Guidance

[Withdrawn] Guidance for parents and carers on supporting children and young people’s mental health and wellbeing during the coronavirus (COVID-19) pandemic

Updated 19 May 2021

This guidance was withdrawn on 19 July 2021

The information in this guidance has been superseded. For up to date information please see Every Mind Matters

A new COVID-19 variant is spreading in some parts of England. There may be additional advice for your area. Find out what you need to do.

What you need to know

The coronavirus (COVID-19) pandemic is having an impact on everybody’s lives. Regardless of their age, this will be a challenging time for many children and young people. How a child or young person responds to their individual situation will vary. Some may react immediately, some not at all, while others may show signs of difficulty later on. It is important to recognise that in most cases, these are normal responses to an abnormal situation.

How a child or young person responds to their individual situation may vary in different ways according to their individual characteristics and circumstances. For example, their age, physical or mental health condition, how they deal with stress, previous experiences or pre-existing mental or physical health condition.

During this time, it’s important that you support and take care of the mental health of children or young people in your care, as well as your own mental health. There are lots of things you can do, and additional support is available if you need it.

Background

This advice is to help adults with caring responsibilities look after and support the mental health and wellbeing of children and young people, including those with additional needs and disabilities, during the COVID-19 pandemic.^{[footnote 1]}

There is more information on how to stop the spread of coronavirus available.

Looking after your own mental health

As well as thinking about the children or young people in your care, it is important to take care of your own mental health and wellbeing. This will help you support yourself and those you care about. Children and young people react, in part, to what they see from the adults around them. When parents and carers deal with a situation calmly and confidently, they can provide the best support for children and young people.

Promoting mental wellbeing and helping children and young people cope during the pandemic

Children and young people want to feel assured that their parents and carers can keep them safe. It will not always be possible to provide answers to all the questions that children and young people may ask, or to address all their concerns, so focus on listening and acknowledging their feelings to help them feel supported.

There are some actions you can consider to support a child’s or young person’s mental health and wellbeing during the pandemic, including:

Look for changes

Children and young people may respond to stress in different ways. Signs may be emotional (for example, they may be upset, distressed, anxious, angry or agitated), behavioural (for example, they may become more clingy, or more withdrawn, or have difficulty concentrating, or they may wet the bed), or physical (for example, they may experience stomach or headaches). Look out for any changes in their behaviour and be aware that these changes may not occur in all contexts (for example they might just happen at school or at home).

Making time to listen

Create a calm safe space where they can communicate how they are feeling without judgement. Some young people may find it easier to talk while you are doing something together, such as playing or exercising in the park, going for a walk, painting or other activities. You can’t always know the answer and it is often better to be honest and say ‘I don’t know’ rather than put more pressure on yourself or set unrealistic expectations. Listen to them and acknowledge their concerns.

Remember to let them know you are there to help and give them extra love and attention if they need it. Children and young people who struggle to communicate how they feel may rely on you to interpret their feelings. For further advice you may contact Young Minds Parents Helpline. They also offer Parents Email and Parents Webchat services.

MindEd for families is a free online educational resource about children and young people’s mental health designed for all adults, which can support parents and carers through these exceptional circumstances. Young Minds also has a useful resource about ‘Starting a conversation with your child’.

Providing clear information about the situation

One of the best ways to achieve this is by talking openly about what is happening and providing honest answers to any questions children have, using words and explanations that they can understand. Explain what is being done to keep them and their loved ones safe, including any actions they can take to help, such as washing their hands regularly.

There are resources available to help you do this, including the Children’s Commissioner’s Children’s Guide to Coronavirus, or the Inter-Agency Standing Committee (IASC) have produced a storybook developed by and for children around the world affected by COVID-19.

Make sure you use reliable sources of information such as GOV.UK or the NHS website – incorrect or misleading information can create stress for the child or young person you care for.

Being aware of your own reactions

Children and young people often take their emotional cues from the important and trusted adults in their lives. How you respond to the situation is very important. Try to manage your own emotions and remain calm, speak kindly to them, and answer any questions they have honestly.

Support safe ways for children and young people to connect with their friends

Where it isn’t possible for them to meet in person, they can connect online or via phone or video calls. Advice for parents and carers on helping children to stay safe online during the COVID-19 pandemic is available.

Creating a new routine

Changes to our lives caused by the pandemic might impact on routines. Routine gives children and young people an increased feeling of safety in the context of uncertainty, so if your routine has changed, think about how to develop some regularity where possible. Some ideas might include:

• make a plan for the day or week that includes time for learning, free time (including play, creativity or hobbies) and relaxing. A weekly timetable that can be visualised can be helpful
• if children have to stay home from school, ask teachers what you can do to support continued learning at home. The Department for Education has a list of recommended online educational resources for those who are learning at home
• add in positive activities that you know the child or young person will enjoy- and discover new ideas for activities to do from home if needed. Encourage maintaining a balance between being online and offline. The Children’s Commissioner guide contains some ideas to help fight boredom
• children and young people ideally need to be active for 60 minutes a day, which can be more difficult when spending longer periods of time indoors. Plan time outside if you can do so safely or visit Change4Life for ideas for indoor games and activities. Physical activity is good for our physical and mental health
• good sleep is important for mental and physical health, so try to keep to existing bedtime and morning routines. The NHS provides healthy sleep tips for children
• try giving children and young people healthier alternatives to treats such as sweets or chocolate. See Change4Life for ideas

Limiting exposure to media and talking more about what they have seen and heard

Like adults, children and young people may become more distressed if they see repeated coverage about the COVID-19 pandemic in the media. Removing their access to the news is also rarely helpful as they are likely to find information from other sources, such as online or through friends. Try to avoid turning the television off or closing web pages when children or young people come into the room. This could make them assume that you are hiding important things from them or could cause them to worry. Instead, consider limiting the amount of exposure children and young people have to media coverage. The British Psychological Society have produced some helpful advice for parents about managing uncertainty.

Young people will also hear things from friends and get information from social media. Talk to them about what is happening and ask them what they have heard. Try to answer their questions honestly but reassure where you can.

How children and young people of different ages may react

All children and young people are different, but there are some common ways in which different age groups may react to a situation like the COVID-19 pandemic. The common reactions to distress will fade over time for most children and young people, though could return if they see or hear reminders of what happened. Understanding these may help you to support your family.

For infants to 2 year olds

Infants may become more easily distressed. They may cry more than usual or want to be held and cuddled more.

For 3 to 6 year olds

Preschool and nursery children may return to behaviours they have outgrown, such as toileting accidents, bed-wetting, or being frightened about being separated from their parents or carers. They may also have tantrums or difficulty sleeping.

For 7 to 10 year olds

Older children may feel sad, angry, or afraid. Peers may share false information but parents or carers can correct the misinformation. Older children may focus on details of the situation and want to talk about it all the time, or not want to talk about it at all. They may have trouble concentrating.

For pre-teens and teenagers

Some pre-teens and teenagers respond to worrying situations by acting out. This could include reckless driving, and alcohol or drug use. Others may become afraid to leave the home and may cut back on how much time they connect with their friends. They can feel overwhelmed by their intense emotions and feel unable to talk about them. Their emotions may lead to increased arguing and even fighting with siblings, parents, carers or other adults. They may have concerns about how the school closures and exam cancellations will affect them.

Advice for groups with additional mental health needs or facing specific issues

Children and young people who are currently accessing mental health services

Children and young people with an existing mental health problem may find changes and uncertainty caused by the COVID-19 pandemic particularly difficult. The increased stress may lead to a change in their behaviours and their mental health needs. If you are concerned about how to access support if they need to stay at home and self-isolate, consider taking these actions.

Speak to the child’s or young person’s mental health team

Contact the team to discuss any concerns and check how care will continue to be accessed. Update any safety and care plans as agreed.

Identify how the support the child, young person or family normally receives will be maintained

Ask if appointments normally offered in person, will now be by phone, text or online or a mixture of these. Ask if there is extra support that the health professional can offer if the child or young person needs it, including how to contact the service if you have any concerns between appointments. Talk to the health professional about what plans are in place and how best to communicate these to the child or young person if you, the child or young person need to stay at home and self-isolate.

Plan how you will get the child’s or young person’s medication

You might be able to order repeat prescriptions by phone or online using an app or website if your doctor’s surgery offers this. Ask your pharmacy about getting medication delivered or think about who you could ask to collect it for you. The NHS website has information about getting prescriptions for someone else and checking if you have to pay for prescriptions.

Continue to order repeat prescriptions in your usual timeframe. There is no need to order for a longer duration or larger quantities.

Your general practitioner (GP) might convert a repeat prescription to one that is supplied under the repeat dispensing arrangements. This means you can go back to the pharmacy for a certain number of repeats without having to get a repeat prescription from the practice.

Be careful about buying medication online. You should only buy from registered pharmacies. You can check if a pharmacy is registered on the General Pharmaceutical Council website.

You might also want to make arrangements for the child or young person if you become unwell or have to isolate – for example, making sure a partner, friend, family member or neighbour is aware of important information including their care plan, medications and emergency numbers.

Identify how you will visit or maintain contact with the child or young person if they have been admitted to an inpatient mental health unit

Talk to the staff about their policies on visiting and access to digital technology and think about how you can stay in contact, particularly if you have to stay at home and self-isolate. Ask the unit if you could participate in a virtual ward round to keep in touch with the child’s or young person’s mental health team. If the situation in your local area or in the unit changes or, if you need to stay at home and self-isolate this will impact on whether the child or young person can come home on leave. It is important to talk to the child or young person about what might happen so they are fully informed.

Eating disorders

Children and young people with an eating disorder may find aspects of the current situation particularly challenging, for example, reduced availability of specific foods, social isolation and significant changes to routine.

If you or the child or young person are worried about an eating disorder, contact your local community eating disorder team. Most community eating disorder teams support direct access that is not reliant on a referral from your GP. These teams have been set up to offer treatment to those requiring early intervention or more urgent care, so don’t wait to seek help.

For children and young people with avoidant restrictive food intake disorder (ARFID), take care about issues that arise if there is:

Reduced availability of specific foods

This may mean the child or young person who is on a limited diet cannot get the foods they eat. Many will go without rather than have something else, but with risk of weight loss or further nutritional deficiency.

Significant changes to the child’s or young person’s routine

For those with ARFID this can be extremely distressing and challenging to manage. Seek advice on how you can reduce the distress and risk of further reduction of their food intake.

General heightened anxiety

Monitor existing anxiety and obsessive-compulsive behaviours that are associated with distress and how this is interfering with eating.

The eating disorders charity BEAT also provides advice, support and helplines for children, young people and students.

Children and young people with learning disabilities

Children and young people with learning disabilities may find it difficult to understand and remember COVID-19 guidance, rules or restrictions and may feel frustrated by the impact and uncertainty. They may also need more support or adapted explanations about the pandemic.

A good way to help them could be by:

• supporting them to make decisions
• representing choices visually through written words, pictures, symbol systems or objects, if helpful
• supporting them to express their emotions
• letting them know they are not alone

While listening, take their feelings seriously and don’t judge their emotions. They may feel anxious about big changes, such as the possibility of having to stay at home. Where possible, it can be helpful to explain any upcoming changes to routine and circumstances before they happen and help them to plan and come up with solutions, such as finding a hobby or doing exercises to relax and cope with anxiety.

Resources to support you and the child or young person include:

• easy-read COVID-19 guide to looking after your feelings and your body – this provides advice on how to look after your mental health and wellbeing during the coronavirus (COVID-19) outbreak
• Beyond Words has published a book that supports those who help people with a learning disability to better understand the COVID-19 pandemic
• Skills for Care provides Top tips for talking about our feelings
• Mencap provides information on COVID-19 for those with learning disabilities, including easy read materials
• BILD (the Learning Disability Professional Senate) has published a collection of resources to support families and carers of people with learning disabilities during the COVID-19 pandemic
• Learning Disability England has some tips for people with a learning disability on looking after their mental wellbeing
• Council for Disabled Children, which has advice with a focus on learning disability and autism

Autistic children and young people

Autistic children and young people may have found disruption to routines and support during the COVID-19 pandemic particularly difficult, emotionally and socially. Also, if the child or young person becomes unwell with COVID-19, they may struggle to manage the physical experience. You can help to manage these experiences using any strategies that you know work for them, or by seeking further advice and support, as well as talking to the child or young person’s education setting.

Autistic children and young people may struggle to recognise the emotions they are feeling and to communicate them to others, for example anxiety or low mood. Be alert for changes in behaviour which may help you to identify their emotional state, for example increased agitation, physical symptoms of anxiety or changes in sleeping and eating.

It is important to be honest when communicating with the child or young person you care for about the changing situation, measures they can take to stay safe, and the symptoms of the virus. Try to avoid giving definitive statements about the future – this is a rapidly developing and changing situation and the child or young person may be more distressed if things change when they were told they would not.

Children and young people with autism often find change more difficult. Let the young person you care for know in the most appropriate way for them if arrangements change so they are prepared. You will know the child or young person best, so consider their own specific needs when deciding when and how to let them know what the new arrangements will be. For example, visual strategies (such as social stories, pictures, timetables or timers) or visiting new places when it is quiet or virtually may help them prepare for any changes.

It is also helpful for children if there is a consistent approach between home and school, so communicating closely with staff at school or college can be supportive. If helpful, ask your health professional for advice.

You should continue to access support of local autism groups online or via phone. The National Autistic Society guidance on managing anxiety might also be helpful. Autistica also provide support and information, including an Autism Helpline.

Children or young people with physical health issues

Where children or young people are managing their health conditions during the pandemic, there may be additional psychological needs to consider. This group of children or young people are at risk of increased disruption, isolation and are at greater risk of mental health difficulties (for example, more intense distress, worry or anger episodes) than their healthy peers.

Support children and young people by listening to their concerns, providing open and honest explanations about the situation, and giving them information about what is being done to protect them.

Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19 is available. The Council for Disabled Children also has information about the support available to children and young people living with a long-term health condition.

Children and young people who care for others

Some children and young people may have existing caring responsibilities for adults or siblings, and these may have increased or become more challenging during the pandemic. They may be anxious about what will happen if the person they care for becomes unwell, or what will happen if they themselves become unwell and are unable to support the person they care for. Even if they don’t currently act as a carer, it is possible that they may become one if they are in a household with one adult.

Plan with the child or young person what will happen if you or the person they care for, or may need to care for, becomes unwell as this will help to reduce anxiety. Include contact details for others who can step in and support them.

Further information about support for young carers is available at Barnardo’s Young Carers Support Hub.

Support for students in further or higher education

If the young person you support is a student, life at university or college this year will probably feel very different to what they were expecting. The COVID-19 pandemic may have affected their life and studies and might leave them feeling unsupported and lonely, frustrated, anxious, or stressed. They may be worried about job prospects after finishing their studies, or current financial concerns might be causing stress. The Student Space website contains advice and information to support students during the COVID-19 pandemic.

Encourage the young person to regularly communicate with friends and family whether that is via messages, calls or video chats. If the young person is feeling the strain on their mental health and wellbeing, support is available. They can inform their learning provider who can then advise what mental health and wellbeing support is available for students, such as a wellbeing or counselling service, student advice services, or other resources.

For NHS mental health support, students can contact their GP or they can self-refer to talking therapies for anxiety and depression via NHS psychological therapies services (IAPT). These services are free, and therapies can be delivered effectively remotely on-line and on the telephone. Students can access these services anywhere in England regardless of where they are registered with a GP. Students that need help with anxiety or depression can contact their local service.

Experiencing grief or bereavement

Whenever it happens, experiencing the loss of a loved one can be an extremely difficult and challenging time. Due to the COVID-19 pandemic, children and young people may not be able to say goodbye in the way they would have wanted to. It may also be harder to connect with their usual support networks.

Grief affects children and young people in different ways depending on their age, their level of understanding, and the changes the death means for their daily life. They often feel waves of powerful emotions such as sadness, guilt, shock and anger, which they may struggle to express. It is very common for their behaviour to change and for them to worry a lot about other people.

It can be challenging to support a child or young person when you are grieving yourself. Listening carefully, answering questions honestly in an age-appropriate way, continuing routines where possible, and providing lots of love and support will help.

The NHS has advice about grief and the support available, and the Childhood Bereavement Network has information and links to national and local support organisations.

Where to get further support

Every Mind Matters provides advice and practical tips for parents and carers on looking after a child’s or young person’s mental health and self-care advice for young people.

If you’re concerned about a child or young person’s mental health, you can get free, confidential advice via phone, email or webchat from the Young Minds Parents Helpline.

You can find more information about NHS Children and Young People’s Mental Health Services (CYPMHS) and how to access them. You can also look at your local Clinical Commissioning Group website - most services also have their own website with information about access, referrals (including whether you can ‘self-refer’) and contact details. Try searching in your area for ‘CYPMHS’ or ‘CAMHS’ (children and adolescent mental health services, an older term used for some CYPMHS). During the COVID-19 pandemic, services are still there for you, so don’t hesitate to ask for help.

Action for Children has lots of tips to help you spot signs of mental health issues in children and provides advice on the action you can take to help.

Barnardo’s COVID-19 Support Hub provides information, resources and tools to support children, young people and their families or carers during the pandemic.

You can get Psychological First Aid training on how to support children and young people’s mental health during emergencies like COVID-19 and crisis situations. This course has been developed by Public Health England and is for anyone who provides care for, or works with, children and young people, including parents and caregivers. No previous qualifications are required to enrol. The course is free to complete, but has an option to buy a certificate once you have completed the course. You do not need to buy this certificate to complete the course modules.

Any professional that works with children and young people should also be able to help you get support. You could talk to a teacher, school nurse, social worker or GP.

Where to get urgent help

If a child or young person needs urgent medical help, then call 999 or take them to the nearest Accident & Emergency (A&E). This is when someone is seriously ill or injured and their life is at risk. A mental health emergency should be taken as seriously as a physical health emergency.

If a child or young person needs urgent mental health support or advice, visit the NHS urgent mental health page to find services in your area, including 24/7 mental health crisis support.

If a child is currently being supported by Children and Young People’s Mental Health Services (sometimes known as CAMHS), Paediatric Services or Children’s Social Care then talk to them if you are worried about the child.

If you are not sure what to do, you can contact your GP for advice or check NHS 111 online.

Helplines and websites for children and young people

If a child or young person would like further information or advice on their mental health or difficulties they are experiencing, they could try one of the following websites or organisations:

Shout 85258 provides free, confidential, 24/7 text message support in the UK for anyone who is struggling to cope. They can help with issues including suicidal thoughts, depression, anxiety, panic attacks, abuse, self-harm, relationship problems and bullying:

• text ‘Shout’ to 85258 to speak to a trained volunteer who will listen and work with you to solve problems

Papyrus provides confidential support and advice to young people struggling with thoughts of suicide, and anyone worried about a young person:

• call 0800 068 41 41 for free – every day, 9am to 12am (midnight)

• you can also text 07860 039967 (charges may apply)

• you can email pat@papyrus-uk.org

ChildLine provides a confidential helpline for any child with a problem. It comforts, advises and protects. You can:

• call 0800 1111 for free, from 9am - 3.30am
• have an online chat with a counsellor, 9am – 10.30pm
• check out the message boards

The Mix provides a free confidential helpline and online service that aims to find young people the best help, whatever the problem. You can:

• call 0808 808 4994 for free – every day, 3pm to 12am (midnight)
• access the discussion boards
• email The Mix

Every Mind Matters includes advice for young people on how to look after their mental health and wellbeing and deal with the issues that matter to them.

1. Some of the links to guidance, resources and services are specific for England. For the devolved administrations, specific guidance can be found on the following pages for Scotland, Wales, and Northern Ireland. ↩