This information is aimed at young people aged 12 years and above and their parents/carers. We recommend that children read this information with their parents/carers. Parents/carers may find the information useful to help younger children by adapting the strategies to suit a younger age group.
If you have had COVID you might have symptoms that last for more than four weeks or several months. This is sometimes called long COVID, which is commonly used to describe signs and symptoms that continue or develop after an acute COVID infection for over 4 weeks, that cannot be explained by an alternative medical diagnosis. This information gives you some ideas of things you can do to make sure that you or your child get back to your normal activities as easily and quickly as possible. If you are concerned that you are not getting better, please speak to your GP.
Illness and uncertainty
It’s very common for anyone with a health difficulty to struggle emotionally with their symptoms and the changes to their lives. This is particularly the case when dealing with uncertainty.
The human brain does not like uncertainty. Generally we like things to be predictable.
This helps us plan how we are going to react and respond.
Dealing with uncertainty means we have to think about lots of possible outcomes, and this uses huge amounts of emotional and mental energy. When we know what is going to happen, even if it is not what we want, at least we can focus on just that and not all of the other possibilities. COVID brings lots of uncertainty because we are all dealing with it for the first time. We are always learning more about it, but it might be a long time before we fully understand it.
Some common reactions are feeling:
- Sad or upset because you cannot do the things as you used to do
- Angry, and that it is ‘not fair’ that this has happened to you
- Worried about your future, feeling left behind, schoolwork, exams (particularly if you are older)
- Frustrated about the length of time it is taking to get better
- Worried about becoming ill again and checking for symptoms (more about this below)
- Worried about other people, for example, parents or siblings becoming ill or dying
- Generally more stressed (more about this below)
Stress is not a bad thing. We need a little stress, just to get us going. The problems happen when we have too much stress, because we only have room for a certain amount. Imagine stress like a glass of water. If we keep putting more and more stress in, without taking any out, eventually it will overflow. It doesn’t matter if the water is added in drop by drop or by a big amount, it still eventually fills up the glass.
What stress looks like
Everybody is different and feels emotions differently, but here are some things you can look out for as warning signs that you are carrying around a bit too much:
- Feeling sad or crying over small things or nothing in particular
- Feeling more irritable, easily annoyed or losing your temper more easily (more on this below)
- Having worries that seem to get ‘stuck’, particularly worries that you cannot do anything about
- Feeling unmotivated even when you ‘know’ something will help – for some people who have had COVID, their recovery has been very unpredictable and they might have experienced setbacks or not made the progress they expected – recovery can be hard work and it can be very difficult to keep going and stay motivated if you are not seeing results
- Wanting to be alone more
- Feeling worried about being away from parents and family
- Checking for lots of reassurance about symptoms, or spending lots of time looking up symptoms (more about this below)
- Younger children might have more tantrums or physical symptoms as they might be less able to talk about what is bothering them – people who have problems with language or communication, do not have the same ability to talk about their feelings in a way that they find helpful and they might react to difficult situations by showing their frustration or becoming physical
- Very young children might regress (behave as if they were even younger or lose some less-established skills) and might need more help (more on this below)
Reactions to stress
Everybody experiences and reacts to stress differently. When we are stressed, we have lots more adrenaline (a hormone) going around our bodies. This is natural and part of the ‘flight or fight’ response. We produce adrenaline when we are threatened, angry or excited.
“Fight or flight” (“Flight or freeze”)
This is an ancient response that human beings developed to help them respond to anger (or threat of danger). It happens in less than a second without us having to think about it. This reaction helps prepare our bodies to fight or to run away (flight).
When we detect a ‘threat’ in our environment (sometimes without realising), a hormone called adrenaline is released into our bodies. This makes our heart beat faster to pump oxygen-rich blood to our arms and legs to help us fight or run away. Our muscles tense (ready for action), and we sweat and flush to keep our bodies cool. We might get a funny feeling (butterflies) in our tummy because our digestive system is not our top priority. Some people might feel dizzy too. Sometimes we ‘freeze’ because it is sometimes safer to ‘play dead’ than to fight or run away.
If we do have to fight or run this reaction is very useful, but these days most of the ‘threats’ we have are social and emotional, not life threatening. This means that the energy we create is not used up and sometimes continues for longer. We can also start to shake, or develop aches and pains, as our muscles are ready to do something that they do not need to do.
Sometimes these physical reactions are frightening or worrying if we don’t know what is causing them. This then makes more adrenaline.
This reaction is not a bad thing. It is one of the things that helped the human race survive. It only causes problems if:
- It is ‘switched on’ by things that are not normally a threat or danger
- Our response is too big when we only need a small one
- We have trouble switching it off again
It is normal when we feel anxious or worried about something, to seek reassurance from an adult, friend or the internet. When things are very unpredictable, like COVID, this reassurance does not feel quite right and so we look for more. This gives some temporary relief but, because the situation is still unpredictable, we then need to seek more reassurance, so the relief lasts for less and less time.
This can also happen with noticing symptoms. No one knows why some people are more affected by COVID, than others. Because we do not know why we have been more affected, it is common to worry about other sorts of illnesses or symptoms. When we worry about something, we become more sensitive to small changes.
We might notice things that are normal but we have not noticed before. When we check for symptoms, either physically or on the internet, we can feel relief at first, but this might only last for a short time before we feel the need to check again.
In younger children, activities such as using the toilet, feeding, dressing, sleeping on their own, take a long time to become ‘automatic’. Until they are, younger children need a lot of mental and emotional energy to do them. When that mental and emotional energy is being used up dealing with uncertainty, tiredness (fatigue) or pain, these skills might ‘slip’ a bit.
Some children, without realising it, might seek the reassurance of feeling younger to balance out the uncertainty. For them, there is safety in being younger, because they were less independent.
Some children might need extra help with these sorts of activities during their recovery.
What you can do to help
Everyone is different, and different things work for different people. Some things will work only some of the time, and some things need practise. Some things are more about attitude or state of mind. Below are some things to try.
Try to do something small every day that you enjoy.
- Pay attention to your sleep and eating
- Try to spend time with others to avoid feeling isolated
- If you cannot go out, try not to spend all day in 1 room
- Do some sort of physical activity, even if this is just a few stretches
Help with worries
- Do not keep your worries to yourself – talk to people you trust, even if your worries seem small or silly
- Writing your worries down can help
- Older children and teenagers might try keeping a journal or diary – for younger children a worry box might help
A worry box or jar is a good way to help children ‘contain’ their worries. If you are a parent or carer of a younger child, these are some ideas about how to use one:
- Choose a box or jar that your child can decorate – this can be a nice thing to do together
- When your child is worried, encourage them to write down, or draw a small picture of their worry and put in the box
- At an agreed time, sit down with your child and go through the worries – a child with lots of worries might need to do this every day
- Some worries will have very practical solutions. Some belong to other people, or do not seem so important when taken out of the box Some just need to be acknowledged and put back in the box until there is a solution
- ‘The huge bag of worries’, is a good companion book
- ‘Worry time’ is a technique when you allow yourself a set amount of time to worry, but make an agreement with yourself that the rest of the day is a ‘worry-free zone’
- Try to limit the amount of time you spend on the internet and looking up symptoms
- If your worries seem to be spiralling out of control, paying more attention to the ‘here and now’ might help – you can use grounding techniques (examples below)
- Take a deep breath if you can, if you can’t just notice a breath
- Notice 5 things you can see
- Notice 4 things you can touch
- Notice 3 things you can hear
- Notice 2 things you can smell
- Notice 1 things you can taste
It might help to name the things you notice.
If you are a parent or carer of a younger child, this can be adapted. Younger children might find it easier to do 3-2-1, see, touch and hear.
Some people have a box of grounding objects. Ideas for objects include: a smooth pebble, a silky scarf or feather, an essential oil, a sweet to suck, some hand cream. The idea is that by bringing your awareness to something physical, these objects help take you back to the here and now.
Help with difficult feelings (emotions)
- Feelings (emotions) are a normal reaction to things that happen in our lives – remember that they are a consequence not a cause and you may be experiencing physical symptoms that are unpleasant or frightening which may make you feel anxious or worried.
- Strong feelings can be very overwhelming -the grounding techniques (above) can help with this
- Some feelings make us really uncomfortable – it can help to notice and name them
Mindfulness is a type of meditation that helps you stay with difficult feelings without becoming panicky or upset. There are lots of different exercises and recordings available. We have listed some in the resources section.
Help with difficult thoughts
How we think about ourselves and the world around us influences what we feel and what we do. We have thousands of thoughts each day. We forget most of them, but when we have lots of worrying thoughts, it can feel overwhelming. When things in our lives are challenging, it can be easy to be caught in a vicious cycle.
Watch out for the following thinking patterns that can get in the way:
- All-or-nothing thinking (if something is not completely perfect it is seen as no good at all)
- Overgeneralisation (when something bad happens, it is seen as bad things are always happening)
- Blaming and labelling (thoughts like, ‘I’m stupid, this is all my fault’)
- Jumping to conclusions (thoughts like, ‘It’s going to be terrible’ or ‘They think I’m not trying’)
You could also try the AHA technique.
Thoughts often feel true and we rarely question them. However, how we think about something affects how we feel and what we do. If you are feeling anxious, fed up, sad or angry in a situation, try to ‘rewind’ and ‘catch’ what you were thinking. Using the AHA technique is very different to ‘thinking positively’ as it helps to look at your situation in a different way.
For example, a person who has been struggling to learn a new skill might think, ‘I’m hopeless, I might as well give up!’
- Is this thought Accurate? No -most people are not very good at something when they start learning and there are other things I’m okay at
- Is this thought Helpful? No – it just makes me want to give up
- Is there a more helpful Alternative? Yes – I’m not good at this now, and I might never be brilliant, but if I practise, I will get better, even if it doesn’t feel like it
Help with difficult physical feelings
The physical sensations we get from stress and anxiety (sometimes called the ‘fight or flight reaction’) can be very similar to some of the symptoms that appear to be experienced by people with long COVID. This means it is sometimes difficult to tell them apart, and the physical impact of stress can make the physical symptoms of long COVID harder to manage.
These can include:
- Very fast (racing) heart
- Difficulty breathing
- Butterflies/churning feeling in your tummy
These physical symptoms can be helped by:
- Breathing exercises (more on this below)
- Relaxation exercises (more on this below)
Even though we do it all the time, practising breathing helps us use our breathing to manage difficult physical sensations when they happen. Practising means that our bodies already know what to do when we need it most. If you have been diagnosed with breathing problems or dysfunctional breathing, please discuss these techniques with your doctor or physiotherapist before trying.
Younger children need adults to help with breathing exercises.
- Create a relaxed atmosphere to practise
- Try using bubbles – dip the bubble wand into the mixture and demonstrate blowing out a long steady breath to make a long string of bubbles, then ask your child to try and make it into a game and see who can make the most bubbles – then try asking your child to imagine blowing as many bubbles as they can
- Try holding a soft, fluffy craft feather about 10 to 15 cm from your face, breathe in and blow a gentle but steady breath out so that the feather flutters with the breath – ask your child to try
- With any of these techniques it is important to demonstrate slow breathing to your child and guide them step-by-step when using them in a real life situation
For older children and teenagers
- Sit somewhere comfortable and supportive – try to have your back straight but not rigid
- Put a hand on your chest and the other on your tummy, just below your ribcage
- Breathe normally and notice how your hands move
- Begin to breathe more deeply, concentrating on your belly pushing your hand out a little -this means that you are using the whole of your lungs to breathe
- Repeat 3 times and build up to 10
This technique helps you to concentrate on the out breath rather than the in breath, by counting. It does not matter how far you count as long as the out breath is longer than the in breath.
- Position yourself somewhere comfortable – try to have your back straight but not stiff
- Take a comfortable breath in and then breathe out gently but really pushing out as much air as you can
- Do this a few times and count along to your outward breath to get a sense of your personal pattern
- The smaller you are physically, the smaller the number will be – you might find that you are 5/7, 7/10 or another combination
- If you have breathing problems, you might need to start at 3 in, 5 out and build up
Relaxation and mindfulness exercises
At the end of this information, there are some links to helpful exercises. These are just some examples that we recommend, but you might find others that you prefer. There are so many available that you are bound to find something that you like.
Try to remember that relaxation and mindfulness are skills, just like riding a bicycle or learning to swim. Some people find these easy, and some need more practise, but with practise everyone gets better at them.
Some tips to help you get started:
- Choose a shorter exercise if it is the first time you have done this
- Make sure you are warm and comfortable
- Try to practise in a place where you can reduce distractions
- If your mind wanders, do not rewind, just ‘tune back in’
- If you are a parent, try to do the exercise with your child
When to worry about mood
Most of this information is about very normal reactions to a very challenging situation, but sometimes these normal reactions can slip into mood difficulties that are problems in their own right. Things to look out for are:
- Feeling too anxious, worried or nervous to do things that you can physically do
- Not looking forward to, or enjoying the activities you can do
- Feeling so low or sad that it is difficult to manage daily activities like getting out of bed or feeling as normal
- Feeling that you are sad more often than feeling okay
- Feeling or thinking about hurting yourself
- Thoughts or worries that stop you from sleeping, or wake you up very early in the morning
- If you are older, using alcohol or drugs to make yourself feel better
If you have been feeling like this for more than a few days, it is very important that you speak to a trusted adult about how you feel. They might speak to your GP about getting you more help with your mood. If you do not feel that you can keep yourself safe, you might need to see someone urgently.
If you are worried about mood, we have listed some organisations where you can find out more or get some help.
For younger children
Cosmic Kids, for practical help on breathing, mindfulness and yoga for primary school aged children. They have a YouTube channel with lots of themed videos to keep children interested, web: www.cosmickids.com
For older children and teens
The Mental Health Foundation has lots of information about mental health and emotional wellbeing issues. These are suitable for parents and young people 14+. They have podcasts about issues such as sleep, breathing, and mindfulness (download through podcast apps) web: www.mentalhealth.org.uk
- 3-minute mindfulness breathing space
- Mindfulness: 10-minute practise exercise
- Stress and relaxation: full works
- Stress and the mind: quick-fix relaxation exercises
- Wellbeing and sleep: full works
- Wellbeing and sleep: quick fix relaxation exercise
The ThinkNinja app is NHS-recommended for 10-18 year olds and helps to identify unhelpful thinking patterns.
Headspace, is a well-known mindfulness resource. They offer mainly-subscription services through their app, but also have a useful free trial and you can access some free exercises on their website web: www.headspace.com
Get Self Help, is a cognitive behavioural therapy (CBT) website with lots of different resources. We recommend their printable resources on worry zones, unhelpful thinking patterns, and panic. They are written for adults but are suitable for older teenagers (14 years and older). Parents of younger teenagers might like to work through these resources with their children web: www.getselfhelp.co.uk
For all ages
New Horizon Holistic Centre, has lots of meditations, relaxation and breathing exercises. They have an app or can be accessed through YouTube. They are particularly good for sleep meditations. Our favourites for younger children include: ‘Spaceship to the moon’ and ‘Sleepy Cottage’, web: www.newhorizonholisticcentre.co.uk/
Mental health resources
Young Minds, has lots of information for children, young people and parents, about mental health difficulties in children and young people, web: www.youngminds.org.uk/find-help/
Childline, a crisis helpline for young people, web: www.childline.org.uk
Kooth, has lots of information about issues such as mood and anxiety. They have discussion boards for peer support and some support from qualified online counsellors, as well as useful features such as mood trackers, web: www.kooth.com
Family lives, aim to support parents whose children are struggling with mood or behaviour issues, web: www.familylives.org.uk