Families

Mother and children using a handheld device
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How to talk with children about COVID-19

Children may differ in how much they’ve heard about COVID-19 and how they think it may affect themselves or their family. They will also notice how much the situation is affecting their parents, even if they don’t worry about COVID-19 specifically. They may be feeling worried or distressed, which might manifest in them acting younger than their age or developing new behavioral issues. You may notice more clinginess, whining, nightmares, nail biting, or aggression, for example.

Parents can help by acknowledging their children’s emotions and providing comforting, supportive, and age-appropriate information. Support for parents’ own emotional needs is also key to helping children during these difficult times. Just like flight attendants tell parents to put on their own oxygen masks before putting on their child’s when there is an emergency, it is important for parents to care for themselves so they can be there for their children. Have conversations about uncertainty and fears privately between adults.

Here are some helpful articles on how to talk with children about COVID-19 and developmentally appropriate ideas for how to keep them feeling good during these unpredictable times:

Information in Arabic

Information in Mam

Information in Spanish


Helping children cope

What do we do now with shelter-in-place?

It is usually hard for children to be out of school and without a predictable routine. A general daily structure with school- and play-based activities so your child knows what to expect can be helpful. Flexibility is also important – parents may not be able to maintain this schedule every day and that’s okay. You are just trying to do the best they can right now! In general, we encourage parents to give themselves grace during this difficult time.

One of the best ways to reduce children’s fear is to provide as much routine as possible, to minimize their exposure to media news about the virus, and to carve out time to connect and bond with them. This, in addition to managing your own stress and caring for yourself, will provide a supportive environment that will help bring them calm. It’s so easy to keep our phones out and our TV on, waiting for the newest news. But putting our phones away enables you to slow down, connect through play or conversation, and give children the extra attention they crave right now.

If you are looking for activities for the whole family during the shelter in place, view our local resource document.

Essential tips from our faculty

  1. Routine, routine, routine. COVID-19 may have caused school and child-care closures and other disruptions. Creating a new routine at home can be reassuring and help children know what to expect in the midst of a lot of uncertainty.
  2. Validate feelings. Some children (and adults) may have big feelings about COVID-19. Take time to talk to children about their feelings, and acknowledge the feelings that you are hearing.
  3. Sometimes “I don’t know” is okay. Be honest and open with children, rather than avoiding their questions. And sometimes that may mean saying “I don’t know.”
  4. Limit exposure to media. Exposure to TV or social media updates on COVID-19 may increase stress and anxiety, especially if the information is not meant for children.
  5. Don’t forget about exercise. Regular exercise can help lower stress and anxiety. Consider outdoor exercise (at a safe distance) or at home workouts.
  6. Help others. Letting children know that activities like 20-second handwashing or coughing into a tissue helps prevent germs from spreading and is a way to help others during this difficult time.
  7. “Social distancing” does not mean social isolation. That’s why we call it physical distancing. It’s important to find ways to check in with friends and family regularly, whether that means calling or video-chatting. Seeing faces is better than just talking on the phone.
  8. Put on your own oxygen mask first. Be sure to take care of yourself so that you can continue taking care of others. Children are watching how caregivers respond, so modeling self-care, especially in tough times, is important. Emotions are contagious.
     

Meals and other resources

  • Contact your local school district to find out information about what resources for meeting essential needs are available near you. For example, in San Francisco, there are emergency resources (including child care) for children, youth, and families during SFUSD's school closures.
  • Also in San Francisco, families can get free breakfast, lunch, and dinner during school closures.
     

Resources to help young children manage fear

  • “Once I Was Very Very Scared” is Chandra Ghosh Ippen's book for parents to support children with feelings of fear. (You can also access other languages from this page.)
    • There is also an accompanying free webinar for children called "When We Are Scared" available in English and Spanish.
       

Resources for adolescents of color

  • The AAKOMA Project offers outreach for depression, anxiety, mental health issues in adolescents.
     

Full resource sheets from other organizations

Helping families cope

Identifying “fake news” and COVID-19 resources for kids

Coping with grief

Resources for children with special needs

Bay Area school closures mean a loss of resources for children with special needs. Many resources can be found through Support For Families. Their phone number at (415) 282-7494. You can also email them at info@supportforfamilies.org and referral@supportforfamilies.org.

Student and families of deaf and hard of hearing programs

Learners using augmented alternative communication (AAC) devices

Resources for students with speech and language needs

Resources for learners with autism spectrum disorder (ASD)

Early intervention: Ages birth to three years

Early Childhood Preschool: Ages 2.5 years through 5 years old

Social emotional learning (SEL) links for exceptional learners

Food insecurity 

  • Save the Children
  • Free breakfasts and lunches in San Francisco and Oakland
  • Expensify is going to temporarily redirect all of its charitable funds to expensify.org/hunger. With its ability to reimburse people directly in real-time, Expensify.org is uniquely positioned to help families in need immediately. Previously, this fund was focused on paying off kids' "lunch debts," but with schools closed around the nation, that isn't the top priority right now. Instead, everything is devoted to a new program: matching SNAP grocery purchases up to $50 per family. Step-by-step instructions are available on the Expensify website.
     

Living well: Family harmony while under "shelter in place" at home

If you spend a few minutes on many social media feeds, you might feel that you’re supposed to be excited about these “shelter in place” quarantine days and that you should be doing picture-perfect family activities, baking, organizing, playing games, dusting off puzzles, smiles all around. Limit your social media if it’s not helpful! Then remind yourself that, as always, social media provides only manufactured glimpses into others’ lives and not the whole story. At the same time, be open to any positives you can find. There will be ups and downs (as you already know), but you may be surprised at some benefits of all this togetherness.

Staying home will magnify family dynamics. Children will more easily become dysregulated or anxious. This can be especially challenging when you’re living with a teen or young adult who is struggling with depression, anxiety, ADHD, or emotion regulation issues (see our special section on this). Here are a few ideas that may help you and your family get through some long days of togetherness under one roof as you engage in physical distancing from much of the rest of the world.

General tips for maintaining emotional well-being in the home

This is a time to draw on your wisdom and experience about your own emotional needs, your child’s needs, and about parenting. You know the early signs when things are not going well. Think about what has worked before and trust your own expertise and resilience. None of us have ever dealt with a pandemic before, but you have dealt with your child’s moods and periodic outbursts. You’ve already had long weekends, bad weather days, and periods of illness when you’ve spent lots of time together. What did you enjoy? What did you do to cope when things were difficult? What worked? What didn’t?

Use your own past experience and rituals. You know your family and yourself best. What family, regional or cultural traditions did you find helpful at times of tremendous worry, stress or pain? Think of one or two difficult times when you were a young child, student, or younger adult, and spend a moment trying to remember what you and those around you did that was helpful. How can you recreate or adapt it for today?

Empathize with your kids. This is hard for them, too. They miss their friends, teachers, routines, sports, and all the other elements of normal life—just like you do!

Carve out quiet for yourself. If there is more than one adult in the house, agree to give each other regular time off for walks, showers, and chill time. Even ten minutes of sanctioned time for yourself can help your mood. If you’re on your own, give yourself permission to let your child have more screen time, or sleep later, if that buys you a little time for yourself.

Make a schedule but be flexible. With school out or online only and group activities cancelled, it is tempting to let everyone sleep in and stay in pajamas. But this can produce escalating distress and restlessness as the day goes on. Enlist your kids in making a simple schedule for the day, which ideally includes some heads-down time working on schoolwork or other projects, some household projects, some attempts at fresh air, and some entertainment. Collaborate on the schedule with everyone at home, so that the kids have buy-in, feel listened to, and can share their own ideas. That said, be flexible and know that in these trying times, we can’t always stick to the planned schedule. Cut yourself, your partner, and your kids slack, when things don’t go as planned.

Remember to listen. Do just that. We’re all facing cabin-fever as well as fear of the unknown, disappointment, and frustration. Take time to check in with your kids without giving instructions—be curious about their experience, and empathic. In fact, your empathy and curiosity might de-escalate an argument!

Don’t talk about the news all the time. For everyone’s well-being, try to limit how much you talk about COVID-19, and limit your own exposure to the constant news barrage. You can be informed enough, by checking the news a few times a day, not constantly.

Lighten up on your own agenda. The pressure is off in some ways. You might just have to let some things go to avoid a power struggle. Try to get clear each day on what really matters. It might change each day, which is okay. This is a good time for flexibility, self-compassion, and adding something fun together. Consider making new goals, like to get through this period well enough, to grow psychologically in our distress tolerance and flexibility.

Reframe this time together and add fun activities. Try to notice and share some of the positive parts about being home together—we all feel better when we start noticing the good. Look for lighter entertainment—check out stand-up comedy specials or feel-good movies on Netflix, Hulu, or Amazon Prime Video. Find reasons to laugh together. Share videos, like these happy bears that will bring much needed smiles.

Turn up the compassion. This is such a hard, unprecedented situation! Every one of us will probably feel unhappy, lonely, stressed, or scared at some point (or even many points) during this time. Be kind to yourself and your family.


For families with mental health challenges

Attention deficit hyperactivity disorder

Children with inattention and disruptive behavior often struggle in the areas of home routines, academic work, and relationships with family and peers. There are many resources available for supporting children with ADHD in these areas which may be helpful for families to apply during the current shelter-in-place. Some overarching strategies include:

  1. Setting clear, manageable expectations for what you expect of your child each day regarding school work and home routines (e.g., chores and self-care)
  2. Providing frequent and specific praise for behaviors you’d like to see more of (e.g., independence/on-task behavior, kind words with others, maintaining a safe body)
  3. Establishing rewards or privileges for routines and challenging tasks
  4. Providing multiple opportunities for breaks and physical activity.
     

There are new recommendations for homeschooling their child with ADHD during this time. Children with ADHD respond well when:

  1. Academic tasks are broken down into manageable steps
  2. They are provided with breaks between activities
  3. Material is connected creatively to something they are interested in (e.g., math problems about outer space)
  4. They are provided with scaffolding from parents as needed.
     

Some children may need more support with getting started or staying on task than others. You might try using a timer for both easy and the harder tasks. When possible, provide hands-on opportunities for learning. Reach out to your child’s teacher or school if you are struggling to manage homeschooling your child. We realize that this is a challenging time for many families so it’s important to be mindful that parents and children are adjusting to new routines. It may be helpful to adjust your expectations for what can be accomplished as we all adjust during this transition time.

Autism spectrum disorders

As described above, all children and young adults, neurotypical or not, require support from caregivers during times of stress, coping with the unknown, and changes in routine. Not an easy formula for those of us who already struggle with rigidity! Individuals with autism and other neurodevelopmental challenges may need additional support to understand the news and adapt the changes. There may be additional challenges related to comprehension, communication, insistence on sameness, and likelihood of anxiety and depression.

It is important during this time to follow this site’s general recommendations for families, about how to create safety and routine during these times. In addition, you can also help them understand COVID-19, offer opportunities for expression, prioritize coping and calming, maintain routines when possible, and see this as an opportunity to build new routines, foster connections (from a distance). While therapies are on hold, parents may want to check out the OT Toolbox, which has free tools, activities, and resources for occupational, speech, and physical therapy at home.

Here are resources for more specific ways to do this:

Emotion regulation issues

When family members have heated conflicts and emotion-regulation issues, it is critical to use skills to quickly de-escalate. We are all in a highly stressful situation that requires adaptability and crisis survival skills. Dialectical behavioral therapy (DBT) offers such skills for adults and children. It is particularly for borderline personality features, but it offers helpful skills for everyone.

The current epidemic often makes us both scared and angry, with thoughts such as “It shouldn’t be this way.” These intense emotions can block our ability to accept our current reality and adapt. Radical acceptance may help us. To accept the situation doesn’t mean we approve of it, we don’t. It may help to remind us we cannot change certain situations right now. Allow feelings of sadness and grief, and breathe into them. Life is still worth living even when we are in pain.

Man surfing

Surf the wave! To help us tolerate intense emotions, there are many ways to "surf the wave" of emotion until it passes. Strong emotions and urges have a beginning, middle and end. They don’t last long, and we can do things to help them end even sooner. Think of a surfer on a wave, what tips will you use to surf the wave and get to the calm sooner?

The full DBT program includes core life skills for good emotional intelligence, distress tolerance, communication, and emotion regulation. We focus on 3 crisis skills, summarized by the images below, that can help us tolerate the stress and emotional discomfort of the current situation. An accompanying video leads us through each one.

ACCEPTS: This set of tips lets us distract ourselves from the spiral of negative emotions so we can return to our wise mind. The video describes these steps. The distraction from intensity can be as simple as comparing yourself to those less fortunate, watching a funny video, petting your cat, or changing your body state which changes your mind (like chewing in ice, taking a hot or cold shower, doing push-ups).

ACCEPTS graphic

IMPROVE the moment: Try one of these skills to get a break from intense negative emotion. Imagine relaxing scenes --visualization is powerful. Finding meaning in the situation that is stressing you out can help. Use any prayer you find comforting. Focus all your attention on one small thing in the moment. Focusing on the body, on breathing or other sensations (tasting, smelling, listening), creates some space for strong emotion to dissipate. Progressive muscle relaxation or a body scan can help. Take a mini-vacation in the moment--change up your surroundings by going outside or to a different room. Say encouraging things to yourself like “I’m doing the best I can. This won’t last forever.”

IMPROVE graphic

PLEASE: Keeping mind-body balance by healthy lifestyle, is very helpful in hard times, as we reviewed in the General Coping section above.

PLEASE graphic

Bipolar disorder, serious depression or anxiety, schizophrenia, and related disorders

Try to continue your current mental health care services through telehealth if possible. See the general tips for coping and keeping structure at home. Some additional considerations include:

  1. Medication management
    1. Ask your provider about a 90-day supply of medication instead of 30 days (except for controlled substances).
    2. Contact your provider now to develop a plan if you receive injectable medication and/or regular labs for monitoring. If taking injectables, ask your provider to order a back-up supply of dose equivalent pills in case you can't leave your household.
    3. If you are taking a controlled substance, remind your provider of the exact date a new monthly supply is due.
    4. If you are taking clozapine, ask your provider to write an "as needed for insomnia" prescription of 50-100mg each evening that can serve as a back-up supply if you can't get a blood test on time.
    5. If for any reason you anticipate running out of a medication, start reducing the dose by 10% every day instead of taking the full dose right up until the day you will run out; this will help minimize withdrawal reactions (but probably won’t eliminate them).
  2. Give extra space. People with mental-health disorders may feel overstimulated more easily. With many family members now home together, this can be a challenge. Try to give each other a little extra space when needed. If family members aren’t sure what a loved one needs, it’s important to just ask.
  3. Consistent schedule. Keeping a regular schedule can be challenging for individuals with mental-health disorders, especially without the external structure of school, work, or treatment activities. Try to create a consistent schedule at home, including getting outside for fresh air daily. But don’t be too rigid and allow flexibility if people need more sleep than usual to cope with increased stress levels.
  4. Stay connected socially in whatever way feels good. Self-quarantine and isolation may increase tendencies to withdraw socially. Try to stay connected to the supportive people in your life through texting or Skyping or via the internet, even if you can’t see them in person.
     

If you have a relapse prevention plan in place, use it to keep an eye-out for early warning signs and symptoms. If you don’t have a plan yet, consider creating one and sharing it with loved ones and providers so everyone is on the same page. Here are three resources:


Learning resources and home schooling support

This section lists resources for parents on cultural resources, home schooling for children with special needs, learning issues, autism spectrum, and resources for food insecurity and school lunches.

Cultural resources for learning and coping for families

Museos para visitar estando en casa: Tour virtual y colecciones online.

  1. Pinacoteca di Brera - Milano
  2. Galleria degli Uffizi - Firenze
  3. Musei Vaticani - Roma
  4. Museo Archeologico - Atene
  5. Prado - Madrid
  6. Louvre - Parigi
  7. British Museum - Londra
  8. Metropolitan Museum - New York
  9. Hermitage - San Pietroburgo
  10. National Gallery of Art - Washington
  11. Inicio Biblioteca Digital Mundial
     

Dealing with home schooling and special needs


How to survive while maintaining distance: Activities during the Bay Area shelter in place

Person walking across a log in the forest

What is physical distancing? Current CDC guidelines (as of April 1, 2020) state that you must:

  1. Stay at home unless you must leave for an essential activity (eg. emergency care, purchase essential supplies and food)
  2. All gatherings are strictly prohibited. Avoid any physical contact with individuals outside of your home.
  3. Do not use public transportation unless absolutely necessary.
  4. Maintain a six-foot distance from others, particularly from anyone who is sneezing or coughing.
  5. No handshakes.
  6. Wash hands every time when going from outdoors to indoors.
  7. Wash hands before every meal.

Activities you can still do while physical distancing:

  • Due to the high volume of visitors looking for relief in the various parks in the Bay Area, many locations have made the decision to close in order to help enforce physical distancing policies.
    • If possible, take walks and enjoy nature in your immediate neighborhood.
    • A regularly updated list of Bay Area park closures is available online.
  • In light of cinemas across the country being shut down as part of coronavirus-mitigation measures, some major movie studios are moving the titles that were headed for first-run theatrical releases to streaming services earlier than planned.
  • Additional activities you can do with your family indoors: A comprehensive database to connect you with mental health resources and organized COVID-19 response efforts. Take a look at the "Families With Children and Teens" section for activities for children at home, educational curriculum, and resources to talk to you kids about COVID-19.

     

Staying well during pregnancy

Black and white image of a pregnant women reclining

Even in the best circumstances, pregnancy can be a time of great uncertainty and heightened stress. We want to help support you during these unsettling times as we face COVID-19. Here are some tips:

Check in

Take a mindful moment to check in with yourself. Ask yourself: What emotions am I experiencing? What thoughts are going through my mind? What body sensations are there? How intense is my distress right now? Is my distress making it hard to take care of my basic needs?

For lower levels of distress, proactively participate in the stress-reducing tips below in order to prevent full-blown depression or anxiety. For more severe distress, now might be a good time to seek help.

Take a break

We are facing a relentless onslaught of frightening information. If you find yourself getting caught in a loop of checking the news, Twitter, Facebook, etc., consider the following questions: How does this affect my mood and anxiety? Does it galvanize me to act in helpful ways, or leave me feeling distressed and helpless?

Experiment with taking a break from social media and the news, and see how this affects your mood and behavior. If you’re afraid of missing something important, delegate a friend or family member to notify you of any urgent updates.

Try meditation or a mind-body activity

Research shows that an 8-week mindfulness-based cognitive therapy program is effective for preventing depression during pregnancy and the postpartum period. Although it’s unlikely that you’re able to embark upon an intensive 8-week program now, making time for even a brief daily mindfulness practice may help. The Headspace app is now free for health care providers and the Calm app has a page with free meditations. A loving-kindness meditation may feel particularly needed during these times. Prenatal yoga videos are available for free online.

Get physical activity

Physical activity can be an effective antidepressant. At the same time, pregnancy can leave you feeling sluggish and a full exercise class may feel impossible (especially if you have other young children at home). See if you can carve out even a brief amount of time for exercise (e.g., 10-minute walks outside). Some exercise apps are now making their programs freely available. For example, Peloton is now free for 90 days, has brief work-outs requiring little to no equipment, and has prenatal and postnatal yoga classes. (More links available in the "Maintaining Physical Activity" section.)

Socialize

Social support is particularly important during pregnancy, so do what you can to safely connect with your friends and family (e.g., Facetime, Zoom, Netflix Party app).

Prioritize sleep

High-quality sleep can be elusive when you are pregnant, and even more so during times of high stress. Sleep disturbances can trigger and worsen depression, stress, and anxiety. But, take heart – research shows that cognitive behavior therapy for insomnia (CBT-I) improves insomnia, depression, and anxiety in pregnant women. Insomnia is defined as difficulty falling or staying asleep, or waking earlier than intended three days per week or more and experiencing significant distress or impairment. If you are experiencing symptoms of insomnia, check out these resources:

  • UCSF is now offering a digital CBT-I intervention, Sleepio, to all employees.
  • Jennifer Felder, PhD, at the UCSF Neuro/Psych Sleep Clinic specializes in treating insomnia during pregnancy and is offering telehealth visits. Call (415) 353-2273 for more information.
  • Rachel Manber, PhD, at the Stanford Sleep Health and Insomnia Program also specializes in treating insomnia during pregnancy. Call (650) 498-9111, option 2, for more information.
  • Good self-help books include "Say Good Night to Insomnia" by Gregg Jacobs and Herbert Benson, and "Quiet Your Mind and Get to Sleep" by Colleen E. Carney and Rachel Manber.
  • Additional resources are available in the "Maintaining Good Sleep" section.
     

If you are experiencing disturbed sleep that doesn’t meet the threshold for insomnia, double-down on implementing good sleep hygiene. If worries are keeping you up at night, try a constructive worry practice.

Keep a schedule

Maintaining a regular schedule (including consistent bedtimes and wake times) that includes activities that feel nourishing, pleasant, or that bring even a small sense of accomplishment can be an antidepressant.

Seek help

If you are experiencing a high level of distress or you are finding it hard to take care of your basic needs, please know that you are not alone and help is available.

Consult reputable sources

It probably goes without saying, but contact your prenatal care provider with any questions or concerns you have about COVID-19. The Royal College of Obstetricians and Gynecologists created an overview that is helpful and easy to understand. If you want to do a deep dive on the emerging literature, a UCLA maternal-fetal-medicine doctor Christina Han, MD, has created a Dropbox folder with the latest updates on the effect of COVID-19 during pregnancy.

Use kindness and compassion

Above all, treat yourself with kindness and gentleness during this time. It is OK to feel grief that this is not what you hoped or expected for your pregnancy. It might help to change your expectations for yourself – your house might be messier, your kids might have more screen time, and you will be less productive (if working from home). Identify the must-dos and prioritize those (e.g., getting adequate sleep, good nutrition, and some physical exercise).

We wish you and your baby health and peace during these trying times.