MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. – During the COVID-19 pandemic, there may be many emotions and new experiences for your family and your child. Depending on your child’s age, he or she may experience this situation differently. We want you to be fully prepared to support your child’s social-emotional and behavioral needs throughout this time.  Here are some general tips that will help you navigate the rapid changes over the next few weeks. Understanding how school closures, social distancing and changes in daily routines may affect your child is an important step in maintaining a healthy emotional response.Babies and toddlers (ages 0-2) experience stress through their parents’ experiences. If mom or dad is feeling more anxious, more tired or more irritable than normal, it is likely that baby is feeling this too and may respond by being extra clingy or needing a little more reassuring touch.  Try calming activities such as bath time, singing, baby massage or social games (tickling, peek-a-boo). Playing interactively with your toddler will help him or her connect with you and hopefully serve as a welcome distraction from any external stressors.Preschoolers and younger elementary-aged children (3-8) are also likely to build off the stress of their parents or caregivers. In addition, preschoolers may begin to demonstrate both rational and irrational fears. Younger children are especially vulnerable to changes in daily routine – aiming to normalize your child’s daily experiences is important in supporting healthy coping during times of stress.School-aged children (8-17) are likely to have a broader understanding of some of the societal risks occurring right now. It would not be uncommon for your school aged child to be fearful of catching “coronavirus” or being fearful to go out in public. It would also be normal for your child to be unaware of the current risks and therefore have persistent interest in exploring fun group activities while out of school. Older children and teens may be absorbing various “facts” from friends, teachers, news and social media. Teenagers may have a cavalier attitude of “I won’t get sick” or “this only affects old people.” Providing facts and clarifying myths will go a long way in both keeping your children emotionally grounded, and keeping them safe from unnecessary exposures. Social distancing may be especially challenging for teenagers, who thrive on the social experience. This may be a good time to explore together which avenues of social media or texting/video-calls may be appropriate for your child to stay connected with his or her peers.  Consider allowing your older teen to provide childcare for a single family who is affected by school closures. Some families will not be able to adjust work schedules to stay home and care for younger children – this may be an opportunity for older and more responsible teens to earn money for college while helping out another military family.If your child begins to display challenging behaviors such as increased irritability or agitation, increased defiance or increased aggression, try to focus on the basics first. You may notice a change in their sleep, increased fears or emotional distress.Children with Special Health Care Needs:  Children with ADHD, autism spectrum disorders, anxiety or other neurodevelopmental diagnoses may be at higher risk for challenging behaviors during prolonged school closures and social distancing. If your child is experiencing this, aim to find ways to stabilize his or her daily routines as best as possible. Children who typically receive special education supports may need additional assistance adjusting to school closures. Generally, it is not recommended to make major medication changes during major psychosocial changes, as environmental pressures are usually the cause of the behavior change. If there are severe concerns, please call your child’s doctor for individualized advice.All children thrive with routine. Whether your child is healthy and well-adjusted, or whether your child has special healthcare needs, dramatic changes in his or her daily routine are likely to result in some level of emotional distress. During school closures, it is recommended that you provide your children with as much of an individualized routine as possible. Daily routines, planned mealtimes, clear expectations and behavior boundaries, help children feel safe and secure.  Many school districts are offering online or home learning options. Many online educational resources are providing free access during this global health crisis. Consider building a daily educational routine for your child to keep them engaged in healthy activities while school is out. While the weather is nice, take advantage of the opportunity to engage with your child in physical activity and spend time outside. Older children may enjoy playing catch or basketball. Outdoor time can help relieve extra energy your child may be feeling while stuck home and away from his or her typical friends and normal daily activities.Recommendations:-      Take this opportunity to reinforce general hygiene and teach your child about proper hand washing (soap, warm water and 20 seconds or more of scrubbing). Remind your children not to share food, drink, sports equipment and make-up.-      Follow responsible social distancing recommendations per the Centers for Disease Control and Prevention (CDC).-      Talk to your children about what is happening. Provide them reassurance through facts, calm discussions and opportunities for them to ask questions.-      Continue regular sleep routines and regular bedtimes (adjust as necessary, but stick to a regular schedule and aim for 10-11 hours of sleep per night for most kids).-      Limit total screen time (TV, electronics, phones, tablets, gaming) to less than 2 hours per day. The only exception to the 2-hour limit is for educational activities connected to your child’s home curriculum.-      Maintain regular schedules for meals and snacks – aim for proper nutrition.-      Maintain regular schedules for medications (if your child takes medications).-      Go outside at least once per day. Play interactively outside.-      For school-aged children, create and stick to an educational routine based on the requirements from your child’s district.-      Give your child age appropriate household duties. This will help you keep the house in line while they are unexpectedly home, and contribute to the sense of routine and responsibility.-      Don’t forget self-care! Take care of yourself so that you can be at your best to care for your children. Stay organized so that you can feel successful and calm.-      Reach out to your military family and ask for help if you need it.You and your child are important to us during this challenging time. While school closures and social distancing may be unexpected or difficult, aim to make the most of it. Spend any time you can bonding with your child and supporting his or her academic growth.  Remember that escalation of typical childhood behaviors is normal and common during periods of stress or when children are out of their regular routine.If you feel your child is responding in a way that is worrisome, please seek assistance by contacting your local primary medical home or at this American Academy of Pediatrics site:  https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/2019-Novel-Coronavirus.aspxMadigan’s Social Media Links:Madigan’s Facebook:www.Facebook.com/MadiganhealthMadigan’s Twitter:www.Twitter.com/MadiganhealthMadigan’s Instagram:www.Instagram.com/MadiganmedicineMadigan’s 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