where the public health system protects people against outbreaks in ways it cannot in other parts of the world:

• Children, 6–10 years old, may fear going to school and stop spending time with friends. They may have trouble paying attention and do poorly in school overall. Some may become aggressive for no clear reason. Or they may act younger than their age by asking to be fed or dressed by their parent or caregiver.
• Youth and adolescents, 11–19 years old, go through a lot of physical and emotional changes because of their developmental stage. So, it may be even harder for them to cope with the anxiety that may be associated with hearing and reading the news of an infectious disease outbreak. Older teens may deny their reactions to themselves and their caregivers. They may respond with a routine "I'm okay" or even silence when they are upset. Or, they may complain about physical aches or pains because they cannot identify what is really bothering them emotionally. They may also experience some physical symptoms because of anxiety about the outbreak. Some may start arguments at home and/or at school, resisting any structure or authority. They also may engage in risky behaviors, such as using alcohol or drugs.

How Parents, Caregivers, and Teachers Can Support Children in Managing Their Responses to Infectious Disease Outbreaks

With the right support from the adults around them, children and youth can manage their stress in response to infectious disease outbreaks and take steps to keep themselves emotionally and physically healthy. The most important ways to help are to make sure children feel connected, cared about, and loved:

• Pay attention and be a good listener. Parents, teachers, and other caregivers can help children express their emotions through conversation, writing, drawing, playing, and singing. Most children want to talk about things that make them anxious and cause them stress—so let them. Accept their feelings and tell them it is okay to feel sad, upset, or stressed. Crying is often a way to relieve stress and grief.
• Allow them to ask questions. Ask your teens what they know about the outbreak. What are they hearing in school or seeing on TV? Try to watch the news coverage on TV or the internet with them. Also, limit access so they have time away from reminders about the outbreak. Don't let talking about the outbreak take over the family or classroom discussion for long periods of time.
• Encourage positive activities. Adults can help children and youth see the good that can come out of an outbreak. Heroic actions, families and friends who travel to assist with the response to the outbreak, and people who take steps to prevent the spread of all types of illness, such as hand washing, are examples. Children may better cope with an outbreak by helping others. They can write caring letters to those who have been sick or have lost family members to illness; they can organize a drive to collect needed medical supplies to send to affected areas.
• Model self-care, set routines, eat healthy meals, get enough sleep, exercise, and take deep breaths to handle stress. Adults can show children and youth how to take care of themselves. If you are in good physical and emotional health, you are more likely to be readily available to support the children you care about.

Tips for Talking with Children and Youth of Different Age Groups During an Infectious Disease Outbreak

A note of caution: Be careful not to pressure children to talk about an outbreak or join in expressive activities. While most children will easily talk about the outbreak, some may become frightened. Some may even feel more anxiety and stress if they talk about it, listen to others talk about it, or look at artwork related to the outbreak. Allow children to remove themselves from these activities, and monitor them for signs of distress.

Preschool Children, 0–5 Years Old

Give these very young children a lot of emotional and verbal support:

• Get down to their eye level, and speak in a calm, gentle voice, using words they can understand.
• Tell them that you always care for them and will continue to take care of them so that they feel safe.
• Keep normal routines, such as eating dinner together and having a consistent bedtime.

Early Childhood to Adolescence, 6–19 Years Old

Nurture children and youth in this age group:

• Ask your child or the children in your care what worries them and what might help them cope.
• Offer comfort with gentle words or just being present with them.
• Spend more time with the children than usual, even for a short while.
• If your child or adolescent is very distressed, excuse him or her from chores for a day or two.
• Encourage the children to have quiet time or to express their feelings through writing or art.
• Encourage the children or adolescents to participate in recreational activities so they can move around and play with others.
• Address your own anxiety and stress in a healthy way.
• Let the children or adolescents know that you care about them—spend time doing something special; make sure to check on them in a nonintrusive way.
• Maintain consistent routines, such as completing homework and playing games together.

When Children, Youth, Parents, Caregivers, or Teachers Need More Help

In some instances, children may have trouble getting past their responses to an outbreak, particularly if a loved one is living or helping with the response in an area where many people are sick. Consider arranging for the child to talk with a mental health professional to help identify the areas of difficulty. If a child has lost a loved one, consider working with someone who knows how to support children who are grieving.1 Find a caring professional in the Helpful Resources section below.

Helpful Resources

Resources Addressing Children's Needs

Administration for Children and Families (ACF)
Website: Link opens in a new windowhttps://www.acf.hhs.gov

Child Welfare Information Gateway
Toll-Free: 800-4-A-CHILD (800-422-4453)
Website: Link opens in a new windowhttps://www.childwelfare.gov/topics/responding/reporting/how

National Child Traumatic Stress Network (NCTSN)
Website: Link opens in a new windowhttps://www.nctsn.org

Additional Resources

988 Suicide & Crisis Lifeline
Toll-Free: 988 or 800-273-TALK (800-273-8255)
TTY: Use your preferred relay service or dial 711 then 988
Website: Link opens in a new windowhttps://988lifeline.org

Reference

1. National Commission on Children and Disasters. (2010). National Commission on Children and Disasters: 2010 report to the President and Congress (AHRQ Publication No. 10-MO37). Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). Retrieved January 16, 2023, from https://archive.ahrq.gov