COVID-19 and children: potential impacts and alleviation strategies

Introduction The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused numerous public health problems worldwide.1 In the early pandemic period, more than 57 million people were infected across 220 countries or regions; the mortality rate was around 2.4%.2 3 Thus far, children have generally been spared from severe COVID-19; affected children are usually asymptomatic or display mild symptoms.4 5 Nevertheless, COVID-19 has impacted children directly through SARS-CoV-2 infection and indirectly by altering education and healthcare; it has also led to social distancing, school closures, and other socio-economic changes.6 Impacts vary among communities depending on disease burden, viral containment approaches, local healthcare infrastructure, and support resources for children and families.7 Here, we discuss the impacts of COVID-19 on physical and mental health, education, and well-being in children, then examine approaches to alleviate such effects. In 2020, about 60% of children worldwide were affected by lockdowns.23Diminished social contact and stress management can cause loneliness, depression, and anxiety,24leading to unhealthy behaviours that increase the risks of obesity and addiction.25 26 The lack of a daily routine affects sleep patterns, potentially influencing general health, mood, behaviour, and cognitive function.27 In early 2020, a cross-sectional study of children in China revealed that 40.4% were susceptible to psychological problems; 14.4% had symptoms of post-traumatic stress disorder.28 A large-scale survey of parents in the UK revealed that after 1 month of lockdown, many of their children displayed increased restlessness, along with greater emotional, behavioural, and attention difficulties; however, children with special educational needs exhibited fewer emotional difficulties.29 The combination of a public health crisis, social isolation, economic recession, and limited mental health support can exacerbate existing mental health problems and create new problems. Excess screen time and prolonged remote learning may lead to health problems.37 38 Extensive use of electronic devices, internet, and social media can increase the risks of cyberbullying, predator encounters, and harmful content exposure.37 39Young children require physical interactions with classmates and teachers to support cognitive and social development.40 In special needs schools, in-person learning