Effects on Children’s Health – Adverse Childhood Experiences
Epidemics or pandemics, such as COVID-19, produce potential risks to child development due to the risk of illness, protective confinement, social isolation, and the increased stress level of parents and caregivers. This situation becomes an adverse childhood experience (ACEs) and may generate toxic stress, with consequent potential losses for brain development, individual and collective health, and the long-term impairment of cognition, mental and physical health, and working capacity of future adults.
Depending on levels and kinds of support, high and continuous stress may either be tolerable or become toxic to children and adolescents. ACEs are traumatic or stressful events that occur in childhood, such as abuse, neglect, domestic violence, and parents with substance dependence or mental illness. The pandemic can be understood as another source of ACE.
In the wake of the COVID-19 pandemic, we have observed a dramatic increase in numbers of children with developmental delays. While the numbers are concerning across all ages and areas of development, the greatest delays appear to be in infant communication and social-emotional development. The increases in children’s psychological and behavioural problems are believed to be impacted by family circumstance around isolation, parental stress, financial hardships, cramped living conditions, limited access to green spaces, absence of early wellness checks, mask wearing, increased screen time and reduced physical activity.
We have noted significant indirect effects on multiple areas of child development, school readiness, educational attainment, socialization skills, mental health, low self-esteem and confidence, increases in numbers of children overwhelmed by learning, decreases in emotional regulation, lower levels of basic selfcare and the ability to adhere to routines, increases in separation anxiety from parents, increases in speech and language development delays in addition to risks based on social determinants of health. We are seeing children in much higher numbers with their neurodevelopment, academic performance, physical, and mental health impacted.
With the onset of the COVID-19 pandemic and the need for virtual learning, with reduced opportunities for in-person activities and sports, screen time use saw a major rise for children of all ages, from toddlers to adolescents. Children under the age of 2 years do not learn well from screen watching and benefit most from in-person interactions. Early language and social development primarily require in-person experiences and peer-play time. In a cohort study of 1994 mother–child pairs, children with two or more hours of screen time a day were more likely to have behavioural problems, delayed developmental milestones, and lower vocabulary knowledge compared to children with lower amounts of daily screen time. In another study of preschoolers, screen time at age three years was predictive of anger, temperament, and frustration at age four years.
Excessive screen time is also not good for the eyes; it may cause eye fatigue and blue light exposure can affect circadian rhythms and sleep. The pandemic thus created a difficult situation with young children at home, preschools closed, and parents needing to telework, all of which led to increased screen usage even among young children. When young children were allowed back into preschool settings the continuation of mask wearing impacted negatively with delays in facial recognition, speech development, mirroring – (the serve and return response) and lack of social awareness.
During this time, many school learning materials made a move to digital formats including storybooks and textbooks. Children learned to use digital platforms for completing assignments and had fewer opportunities for reading and writing on paper. Handwriting was a fine motor skill that certainly suffered during the pandemic for many children. There has been an increase in children with developmental delays, learning disabilities, and behavioural disorders that may be a sequela of multiple changed experiences during the early years of the COVID-19 pandemic for a child who may have already had some underlying risk.
