• Dr. Ryan Hassan MD MPH

Coping with COVID

Essential activities to keep your children healthy


As the COVID-19 pandemic has spread over the last several weeks, I have had many telemedicine visits with patients who have found themselves struggling to cope with the boredom and monotony that has come with Oregon's shelter in place order. Many children, especially teenagers, have found their daily routines becoming disorganized and random, which has led to skipping meals, disrupted sleep schedules, several hours of screen time per day, and little to no time spent outdoors, getting physically active, learning, or just hanging out with family members. When we neglect these essential components of growth and wellness, we put our children at risk of apathy, irritability, and multiple mental and physical illnesses. This is especially true for children with underlying medical conditions to begin with, such as ADHD, ODD, Depression, Anxiety, PTSD, or any history of trauma. But parents can be proactive to mitigate these risk factors and promote their children's wellness, and have fun at the same time, by creating and sticking to a consistent daily routine.


Make a schedule

This doesn't have to be typed out, and it doesn't have to breakdown each part of the day by the hour, but it does need to include relatively consistent times for the following essential activities that every child should engage in daily: sleep, adequate and appropriate meals, physical activity, time outdoors, family time, and unstructured free time. As you are creating a schedule that works for your family, it is important to let your child make shared decisions about what they'd like their daily routine to be like, so that it meets their needs, and so they are more likely to stick to it. Also, remember that routines are most effective when the entire family is on the same or similar schedules.


Sleep

The most basic and often overlooked part of a healthy routine is having a consistent bed time each night. Adolescents in particular naturally stay up later when they can, as their circadian rhythm is shifted so that they get tired later than they did when they were younger. It is normal and appropriate for adolescents to stay up until 10 or 11 at night, if they can get at least 8, but ideally 10, hours of sleep each night. However, when teens are allowed to lie in bed with their phones, they tend to stay up significantly later than that, and then sleep in later the following day. The next night they stay up later than the night before, and within a week some children can be sleeping through the day and awake all night. This means fewer meals with the family, less time outside, less time being physically active, and more sedentary screen time. When it comes time for school to resume, children with these reversed sleep schedules will struggle to reset their circadian rhythm, and will be late for school, or miss it completely, and be sleep deprived. This puts them at increased risk for depression, anxiety, obesity, and school failure. Children who are sleep deprived also have higher risk for contracting infectious diseases. I have seen this pattern play out in various degrees of severity in dozens of my patients, and it is becoming a much bigger problem in the wake of the COVID outbreak.


Fortunately, this is an easily avoidable problem. Protect your child's health and success in school by protecting their sleep. Set a reasonable bed time. Make sure electronics are off at least one to two hours before bed time. Make your child's bedroom a sanctuary for sleep by keeping it dark and quiet at night, and free of electronics if possible. Children should minimize time spent in their room except when sleeping, and avoid doing any activities other than sleeping while in bed. This helps build associations in your child's brain that trigger a sleep response when your child is in their room, in their bed, at bed time.


Nutrition


Consistent meal times are also essential for healthy child development. Try to have meals scheduled for the same time each day, to ensure that your children aren't missing meals. It is also important to have rules about snacks. Many children get poor nutrition because of indiscriminate snacking, particularly on processed junk foods, which leads to less consumption of healthy foods like fruits, vegetables, and whole grains, and predisposes to excessive weight gain. This becomes a more common problem when children have lots of time on their hands with nothing to do. Healthy eating means eating because you're hungry, not because you're bored.


If you are able to, it is also helpful to have meals as a family whenever possible. Meals together are a great opportunity to build your relationship with your child. The key concepts I always emphasize to my patients about feeding children are that parents have complete control over what foods their children have access to, and what times meals and snacks are; whereas children should have complete control over how much of which foods they want to eat at those meal times.


Lastly, try to make meals a screen-free time. Children should be focused on their food and conversation with loved ones while eating. Dinner and a movie can be lots of fun, and great way to spend an evening, but for most meals, screens should be off.


Physical Activity and Time Outside

Staying inside most of the time doesn't have to mean staying sedentary. It is still okay, and a good idea, to get out and go for walks, runs, or bike rides locally, as long as you are able to maintain separation from other people. Time being active outside is essential for both physical and mental wellness. Exposure to fresh air and direct sunlight in particular can help mitigate or prevent mood problems, and relieve stress.


There are plenty of ways to stay active in or around your home as well. If you have a basketball hoop in your driveway, use it. If you have a backyard, spend time in it. If you have pets, play actively and frequently with them. Have a dance party with your child. Play games that incorporate a simple exercise; for example, a game of poker where you bet push ups, or monopoly using jumping jacks as currency in conjunction with the game money. If you have the space for it, play a game of tag or hide and seek. These are just a few examples, but there are dozens more ways to have active fun inside that you can find online, or come up with yourself with a little creativity.


Family Time


Every child needs time with the people who love them most. That means as a parent it is important to schedule some time to spend with your child each day, if possible. Doing some of the activities above as a family is a great way to do that, but for those parents who are still having to work through the day and may not have the energy to be as physically or mentally active at the end of the day, it can still be helpful to just schedule some time to sit with your child and talk, tell stories, or joke. Talking about how everyone's day went is a simple, but effective way to build family connectedness.


Drawing or coloring together with your child is another easy way to spend time together, and even older adolescents who don't care for drawing can often find calm and enjoyment from working on an adult coloring book together.


For the musically inclined, have a family jam session. It's easy to have a good time playing the pots and pans with a parent on vocals. You could also have a YouTube Karaoke night, which is a personal favorite past time of mine.


I love board games, and these days there are so many good ones for the whole family. If you're a board game geek like me, try Pandemic, where you work as a team to defeat infectious diseases (particularly timely for the moment). I also like the relatively new game Everdell, and the classic favorite, Scrabble. If you want a simpler game, try Bananagrams, Ticket to Ride, or Sushi Go! One of my favorite simple games is Throw Throw Burrito, which I'd describe as a combination of the card game spoons and dodgeball. It's easy to learn, and also a great way to stay active inside. This is also a great time to sharpen your and your child's chess skills, if you're an enthusiast like me. There's also dozens of fun games you can play with just a regular deck of cards. Whatever you do, do it together!


Free Time

It is also important to include some unstructured free time in the day, where children can do what they want to do. Have them decide ahead of time what would be the most fun thing for them to do that is safe and appropriate during the pandemic, and then let them do it. Most children will not say that they want to spend several hours each day scrolling through social media on their phone, but often times that's what they (and we) end up doing if given the opportunity. By having them verbalize ahead of time how much time they'd like to spend doing specific activities, you allow them to recognize that they'd rather spend some time on more constructive activities, and make it easier for them to follow through. Children will inevitably spend more time on screens during the pandemic than they normally would, but it is still important to agree on some appropriate restrictions on how much screen time each day is appropriate. See if you can find some new books that your child is interested in reading. My philosophy is that the only people who don't like reading are those who haven't found the right book yet.


If you find you are unable to follow through with any of the recommendations above, that's okay! This guidance won't work for every family. The most important thing to do is to be mindful of the ways in which you can help support your family's physical and mental wellness, as well as your own.

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