兒童與青少年在COVID-19期間的心理健康

兒童與青少年在COVID-19期間的心理健康

依兒童及青少年發展階段與家長分享之實務指南

在評估心理健康及福利時，應考慮其發展階段、功能或行為表現、與疫情相關的難題與嚴重程度，以及個人、家庭、社區可提供支持力量及防護因素。
兒童或青少年不一定立即會表現出明顯的壓力症狀，甚至完全不會表現出來。
基層診所之醫師的責任包含檢查、拓展、辨識、轉診、持續監測、支持，以及與專科醫師協調。
鼓勵所有個案保持堅強，並非只關注出現心理健康問題的病人。

階段	建議的介入措施和指導
嬰幼兒 (0-3歲)	協助照顧者認識對於嬰幼兒保持冷靜、耐心、安撫的支持與活動盡量維持正常作息保護幼兒免受媒體報導影響在可能情況下，製造照顧者全心全意陪伴嬰幼兒的時光
學齡前兒童 (3-5歲)	確保兒童與家人的安全，以及預防染疫之措施（例如勤洗手、避免出門、佩戴口罩、接種疫苗）用兒童可以理解的方式回答他們的問題，並觀察他們表情以確定孩子能夠理解確認並認可兒童的感受盡可能嘗試維持正常作息限制兒童接觸電視/媒體；幼童可能無法理解他們看到的圖像並可能因此受驚嚇確保兒童知道家長的去向及日常安排創造讓孩子能夠玩耍及放鬆的機會；以互動式戲劇參與孩子遊戲若兒童堅持己見，請提供正向的扮演遊戲(讓兒童透過戲劇中學習處理問題)協助兒童解決問題
學齡兒童 (6-12歲)	直接且誠實地回答孩子疑問；讓孩子知道你願意進一步討論提供開放、適合孩子年紀且安心的資訊給孩子對於問題保持開放態度：「你能多告訴我一點嗎？」確認並認可孩子的感受：「沒錯，這的確令人害怕，所以我們會這麼做以保持健康⋯⋯」詢問孩子意見盡可能嘗試維持正常作息著重於正面行為，而非負面行為盡量降低觀看電視時間：若孩子看見新聞報導，陪伴在一旁並釐清他們看見或聽見的內容鼓勵參與或幫忙家庭事務若兒童堅持己見，請提供正向的扮演遊戲(讓兒童透過戲劇中學習處理問題)協助兒童解決問題
青少年 (13-17歲)	尊重青少年的感受討論青少年的想法、感受、不同的應對方式討論COVID-19的原因及影響傾聽並討論青少年在社群媒體上或於朋友間聽見的內容陪伴他們看電視，共同討論並提供你的觀點時常注意孩子狀況清楚並直接地說明可能有風險的行為分享並討論COVID-19衝擊下會遇到的情形（例如線上畢業典禮、畢業舞會取消等）讓孩子知道他的經歷與其他人沒有不同：「你不孤單，大家都面對一樣的狀況。」鼓勵青少年與朋友聯繫，若狀況許可最好能實體互動；或是透過電話遠端聯絡；並採取的安全措施（例如於戶外見面、佩戴口罩、避免肢體接觸等）分享你自己的感受及應對措施，成為孩子的學習榜樣青少年可能會想幫忙。協助他們參與社區或其他合適計畫。

Mental health and wellbeing of children and adolescents during the covid-19 pandemic

What you need to know

When assessing mental health and wellbeing, consider developmental stage, functional or behavioural manifestations, proximity to and severity of pandemic related hardships, and individual, family, and community strengths, supports, and protective factors
A child or adolescent may show no observable or reported symptoms of distress, or may show them at some later time
Primary care physicians’ roles include screening, outreach, identification, referral, ongoing monitoring or surveillance, support, and coordination with specialist clinicians
Encourage resilience in all patients, not just those presenting with mental health and wellbeing concerns

Practical guidance to share with parents and caregivers by developmental stage

Stage	Suggested interventions and guidance
Infants and toddlers (0-3 years)	Identify supports and activities that help adult caregivers remain calm, patient, and reassuring with infants and toddlers Attempt, whenever possible, to preserve normal routines Shield toddlers from media coverage “Special time” with parent/caregiver when possible
Preschool children (3-5 years)	Provide reassurance about the child’s and family’s safety and what is being done to prevent future infection (eg, handwashing, staying home, mask wearing, vaccination) Answer questions simply and watch the child’s face to know when the child has heard enough Label and validate the child’s feelings Attempt to preserve, as much as possible, normal routines Limit television/media exposure; young children do not understand the images they see and may be frightened by them Ensure that the child knows parents’ and family members’ whereabouts and schedules Develop opportunities for the child to play and relax; engage with the child in interactive play Offer suggestions for positive resolution of play scenarios if children repeatedly persevere with one scenario (children work through issues through play)
School aged children (6-12 years)	Answer child’s questions directly and honestly; let child know you are available to talk further Provide information in an open, age-appropriate, reassuring manner Be open to questions: “Tell me more about that” Label and validate feelings: “Yes, it is scary, and this is what we are doing to do to stay healthy” Ask their opinions Keep usual routines where possible Focus on positive behaviour, rather than negative behaviour Minimise television viewing; if they do hear news reports, be present and clarify what they see or hear Encourage participation in family or other efforts to help as appropriate Offer suggestions for positive resolution of play scenarios if children repeatedly persevere with one scenario (children work through issues through play)
School aged children (6-12 years)	Answer child’s questions directly and honestly; let child know you are available to talk further Provide information in an open, age-appropriate, reassuring manner Be open to questions: “Tell me more about that” Label and validate feelings: “Yes, it is scary, and this is what we are doing to do to stay healthy” Ask their opinions Keep usual routines where possible Focus on positive behaviour, rather than negative behaviour Minimise television viewing; if they do hear news reports, be present and clarify what they see or hear Encourage participation in family or other efforts to help as appropriate Offer suggestions for positive resolution of play scenarios if children repeatedly persevere with one scenario (children work through issues through play)
Adolescents (13-17 years)	Show respect for the adolescent’s feelings Discuss the adolescent’s opinions, feelings, and different ways to cope Discuss causes and effects of the covid-19 pandemic Listen to and talk about what adolescents see on social media and hear from their friends Be present if they watch television; discuss and provide perspective Check in regularly Address risk taking behaviours clearly and directly Share and talk about reactions to covid-19 related disruptions (eg, virtual graduation, cancellation of prom, etc) Normalise experiences: “You’re not alone; everyone is struggling” Encourage adolescent to connect with their friends—in person if restrictions are lifted; or virtually, by phone, or taking the advised safety precautions (eg, outdoors, masks, no physical contact, etc) Share your own feelings and coping mechanisms (be a role model) Adolescents may want to participate in efforts to help. Help them to engage in community or other projects as appropriate

參考文獻：

Rider EA, Ansari E, Varrin PH, Sparrow J. Mental health and wellbeing of children and adolescents during the covid-19 pandemic. BMJ. 2021 Aug 24;374:n1730. doi: 10.1136/bmj.n1730. PMID: 34429302.

兒童與青少年在COVID-19期間的心理健康

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