Children suffer anxiety while in isolation during COVID-19 pandemic

Hospital isolation for COVID-19 caused heightened anxiety in families, particularly children, during the early phase of the pandemic, according to a Singapore study.

The most common stressors were separation from other family members, prolonged hospitalization, and discomfort from frequent nasopharyngeal swabs.

“Therefore, home-based recovery from COVID-19 and psychological support for children and their families, with focus on early recognition of anxiety disorders, are recommended,” the researchers said.

Of the fifteen family units that had been hospitalized between March 2020 and May 2020, 13 (73 percent) were recruited to this study. The median age of the children was 57 months, and the median length of hospital stay was 21 days. [Singapore Med J 2025;66:327-332]

Each child underwent a median number of eight COVID-19 polymerase chain reaction swabs. All paediatric COVID-19 patients had asymptomatic or mild disease.

Forty percent of adults and 80 percent of children met the criteria for anxiety disorder, while 60 percent and 100 percent, respectively, met the criteria for separation anxiety. One child also met the criteria indicative of depression.

Several factors such as uncertainty, separation, prolonged hospitalization, and frequent swabs caused anxiety among hospitalized patients.

“We recommend that a psychosocial review be offered to all families in isolation and frequent review of isolation policies be conducted as the information on transmission and severity of infection evolves,” the researchers said. 

“With home isolation, beyond the benefits of appropriate siting of care and healthcare resource utilization, children are also spared the negative effects of hospitalization,” they added.

Time-based discharge

In Singapore, the national policy was revised after 29 May 2020 to allow the shift from a test-based to a time-based discharge of patients who were well after day 21 of illness regardless of the nasopharyngeal swab results in asymptomatic patients. [https://www.moh.gov.sg/covid-19/general/faqs---border-measures-and-changes-to-stay-home-notice-requirements/faqs---leave-of-absence-(loa)-stay-home-notice-(shn)-and-quarantine-order-(qo)]

By 6 October 2021, the policy was again revised to permit home isolation of children aged >1 year who were well, along with adults, through the Home Recovery Programme (HRP). [https://www.moh.gov.sg/covid-19/general/faqs---border-measures-and-changes-to-stay-home-notice-requirements/faqs---leave-of-absence-(loa)-stay-home-notice-(shn)-and-quarantine-order-(qo)]

"We postulate that the HRP is a step in the right direction,” the researchers said. “Having certain and shortened isolation durations, fewer nasopharyngeal swabs, and being in the comfort of their own homes with family, will likely reduce anxiety in parents and children.”

New normal

More and more studies are recognizing the psychosocial impact of the pandemic on children, and thus several resources are being dedicated to supporting this vulnerable population not just in Singapore but across the globe. [J Policy Pract Intellect Disabil 2020;17:256-269; Int J Environ Res Public Health 2021;18:4348; J Pediatr Rehabil Med 2020;13:349-354]

"This is timely as increasing literature has emerged showing that the ongoing pandemic and restrictions have led to deterioration of both parent and child mental health,” the researchers said. [Fam Process 2020;59:1060-1079; Pediatrics 2020;46:e2020007294] 

“Assessing changes in their perspective through the course of the pandemic may reveal fatigue, frustration, and perhaps eventual acceptance of the ‘new normal’,” they added. 

The current study employed a prospective mixed-methods design and assessed the psychological status of hospitalized family units with one or more children aged <18 years who had SARS-CoV-2 infection. Medical records were reviewed for demographic and clinical information.

Both parents and children aged 7 years and above were interviewed by a psychologist via telephone. The researchers then assessed anxiety and depression using self-reported, age-appropriate instruments, Short Mood and Feelings Questionnaire, and Screen for Adult/Child Anxiety-Related Disorders. Patients also underwent a qualitative interview.