First author and year Crisis Country Participants
(N; ages)
Study Design Key findings
Aitken 2010[@38537] H1N1 Australia 1292
over 18 years
  • 94% have food for 3 days of isolation 
  • 54% have food and water for 3 days of isolation if utility services were stopped 
  • Households with children less prepared for 3 days of isolation
Borse 2011[@38564] H1N1 USA 554
elementary school children
  • 70% of children stayed home
  • 30% left home during the school closure (most commonly to playgrounds)
  • Households in which adults were employed, 24% left home
Buzzi 2020[@38513] COVID-19 Italy 2064
13-20 years
Cross-sectional Regarding pandemic:
  • 35% little/no concern
  • 51.2% moderate concern
  • 14.5% extreme concern
  • 36% believed media exaggerated COVID-19 and distrusted media networks
  • 36.8% concerned about school closures
Casanova 2020[@38514] COVID-19 Italy 75 (25 cancer patients receiving treatment, 25 cancer patients in follow-up post-treatment, 25 peers with no cancer)
15-21 years
  • Large number of patients expressed worry about the virus; not seen in healthy peers
  • Patients burdened by parental concerns, while healthy peers did not
  • Patients deemed public health measures appropriate; healthy peers deemed them excessive
Chow 2013[@38570] Influenza (general) Australia 23 parents of children aged 6 months – 3 years Qualitative
  • Parent-child relationships worsened; communication centred around responsibilities
  • Older siblings were more understanding when told they had to stay home due to a sick child, but younger ones would act out.
Cui 2020[@38510] COVID-19 China 33
hospital representatives
  • 15% of hospitals opened online mental health services for children:
  • One hospital provided child services:
    • 45% had anxiety
    • 22% had insomnia
    • 13% had depression
    • 13% had somatic symptoms
    • 8% had other concerns
  • School closures created fear, frustration, boredom, lack of in-person contacts with friends, teachers and classmates 
  • 58% of children finished online schoolwork
  • 3% of children who experienced trauma due to the infection were diagnosed with PTSD
  • Increased conflict in child-parent relationships, authoritative parenting styles are not well suited to coping with the pandemic
Denis-Ramirez 2017[@38535] Ebola Sierra Leone 24
8-14 years
  • Orphans experienced name calling, distancing, othering, driving away, fear from family and friends, exhaustion, and rejection
  • Psychological impact of stigma included psychological distress, ostracization, and abandonment
Effler 2010[@38521] H1N1 Australia 223
parents of school children (elementary - grade 7)
  • 90% reported school closure cased little-no anxiety for their child
  • 55% indicated that school closure caused moderate-severe disruption to family routine
Epson 2015[@38538] General ILI USA 67 school aged children Cross-sectional
  • 3% reported missed subsidized school meals as a challenge
Etard 2017[@38533] Ebola Guinea 802;
20% < 18 years
  • 98.9% of participants reported stigmatisation
Green 2018[@38569] Ebola Liberia 201
Parents of children aged 3-4
  • Parental preference for harsh parenting methods from pre-EVD to post-EVD decreased by 28.1%,
  • Exposure to EVD associated with increased parent preferences for harsh punishment 
  • Parents exposed to EVD reported significantly more household conflict and personal anxieties
Ji 2017[@38520] Ebola Sierra Leone 18 EVD survivors; 8 aged 12-30, 8 aged 31-50, 2 aged > 51 Cross-sectional
  • High proportions of positive symptom scores in EVD survivors:
    • 83.3% obsessive-compulsive
    • 83.3% anxiety,
    • 94.4% hostility, 
    • 94.4% phobic anxiety, 
    • 72.2% paranoid ideation
Johnson 2008[@38542] Influenza B USA 355
school-aged children
  • 41% of responding households lost access to subsidized lunch programs
Kamara 2017[@38518] Ebola Sierra Leone 143
27 under age of 17
  • Depression, anxiety disorders, grief, social problems most prevalent disorders
  • EVD survivors and bereaved relatives experienced grief, mild depressive, anxiety symptoms, stigma
  • MAM diagnoses increase by 4.6% in community and 2.8% increase in health facilities (P< 0.001) 
  • SAM diagnoses 2% increase from pre to post outbreak (P<0.003) with ¼ completing monthly treatment
Kodish 2019a[@38541] Ebola Sierra Leone 42 key informants and community informants Qualitative
  • Impacts on feeding practices and food chains affect nutrition 
  • Breast feeding halted
  • Some struggle switching to formula
  • Pandemic increased purchase of affordable, unhealthy food
  • Increased orphans, new caregivers take on feeding responsibilities
  • Nutritional challenges for infants and young children 
Kodish 2019b[@38540] Ebola Guinea and Sierra Leone 105 adults/parents Qualitative
  • Challenges related to infant and young child nutrition during EVD:
    • Limited nutrition programming
    • Decreased health system access
    • Poor caregiving
    • Nutritional response implementation challenges
    • Increased rate of malnutrition
    • Household food insecurity
    • Changing breast feeding
    • Delivery of food assistance 
    • Funding diverted from nutrition to EVD containment/treatment
Koller 2010[@38515] SARS Canada 21
  • One visitor at a time in hospital was difficult for children and family 
  • Patients lonely, fearful and sad
  • Visits from family show support
  • Hospital staff need to be calm for children to feel comfortable
  • Miscommunication and misinformation about virus caused anxiety, confusion, fear in children
  • Isolation and news resulted in fear of the “worst case scenario” 
  • Play/distraction important for psychosocial care
Koller 2006[@38525] SARS N/A 23
(5 children aged 6-18, 10 parents and 8 health care workers were interviewed)
  • Changes in play: confined to home, no extracurriculars, no social spaces
  • Children were unhappy, lonely, heartbroken for the loss of loved one
  • Emotional well-being was disrupted; changes in friendships, bereavement, loss of care and intimacy with parents
  • Problematic food availability/prices
  • 16,600+ children orphaned by EVD
  • Relatives, friends, neighbors often care for orphans, despite stigma
  • >20% of adult participants stated orphans were not properly supervised/fed
  • Survivors/children related to victims of EVD suffer social isolation
  • Lack of studying from home during school closure; children were too hungry/busy working
  • Girls less likely to study than boys
Liang 2020[@38527] COVID-19-19/2020 China 584
  • Men scored higher in mental health (General Health Questionnaire-12) and PTSD measurements (indicating worse mental health and more PTSD)
  • Lower education level associated with symptoms of PTSD and worse mental health
  • 14-35 age bracket found no significant effect of age and mental health scores; can be generalized to ages 14-18
Miller 2010[@38566] H1N1 N/A 63 parents Cross-sectional
  • Decreased activity rates in grade 9-12 students 
Murray 2010[@38509] H1N1 USA N/A Qualitative
  • Fears result from unanswered questions and misconceptions
  • Infants experience detachment and regression
  • Preschoolers have sense of guilt or responsibility for pandemic
  • Toddlers experience stress if their environment changes
  • School-aged children at risk for adjustment reactions due to stress 
  • Adolescent stress may be exacerbated by pandemic due to other developmental changes
  •  PTSD may result due to enduring adjustment difficulties 
  • Children experience significant grief due to loss of family/peers
Nicholas 2010[@38531] General Pandemics Canada 290 professionals in pandemic planning and pediatrics (working with children and youth) Mixed methods 
  • Grief bereavement counselling for children is needed
Page 2011[@38512] H1N1 United Kingdom 144 clinical records, not all were children, but specified results for children separately (49 under the age of 16) Qualitative
  • Children were found to be vulnerable to media
  • Child mental health was especially impacted by H1N1
  • Age < 16 associated with having moderate/severe H1N1 concerns
  • Children/adolescents were overrepresented amongst patients who expressed significant concern about H1N1
Pietrobelli 2020[@38539] COVID-19 Italy 41 children and adolescents Longitudinal
  • No changes in fruit and vegetable intake (P=0.055) 
  • Potato chip, red meat, sugary drink intakes increased during lockdown (P=0.005-0.001)
  • Number of meals per day increased by 1.15 ± 1.56 (more in males - 1.64 - than females - 0.58)
  • Sports activities decreased by 2.3 ± 4.6 hours/day (P=0.003) 
  •  Screen time increased by 4.85 ± 2.4 hours/day (P<0.001) 
  • Inverse correlation b/w change in sports participation and change in number of meals/screen time
Street child 2015[@38528] Ebola  Sierra Leone 12,023
≤ 18
Mixed methods
  • Difficulty re-homing “EVD orphans”
  • Children of parents with EVD face stigma themselves
  • Orphaned children tend to isolate themselves, have nightmares about deaths of parents, live in constant fear
  • 91% orphans are reliant on food aid
  • Loss of parent linked to malnutrition
  • Orphans struggle with return to education
Sprang 2013[@38511] H1N1, SARS, and Influenza USA and Canada 586 parents Mixed methods
  • 30% quarantined children had PTSD 
  • 1.1% of non-isolated children had PTSD
  • Symptoms: avoidance/numbing (57.8%), reexperiencing (57.8%), and arousal (62.5%)
  • 85.7% of parents who met criteria for PTSD also have children who meet criteria 
  • Pediatric diagnoses during/after pandemic: 
    • Acute stress disorder= 16.7%,
    • Adjustment disorder=16.7%,
    •  PTSD= 6.2%
  • Diagnoses during/after the pandemic for youth:
    • Adjustment disorder=20%
    • PTSD= 1.4%
  • Gender played no role
Xie 2020[@38519] COVID-19 China 1784
grades 2-6
  • 18.9% had anxiety symptoms
  • Students worried about contracting virus had higher Child Depression Inventory-S scores than those who were not worried about getting the virus (37.3% were worried)  
  • 22.6% had depressive symptoms
  • Wuhan students received higher scores on a depression and anxiety scale than those in Huangshi; greater risk of depressive symptoms 
  • Those who were pessimistic about pandemic had higher scores on the anxiety/depression scale than those who were optimistic about the pandemic; pessimists had increased risk of depressive symptoms (50.9% of students were optimistic)
Zhou 2020[@38516] COVID-19 China 8079
  • Anxiety symptoms lower in city vs. rural (32.5% vs. 47.5%) 
  • Proportion of male students with depression/anxiety lower than female students (41.7 vs. 45.5/36.2% vs. 38.4%) 
  • The total proportion of the students with anxiety was 37.4% (mild-severe symptoms) 
  • Comorbid depressive and anxiety symptoms was 31.3% 
  • Nervousness, anxious or on-edge (53.6%), worrying (47.3%), becoming easily annoyed or irritable (47%) are common symptoms of anxiety 
  • COVID education higher among those without symptoms
  • Depression symptoms in cities were lower than rural (37.7% vs. 47.5%)
  • As the grade increased so did the frequency of depressive symptoms  
  • Total depression in sample 43.7%
  • Little interest in pleasure/doing things (53.9%), feeling tired or low energy (48.4%), poor appetite or overeating (45.6%) are common symptoms of depression