As nurse practitioners, learning to communicate with pediatrics patients determines success in patient care. When children are communicated with in a way they are able to understand, they are more cooperative with treatments and less anxious about procedures, often to the astonishment of parents. As a pediatric nurse practitioner, parents often would ask for advice about how to talk with their children about stressful life events such as divorce, military deployment of a parent, or a change of schools, to name a few. In these situations, parents would require education and support while they navigated through these stressful events with their children. Parents are now in the midst of the COVID-19 pandemic that impacts every aspect of family functioning and life.

Children account for 8.8% of all COVID-19 cases in the U.S., have milder symptoms, and a lower mortality rate as compared to adults, according to the CDC. However, the psychosocial impacts of the disease from the death of a loved one, extended separation from parents due to quarantine or hospitalization, and the impact of mitigation efforts such as school/daycare closure, parental job loss, and social isolation can lead to long-lasting psychological effects on children. Studies have indicated that prolonged separation from parents, isolation, and quarantine can lead to a post-traumatic stress disorder, anxiety, and depression in children well after the period of isolation and quarantine have ended. However, studies have indicated that the impact of natural disasters, terminal illness, and national emergencies on children can be mitigated when they are given accurate, honest information communicated in a way that they can understand. Nurse practitioners can learn from these events and apply communication strategies used in the above situations to the pandemic. Therefore, what can nurse practitioners do to support parents as they try to communicate with their children about the COVID-19 virus?

Nurse practitioners can encourage parents to talk to their children about the difficulties that arise from the COVID-19 and its impact. Parents may think they are protecting their children by not talking to them about the disease, but research shows that even children as young as two years of age are aware of the changes around them. It is important that adults communicate in simple terms, taking into account the child’s age and level of understanding. As children’s understanding of the world changes as they develop, it is essential for adults to understand children’s comprehension of illness and causality. Very young children do not have an understanding of cause and effect and believe that thoughts, wishes, or unrelated actions can cause external events. As a result, children may blame themselves or perceive that the illness is punishment for bad behavior. Therefore, listening to what children believe about COVID-19 transmission is essential; providing children with an accurate explanation that is meaningful to them will ensure that they do not feel unnecessarily frightened or guilty. It is essential that communication guidelines are developed to aid in communication about the disease. The American Academy of Pediatrics recommends the development of and the distribution of developmentally appropriate guidelines and materials to help parents communicate clearly and honestly about COVID-19 with their child. Currently, the Centers for Disease Control and Prevention (2019), Unicef (2020), and the World Health Organization (2020) all have online resources available to parents to assist them with communicating with their child about COVID-19. In addition, an interactive multilingual book called #COVIBOOK has been developed to explain COVID-19 to children. Nurse practitioners can ensure that parents have these resources available and provide time during office or telemedicine visits to answer questions or concerns about the disease.

Nurse practitioners can implement palliative care communication principles to assist parents in communicating with their children about the disease. Weaver and Wiener (2020) have suggested that principles of palliative care communication principles could be applied to assist parents with communicating with children about some of the difficult situations that can arise from COVID-19 such as the death of a grandparent or a child’s isolation from family due to quarantine. Palliative care principles of communication are grounded in honesty and trust, self-compassion, safety, sensitivity and intuition, connection, preparedness, community building, death as part of life cycles, and legacy. In this model, children are given accurate information delivered in a way that is sensitive to the maturity, developmental level of the child, family environment, and the influence of external factors such as social media. The palliative care model of communication is child-centered, supportive of the changes the child is experiencing, and responsive to the child’s needs. Principles of palliative care communication have been effective in providing comfort to parents and children in dealing with terminal illness. Applying these principles of communication to children impacted by COVID-19 may mitigate its effects. However, more research is needed to provide evidence that palliative care principles of communication are effective in providing comfort to children and families impacted by the COVID-19 virus.

Nurse practitioners provide time spent educating parents about communication strategies about COVID-19. Telemedicine visits can be a means by which nurse practitioners can provide education and support to parents. However, nurse practitioner telemedicine services are not consistently reimbursed by private insurance or Medicaid Payment redesigns are needed to ensure nurse practitioners are reimbursed for telemedicine visits related to talking to parents about COVID-19 related communication strategies for their children.

There are currently 74 million children in the U.S. being impacted by COVID-19. Knowing that the impacts of the virus can have long-term psychological sequelae on children’s well-being, nurse practitioners need to be provided the tools necessary to support parents through the pandemic. Communicating with children about COVID-19 needs to be a priority and resources, research, and money are needed to support this endeavor.

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