By Danielle Roubinov, Nicole R. Bush, and W. Thomas Boyce, JAMA Pediatrics, July 27, 2020

The reach of the coronavirus disease 2019 (COVID-19) pandemic is global, a health crisis with a ubiquity never before experienced. While the physical health consequences of COVID-19 appear to affect proportionally fewer children compared with adults, its psychosocial consequences may be magnified within families who consistently weather a landscape of severe stressors or adverse childhood experiences (ACEs; eg, domestic violence, abuse, maltreatment, and parent mental health issues). Leveraging the scientific evidence of early childhood research can aid in developing and implementing evidence-based practices that reduce risk and promote resilience within vulnerable families.

For families with a history of severe stress exposure, the trauma and unpredictability of the COVID-19 pandemic will add to the types, intensity, and duration of ACEs in the short term and the months to follow. For example, risk factors for child maltreatment include parental unemployment, substance use, marital strain, and parent-child conflict,¹ all of which may emerge as pandemic-associated sequelae. In vulnerable families, parents may be more likely to have underlying physical health conditions that lead to hospitalization or death as a result of COVID-19, disproportionally exposing such children to caregiver separation or loss. Children and parents with preexisting mental health conditions may struggle without access to their usual treatments or support. The pandemic is also likely to disrupt previously established protective family routines, creating greater disarray in the often chaotic family lives of vulnerable children.

Importantly, many families will also display resilience during this exceptionally difficult time, drawing on social support, religious/spiritual beliefs, and other coping strategies to maintain (or even increase) well-being during and after the pandemic.² However, vulnerable families may be limited in their ability to cope given diminished resources that are amplified by inequities in the health and financial effect of COVID-19. For example, positive peer and teacher relationships are known protective factors in the association between stress exposure and adverse child outcomes³ but are not accessible as schools remain closed. The feasibility of video or “live stream” offerings with teachers and peers may be scarce within disadvantaged communities because of a lack of technology and limited internet availability in homes. Safe, walkable streets and recreational spaces where children can play (while maintaining appropriate social distance) are less available in under-resourced neighborhoods. Many disadvantaged families rely on multigenerational family structures to maintain order and support children.⁴ The pandemic and its lockdowns will present new impediments to allowing these cross-generational structures to work.

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