Since the initial days of the coronavirus disease 2019 (COVID-19) outbreak, there is increase in fear and anxiety in general population which is palpable worldwide [1]. Pandemics are known to cause short- and long-term mental health issues, particularly in children and adolescents [2].

A 9-year-4-month-old girl was referred to our child development clinic with complaints of on-and-off shortness of breath, crying episodes and excessive fear of the COVID-19 to herself and family members. These symptoms were present since a week. She was developmentally normal. She was reported as a bright and friendly child. No psychiatric illness was reported in any family members. The screen usage of family was increased significantly mainly related to news on the outbreak. Ten days back, her neighbours, including her close friend, were moved to a hospital due to COVID-19. Parents reported that she had excessive fear thereafter of COVID-19. Her daily routine including appetite, sleep, play and class work was also affected.

While conversing with the child she had moist eyes with mainly short answers to any questions asked. On probing further, she reported about the incident and her fear of separation from the parents if either of them got infected. She had nightmares of being infected with COVID-19. On asking her what she knows about COVID-19, she replied "it is a deadly virus which spreads from one person to another – once infected the person dies within a short time." Her vitals were stable and systemic examination revealed no significant findings. Looking at the clinical scenario, the child was diagnosed to have acute stress disorder with panic symptoms [3].

Cognitive behavioural therapy (CBT) (3-4 sessions in a week) was initiated with a clinical psychologist, focused on restructuring her thoughts and cognition. Due to significant impairment of daily activities and sleep, clonazepam was started at the dosage of 0.5 mg/day in 2 divided doses. Relaxation techniques were advised at home. Parents were asked to decrease screen usage focussing on COVID-19 and to divert her in activities she relished.

Panic disorder, generalized anxiety disorder (GAD), specific phobia, and post-traumatic stress disorder were also considered in differential diagnosis. However, presence of triggering factor and duration of illness helped to rule out the differentials [3]. After one week, overall improvement was observed in the child, and parents reported her improved well-being. Medications were stopped and she was asked to follow up for CBT. The child is on follow-up and symptom free since 4 weeks.

Children are having an increased exposure to media and inadequate knowledge about pandemic. Some individuals can cope up with it. However, fear of the unknown raises anxiety levels in many children, especially the one with preexisting mental health conditions or neurodevelopmental disorders [2]. They may experience a broad range of concerns, including various internalizing and/or externalizing behavioral issues, increased substance abuse, social isolation, mental health disorders and lowered perceived good health [4].

Proactive and empathetic approach not only to the exposed but also with the unexposed is required. Early pick up with comprehensive history and observation is crucial for diagnosis. Appropriate intervention and meticulous follow up can benefit such children to build resilience during these difficult times.

1. Macapagal PM. COVID-19: Psychological impact. African J Biol and Med Res. 2020;3: 182-87.

2. Taylor S. The Psychology of pandemics: Preparing for the next global outbreak of infectious disease. Cambridge Scholars Publishing, 2019.

3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

4. Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019 nCoV) in Japan: Mental health consequences and target populations. Psychiatry Clin Neurosc. 2020;74:281.