There is good news for most children and bad news for some in this pandemic. Unlike most epidemics, where those at both ends of the age spectrum are more likely to succumb, the good news is that we are seeing a smaller proportion of deaths and infections in children.
The reasons are unclear. Some speculate that as young children are constantly meeting viral infections, their immune systems are more active, but basically at this stage we just don’t know.
On 16 March the North American journal, Pediatrics published a study showing that of 2143 confirmed or suspected cases involving children in China, over 90% had no symptoms or were mild to moderate in severity. A separate study in the USA found that children or teenagers comprised less than 1% of the coronavirus cases severe enough to require hospitalisation. However, some children do develop severe illnesses, particularly the youngest. And of course, children with mild symptoms can still spread the infection.
The other good news for some children in a near lockdown situation is that spending more time at home with their parents can be an enriching experience all round, an opportunity to increase the depth of the relationship and find new ways to enjoy each other’s company.
That’s the good news. But of great concern is that because of the measures that must be taken, some children will face different dangers. There is likely to be more exposure to domestic violence, more physical abuse and an increased risk of intra-familial sexual abuse during long periods of home confinement or enforced lockdown. Why? Families will spend much more time together than they would normally. There is far less to do. There will be feelings of anxiety, frustration and uncertainty. Children can be demanding. Tempers can flare. There is a danger that some parents whose main method of discipline is physical may go too far. There has been evidence from the USA that in times of high unemployment, where men have spent more time at home, sexual abuse of children has increased.
The close proximity of parents, along with all of the frustrations that may go with not being able to get out much may increase the risk of domestic violence in some families. When there is domestic violence, children are at risk of abuse. We now know that domestic violence has a clear link with physical abuse and sometimes with sexual abuse of children. Forty-five to 76% of women seeking shelter in refuges report some form of abuse to their children, be it physical, emotional or sexual. In addition, children who witness domestic can suffer. Some become fearful and anxious. Some worry because they have not been able to protect their mother. Some see the aggressive behaviour they witness as the way to behave and become violent towards others, as children and later as adults.
While the good news is that children seem to be less susceptible to coronavirus, we need to be aware that in some families during this time of isolation and limited freedom, children are at increased risk of other serious problems.
Isolation and lockdown are appropriate responses, but part of the flexibility our society needs in this situation is to think of how to make these responses safer for children. The wider availability of child helplines, which children can call, should be supported and encouraged. Other telephone counselling services for adults will need to expand. We will need more advice for families about coping with stress and confinement, including advice and support for when the adult is at a low ebb and the demands of the child seem overwhelming. Innovative forms of direct support for children are needed. These measures should be an integral part of the package that is being delivered to help Australian families. In the midst of this crisis, we cannot forget the children
Kim Oates is an Emeritus Professor in the Discipline of Child and Adolescent Health at Sydney University and a former President of the International Society for the Prevention of Child Abuse and Neglect.
Kim Oates is an Emeritus Professor of Paediatrics, a former CEO of the Children’s Hospital at Westmead, a former President of the International Society for Prevention of Child Abuse and Neglect and an elected Founding member, International Academy of Quality and Safety.
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