key: cord-0913787-4lme132w authors: Hangai, Mayumi; Piedvache, Aurelie; Sawada, Naomi; Okubo, Yusuke; Sampei, Makiko; Yamaoka, Yui; Tanaka, Kyoko; Hosozawa, Mariko; Morisaki, Naho; Igarashi, Takashi title: Children’s Daily Lives and Well‐being: Findings from the CORONA‐CODOMO Survey #1 date: 2021-09-04 journal: Pediatr Int DOI: 10.1111/ped.14981 sha: beb430414b8a3d1a3007b54c0a3abc3cc324688a doc_id: 913787 cord_uid: 4lme132w BACKGROUND: The coronavirus disease 2019 (COVID‐19) pandemic has changed people’s lives dramatically. Few data on the acute effects of the pandemic on children’s daily lives and well‐being have been published to date. This study aimed to capture the effects on Japanese children during the first peak of the outbreak. METHODS: We conducted a web‐based, anonymous cross‐sectional survey targeting Japanese children aged 7–17 years and parents/guardians of children aged 0–17 years. Eligible individuals were invited to the survey from April 30 to May 31, 2020. This self‐report questionnaire examined daily life and behaviors, psychological symptoms, well‐being, quality of life, and positive parenting or abusive behaviors at the very beginning of the outbreak. RESULTS: A total of 2,591 children and 6,116 parents/guardians participated in our survey. Sixty‐two percent of children reported screen time exceeding 2 hours. Twenty percent of children reported abusive behaviors by family members. Nine in ten parents/guardians of school‐aged children reported their child had at least one acute stress symptom in the past month. Average mental health subscale scores from KINDL‐R questionnaire on quality of life were lower than the national average for all grades. Nearly half of parents/guardians refrained from seeking medical care for the child’s symptoms. CONCLUSIONS: The COVID‐19 pandemic had serious acute impacts on Japanese children’s daily lives, well‐being, family relationships and health care utilization, including some impacts that are potentially long‐lasting; thus, proactive interventions and services are needed, as well as longitudinal surveys. The coronavirus disease 2019 (COVID-19) pandemic has changed children's lives 36 dramatically. In spring 2020, many governments conducted quarantine and required 37 citizens to avoid unnecessary outings. Most governments also instituted nationwide 38 school closures, but its effect on disease control has been controversial(1, 2). In Japan, 39 the government asked all primary, secondary, and high schools to close by March 2, 2020, 40 prior to the declaration of a state of emergency that called for the restriction of people's 41 activities(3). Schools were originally scheduled to be in session until early April; 99% of 42 public schools complied(4). A state of emergency was declared on April 7, 2020, in 7 43 prefectures where the outbreak continued unabated. It was extended to the entire country 44 on April 16, 2020. Citizens were urged to refrain from going outside to reduce 45 interpersonal contacts. Initially, the state of emergency was scheduled to end on May 6, 46 2020, but on May 4, 2020, it was extended to May 31, 2020. The state was lifted in stages 47 by region starting on May 14, 2020, and nationwide on May 25, 2020. Thus, 80% of 48 primary and secondary schools remained closed until mid-May 2020(5, 6). 49 This unusually long period of school closure and prolonged home confinement likely 50 caused negative impacts on children(7) due to (i) changes in daily routines(4); (ii) fear, 51 frustration, boredom, and lack of in-person contact(8); and (iii) changes in the parent-child 52 relationship due to conflicts among family members, increased financial stress, or both(9). 53 The impacts on children's daily lives and well-being during this pandemic have been 54 reported in some countries(10, 11), but little has been evaluated in Japan. The This article is protected by copyright. All rights reserved 58 To capture the early and long-term influence of the COVID-19 pandemic on children in 59 Japan, find solutions, and disseminate information to minimize its adverse effects, we 60 launched the CORONA-CODOMO project. This serial cross-sectional study evaluates 61 children's well-being related to the pandemic and provides informative and educational 62 materials to the general public. In this report, we describe our first survey and show the 63 highlights of the findings. The flow of the survey is shown in Figure 1 . The flow differed slightly depending on 85 whether the parent/guardian and child participated together. The parent's/guardian's 86 consent was required for a child to participate. When the parent/guardian was involved, 87 he/she answered the questionnaire first, followed by the child if the child wanted to 88 participate in the survey. The survey consisted of 38 questions for children and 82 questions for parents/guardians This article is protected by copyright. All rights reserved 144 participate in play that he/she used to like or enjoy with family and friends" was used for 145 children aged <6 years whereas "My child expresses loneliness, even when he/she is with 146 someone else" was used for older children. Parents/guardians were also asked about the 147 duration and impact of symptoms (Appendix A). 148 Parenting, Abuse, and Domestic Violence 149 We asked about several aspects of positive parenting behavior and abusive behavior. For Parents/guardians were also asked whether they were able to perform self-care, 177 strategies used to relieve stress over the past month, and whether they were able to 178 contact confidants over the past month using 5-level Likert scales. Needs for Support and Information Demographic characteristics of respondents are summarized in Table 1 . Mean age of the 208 child was 7.5 ± 4.4 years. Most parent/guardian respondents were mothers (94%). Special 209 support for education was being utilized due to health or behavioral issues by 11% of 210 children. Two percent of parents/guardians reported that a family member was or had 211 been affected by COVID-19. This article is protected by copyright. All rights reserved 212 213 Forty-seven percent of parents/guardians reported they only left the home for daily 214 necessities. Among parents/guardians who reported that they had scheduled 215 appointments for their child in the past month (59% overall), 65% went to the doctor as 216 usual, 12% used telemedicine or online prescription, and 30% canceled the appointment. Among parents/guardians who answered that their child had symptoms in the past month 218 for which they would have usually sought medical care (38%), 45% reported they had 219 refrained from visiting the doctor. . Figures 2a, 2b, and 2c show the frequency distribution for 257 each symptom for 3 age categories. Irritable or aggressive behavior (Q7) was the most 258 common symptom across all ages; 59% of parents/guardians responded that their child This article is protected by copyright. All rights reserved 259 had this symptom. The second most frequent symptom among early childhood was 260 difficulty sleeping (Q9); 24% reported this symptom 1-2 times a week or more (Figure 2a) . 261 The second and third most frequent symptoms among school-aged children were poor 262 concentration (Q8) and discomfort when thinking of COVID-19-related issues (Q1), 263 respectively (Figure 2b and 2c) . The frequency distributions for 3 age categories by 264 gender are shown in Appendix D. 265 One in 5 children reported abusive behaviors by family members, among which 266 psychological abuse, being yelled at (16%), and being threatened or insulted (8%) were 267 the most common (Figure 3) . Physical abuse (being slapped) and neglect (lack of 268 necessities) were reported by 6% and 0.6%, respectively. Most behaviors were reported 269 more frequently by younger children. Among primary school age, boys were significantly 270 more likely than girls to be yelled at (24% vs. 14%; p <0.001), while there was no gender 271 difference in older age (14% vs. 10%; p = 0.101). Thirty-two percent of parents/guardians 272 reported that abusive behaviors directed at children or domestic violence had increased. Moderate mental distress on the K6 scale was reported by 45% of parents/guardians, with 275 severe distress reported by 16% of parents/guardians. Thirty-nine percent of all 276 parents/guardians reported they were able to perform self-care and use stress relief 277 strategies over the past month "none of the time" (13%) or "rarely" (26%). We report that the COVID-19 pandemic had a serious impact on children's well-being 281 during the first peak of the outbreak in Japan. The impact included changes in daily life, 282 high rates of acute stress symptoms, and increased prevalence of abusive behaviors. In Japan, many schools remained closed for approximately 3 months after the sudden call Our findings of irregular sleep patterns, acute stress symptoms, and poor mental health 304 might be associated with longer screen time. However, digital devices might have some 305 benefits; many older children reported keeping in touch with friends via such devices. Parents/guardians are encouraged to pay attention to the quality of content in addition to 307 setting limits on screen time(28-30). 308 We found an increase in abusive behaviors from family members, reported by children. A change in health care utilization was also reported. Nearly half of parents/guardians 321 whose child had symptoms reported that they had refrained from taking their child to the 322 doctor. That means some children might have underutilized health care, which has been 323 reported in Italy(37) and the United Kingdom(38). Our study has some limitations. First, there may be sampling bias because the survey was 325 announced through social media platforms and media coverage. To fill out the 326 questionnaire on a computer or a smartphone, an internet connection was required. The 327 majority of subjects lived in the Kanto area. The actual percentage of children in Japan 328 with special needs in our context is unknown, but the percentage of 11% among our 329 samples seemed to be higher than expected in general Japanese children(39), likely due 330 to the recruitment using networks of a medical institution. The proportion of respondents 331 whose family members had experienced COVID-19 was likely to be higher than the one in The frequency distribution of 10 acute stress symptoms reported by parents/guardians of early childhood (2a), primary school age (2b), and secondary school age or older (2c). Q1: My child seems uncomfortable, scared, or sad (such as suddenly starts to cry or hides) when thinking about issues related to COVID-19 (such as lifestyle changes), Q2: When my child remembers something related to COVID-19; she/he may have a tantrum or pretend play is related to COVID-19, Q3: My child dislikes and tries to avoid places and activities that remind her/him of things related to COVID-19 (such as television images), Q4: My child seems to have COVID-19-related or other nightmares, Q5: My child avoids conversations that remind her/him of things related to COVID-19 and dislikes meeting people that remind her/him of it, Q6: My child doesn't participate or show interest in play that he/she used to like or enjoy with family and friends (asked for early childhood, aged 0-5) or My child expresses loneliness, even when he/she is with someone else (asked for school-aged children, aged 6-17), Q7: My child is easily irritated, has outbursts of emotions even in an understandable situation, or has severe tantrums, Q8: My child can't concentrate or pay attention as much as before the pandemic, Q9: My child has trouble falling asleep and wakes up many times during the night, Q10: My child hurts him/herself on purpose or is violent towards family and pets. 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Violence against children: A hidden crisis of the COVID-19 pandemic: 443 World Health Organization (WHO) Physical child abuse demands increased awareness during health and socioeconomic 448 crises like COVID-19 Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey Intimate partner violence, maternal stress, 453 nativity, and risk for maternal maltreatment of young children Stressed parents with infants: reassessing 456 physical abuse risk factors A 458 longitudinal investigation of the role of parental responses in predicting children's 459 post-traumatic distress Delayed access 461 or provision of care in Italy resulting from fear of COVID-19 Covid-19: A&E visits in England fall by 25% in week after lockdown The influence of the COVID-19 pandemic on children's acute stress symptoms and their 348 environment needs to be carefully monitored over the long term. Our CORONA-CODOMO 349 project also plans to conduct cross-sectional surveys with repeated sampling every 1-2 350 months to monitor children's well-being, adding new items as needed in response to 351 changing social conditions. This article is protected by copyright. All rights reserved This article is protected by copyright. All rights reserved