The authors describe a range of potential adverse effects and contributing factors

Research finds indirect effects of COVID-19 on young people’s mental and physical health

While children and young people appear less likely to get COVID-19 than older adults, new research suggests there may be substantial indirect adverse effects of the disease on their physical and mental health.

An analysis published in CMAJ (Canadian Medical Association Journal), co-led by the University of Exeter Medical School with the Hospital for Sick Children (SickKids, Canada) has found factors caused by the pandemic, such as delayed medical appointments, forced isolation and reduction in support, have negatively impacted children’s health. 

SickKids is affiliated with the University of Toronto and is Canada's most research-intensive hospital, dedicated to improving children's health in the country.

Dr Neil Chanchlani, co-author from the University of Exeter Medical School, said: “While children and young people seem rarely to be victims of severe COVID-19, we should anticipate that they will experience substantial indirect physical, social and mental health effects related to reduced access to health care and general pandemic control measures.”

The authors describe a range of potential adverse effects and contributing factors as well as mitigation strategies for health care providers and health systems, including easy-to-reference boxes with practical tips.

Adverse physical effects identified in the analysis include:

• Delays in seeking care for non-COVID-19 related illnesses which can lead to severe illness and even death
• Widespread delays or omissions of routine childhood vaccinations can threaten herd immunity
• Missed detection of delayed development milestones usually identified during routine child health checks

Dr Peter Gill, co-author from the Hospital for Sick Children (SickKids), Toronto, Canada said: “Delays in bringing children and young people to medical attention may be due to parental fears of exposure to COVID-19 in hospitals or on public transit, lack of childcare for other children, lack of access to primary care due to closures, or changes to hospital visitation policies.”

However, reduced social contact because of travel and quarantine restrictions may reduce transmission of other commonly acquired illnesses.

The analysis identified a number of factors affecting social and mental health:

• Families living in inadequate or crowded housing may experience heightened stress or conflict which can affect the mental and physical health of children. Refugees, some Indigenous communities and low-income families living with financial strain and food insecurity are particularly vulnerable.
• Restrictions and cancellations of child welfare visits to at-risk families can reduce visits of birth parents and children in foster care, leading to harms
• Forced isolation and economic uncertainty may lead to increases in family violence, contributing to mental and physical trauma
• School cancellations may heighten food insecurity for children who depend on meal programs and increase vulnerability with the loss of school as a safe place
• Lost social interaction and lack of structured routines may lead to increased screen time, decreased physical activity, lack of concentration, anxiety and early depression.
• Reductions in support for children with additional healthcare needs such as developmental delays can lead to delayed diagnosis and support.

Francine Buchanan, co-author and Research Patient & Family Engagement Coordinator at SickKids, said: "We need to better understand what goes into the decisions families make regarding the complex needs of their children during this pandemic and how we can better support them. Both practical and personal considerations need to be taken into account."

The authors suggest several mitigation strategies including:

• Clear communication that health services are open for children and young people if needed, and to inform and reassure families and collect feedback
• Hospital-based programs should find alternate ways to deliver vital services, such as offering in different locations or online
• Adequate data collection to assess readiness to return to school, how children and young people contract and spread COVID-19, hospital use and admission data, and more will be helpful.

“We owe it to our children and young people to proactivley measure the COVID-19 pandemic’s indirect effects on their health and take steps to mitigate the collateral damage,” urge the authors.

“Addressing the indirect effects of COVID-19 on children and young people’s health” is published June 25, 2020.

Date: 25 June 2020