Parents find themselves in uncharted territory, as they have to navigate the uncertainties of the nationwide lockdown. Concerns around income, lack of productivity and changing routines cause anxiety levels to soar and panic to spread. Whilst anxiety is a normal reaction to uncertainty and change, children might find this time especially scary and distressing. Children primarily take their cues from their parents. If parents are anxious, distressed or constantly angry, children find it hard to stay calm. So, parents are essential in helping children regulate their emotions. Children seek comfort and security from their parents or their environment. The ability to anticipate change provides children with a sense of certainty and control in uncertain times.

Understandably some children may find it especially hard to tolerated worry during this time as the world around them echo messages of death, infection, contamination, and social isolation. Some, with existing anxiety symptoms or other mental disorders, can be particularly at risk of developing more severe anxiety symptoms. In an attempt to safeguard against pathogens, children may become hyper-focused on the possible factors that may threaten their safety and wellbeing. This hyper-focus or preoccupation is markedly different from what is developmentally expected in that it produces clinically significant levels of distress and impairment in functioning. As children grow, rituals and obsessive thoughts normally happen with a purpose and focus. Pre-schoolers often have rituals and routines around meals, bathing, and bedtime. These rituals bring structure and predictability to their world. Rituals are also part of learning and underpin play, team sports, and cultural activities. These rituals help children to socialize and learn to deal with anxiety. However, if these rituals are excessive or persist beyond developmentally appropriate periods, it might be indicative of Obsessive-compulsive disorder (OCD).

Preoccupations or obsessions are hard to identify in young children as they may not be able to articulate the reasons for their repetitive behaviours or thoughts. In contrast, compulsions are more overt. Boys are more affected by OCD in childhood and have an earlier onset than girls. In very rare cases, symptoms may develop suddenly with a rapid change in behaviour and mood and the abrupt appearance of severe anxiety. If this is the presentation, it is that the child has a sub-type of pediatric OCD caused by an infection (e.g., strep throat). Strep throat is a bacterial infection that is characterised by a sore and scratchy throat. This infection can confuse the child’s immune system into attacking the brain instead of the infection. This then causes the child to begin having severe symptoms of OCD, often seemingly all at once, in contrast to the gradual onset seen in most cases of pediatric OCD. This rare type of OCD is called Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS) if it is due to a strep infection, or Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) if it is caused by any other infection.

Overall OCD is treatable, but overcoming it isn’t a quick or easy process. Children diagnosed with OCD usually need to work with a therapist and take medicines to help manage their behaviours and the accompanying thoughts and feelings. Parents are however invaluable in supporting their children during this pandemic. One way they can assist their child diagnosed with OCD is to stay informed. Knowing the facts surrounding Covid-19 can help reduce stress. If your child is fearful of getting sick, parents can remind them that people are staying home to prevent the spread of Covid-19. By reframing the situation, parents can bring more certainty to an uncertain situation.

Similarly, parents can create more structure and predictability at home by establishing a daily routine. Write out a plan for each day and notify your children of the plan. Ideally, parents need to keep the routine as close as possible to what it was before COVID-19. Have children wake up, get dressed and eat breakfast at the same time they would for school to help create a sense of “normality”. Use the school schedule as a template but switch activities every 30-40 minutes or so. At “lunchtime,” eat lunch together. Also, try to encourage healthy eating during the day as it helps managing energy levels. Children should also get enough sleep and engage in physical exercise. Parents may want to think about the types of activities that relax their child when they experience other stressful events. What has helped in the past?. Activities that soothing and promote self-care should be at the heart of the daily routine.

Social interaction and connection are vital and children might feel sad or angry that they cannot see their friends or family. To prevent children from feeling alone help them stay connected with others in new ways. Use technology like Skype, Zoom, Facetime or other apps to set up “virtual playdates.” They can watch a show with their friend or have a picnic via Zoom or Skype. If not possible set up regular times for your children to talk with their friends on the phone.

If you suspect that your child may has OCD or present with OCD symptoms reach out to a health care professional. You can consult your general practitioner during the lockdown period and request a referral to a psychiatrist or specialist paediatrician. In addition, you can contact a psychologist in your area to set up an online consultation during the lockdown or an in-person consultation for after the lockdown. The South African Depression and anxiety group 0800 205026 helpline can also provide you with a list of mental health professionals. I am also available to assist during this lockdown period via online therapy.