key: cord-0898186-de90df31
authors: Alan Ong, Sze Kiat; Sung, Min; Tan, Mae Yue; Kang, Ying Qi; Aishworiya, Ramkumar; Lim, Tammy
title: Visual Supports to Optimize COVID-19-Related Healthcare Encounters for Young/Preschool Children
date: 2022-04-01
journal: Pediatr Neonatol
DOI: 10.1016/j.pedneo.2022.01.007
sha: 8a098f476595912d5e2519a8c1ec0e664e5858cf
doc_id: 898186
cord_uid: de90df31

nan

Consequent to the coronavirus disease 2019 (COVID-19) pandemic, healthcare visits have heightened infectious disease protocols, including COVID-19 testing of patients with suspected or proven infections. This has resulted in additional stress and anxiety for children who have limited understanding of the rationale for these changes. 1 Isolation protocols, unfamiliar appearance of healthcare workers in personal protective equipment, and discomfort of nasopharyngeal swabs are among the many new but distressing experiences that children encounter during a healthcare visit nowadays. Support kits such as visual schedules and social stories are well-established interventions for children with special needs, particularly those with autism spectrum disorder. 2 Visual support kits have been used in the dental setting to help prepare children with autism for dental examination. 3 Social stories have also been shown to improve outcomes in children with disruptive behavior. 4 However, recent research is limited with regard to the utility of such a visual support kit in the COVID-19-related medical setting.

Thus, our team created a "Special Care Kit" (https://bit.ly/specialcarekit-covid19 ) to provide resources to support children (both neurotypical and developmental needs) and their caregivers during their visits to healthcare facilities for COVID-19-related issues. The kit comprises visual schedules (Figure 1 ), social stories, pictorial boards, and animated videos to illustrate and explain the different COVID-19 processes in a developmentally appropriate manner. The kit was made available online for free. Physical copies were distributed to community clinics managing COVID-19 suspects, ambulances, and hospital emergency departments. Details of the kit were previously discussed. 

A total of 46 caregivers participated in the study. The mean age of the patients was 5.1 years.

Six (13.0%) patients had developmental difficulties (four had speech and language delay and two had autism spectrum disorder), of which three were still at the pre-verbal stage (such as using pictures or pointing and gestures to communicate). The remaining patients were reported to be typically developing.

Nearly all (98.0%, 45/46) caregivers felt that the Special Care Kit helped their children have a better healthcare experience, with 39% (18/46) of them noting that their child was calmer and took the whole experience better than expected. Moreover, 61% (28/46) of the caregivers felt that their children had a better understanding of the events during the encounter, and 21% (13/46) felt that the kit helped improve the communication between the medical team and family.

The majority 91% (42/46) would like to have access to other similar support kits during their child's future healthcare visits.

The use of age-appropriate support kits in young children is potentially effective in improving their healthcare experience during the pandemic. The Special Care Kit may allow for better understanding of the processes, reduce the anxiety of the encounter, and improve the communication between the medical team and family. While visual support is widely used and effective in children with developmental needs, preliminary evidence from this pilot study performed during the pandemic established that they can be also helpful in typically developing children. The study is limited by the lack of data from children who did not utilize the kit. However, the psychological effect of COVID-19 on children (without using the Special Care Kit) is well established with significant difficulty during quarantine, routine change, and access to healthcare for those with pre-existing behavioral issues. 6 Children who were hospitalized for COVID-19 were also reported to have more severe depression, anxiety, and post-traumatic stress disorder symptoms than healthy controls. 7

Beyond its utility in a pandemic, caregivers would likely benefit from more age-appropriate support for their children in healthcare settings, as these can help reduce the stress and anxiety for the family during a new healthcare experience.

Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review

Evaluating visual activity schedules as evidencebased practice for individuals with autism spectrum disorders

Dental stories for children with autism

A Pilot Randomised Control Trial of Digitally-Mediated Social Stories for Children on the Autism Spectrum

Supporting individuals with Autism Spectrum Disorder in medical settings during COVID-19

Psychological and behavioral impact of lockdown and quarantine measures for COVID-19 pandemic on children, adolescents and caregivers: a systematic review and meta-analysis