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Introduction
Child development encompasses a series of biological, physiological, and behavioral changes in children from the moment they are born, when they are fully dependent, until their adolescence, when they achieve certain autonomy 1,2. The first five years of life, characterized by high brain plasticity 3,4, are especially important for children to have timely promotion experiences and to interact with their environment, aiming to reach optimum levels of physical, cognitive, language, and social development 5,6.
Ecological Theory 7 confirms how the interactions between a person and their environment can significantly affect human development, it describes the ecological environment as a set of nested structures that extend beyond the immediate situation faced by an individual and which is comprised of four levels: a) micro-system, defined as the inter-relations within the developing person’s closest environment (e.g., school, community, group of peers); b) meso-system, which is the interconnection between the micro-systems: c) exo-system, which includes the elements with which the developing person has no contact but that produce events affecting their immediate environment (e.g., parents’ workplaces, communication media); and d) macro-system, which represents the culture and its subcultures, the social institutions, the health policy and the values 7,8.
In this regard, brain development results from the interaction between biological and environmental influences. In the first years of life, those interactions should be generated by the caregivers, who should motivate children to move and turn around, providing them objects to explore, reach, and play with; in addition, during this stage, children need love and affection and that their hunger, tiredness, sleep, sadness, or happiness signals are acknowledged 6,9.
In this sense, the father-/mother-child relationship becomes the center of the environment for children. The interactions between mothers and their newborns were carefully observed in a longitudinal study, finding that, when the caregiver intervenes confidently with the infant and constantly generates social interactions, the child’s functionality is protected and premature maturation of structures such as the amygdala and hippocampus is prevented (which intervene in the memory and socioemotional relationships processes) 10. In opposition, the absence of a bond with a caregiver due to abandonment situations, for example in institutionalized children 11, severely impairs neuronal circuits, which generates future developmental delays and behavioral deficits 12.
During the years of the COVID-19 pandemic, families faced demanding childcare situations. Their routines were disrupted, as the parents had to work from their homes, take care of household chores, assist their children’s education and simultaneously meet the rest of their demands. All this produced an increase in the onset of parental anxiety, depression, and stress, which in turn triggered negligent or punitive parenting situations and unfavorable environments for the progression of children’s cognitive, socioemotional, and communication skills 13-15.
It can be asserted that the pandemic did not only cause physical ailments in people or communities 16; this phenomenon also reduced the possibilities of generating stimulating spaces for children’s development 17. In terms of the Ecological Theory, all systems with which developing children interact were affected 7.
It is also known that experiencing adverse events in childhood (such as natural disasters, wars, confinement, or chronic stress) can impair children’s neurodevelopment 18,19. In this sense, the COVID-19 pandemic equals a natural disaster 20, and it is possible the impact generated on the child population is not yet tangible.
However, this integrative review will allow conducting a search, critical assessment, and synthesis of the diverse available evidence 21, to know the effects on child development in children aged less than 5 years old that were living with their parents while the social distancing measures adopted were in force. The topic is of utmost importance for all health areas, especially for the Nursing discipline, as there is an urgent need to devise care actions around young children, putting into practice continuous programs to evaluate development and instruct families on the care to be provided for optimum child development 1,9.
Methodology
An integrative review was conducted following the five-phase design proposed by Whittemore and Knafl: 1) Identification of the problem; 2) Search in the literature; 3) Assessment of the information; 4) Analysis of the information, and 5) Presentation 22. In addition, to improve quality and transparency, the PRISMA statement guide extension was adopted as a reference 23.
In the first phase, Identification of the problem, it was determined that the review purpose would be to know the effects on child development in children aged less than 5 years old that were living with their parents while the social distancing measures adopted due to COVID-19 were in force. For this reason, the research question was formulated according to the PICo strategy (Population, Phenomenon of Interest, and Context) 24, where P: children aged less than 5 years old, I: effects on child development due to social distancing and the parents’ remote work; and Co: during the COVID-19 pandemic. This strategy allowed the formulation of the question: What were the effects of social distancing and the parents’ remote work during the COVID-19 pandemic on the development of children aged less than 5 years old?
For the second stage, Search in the literature, the following databases were chosen: Medical Literature Analysis and Retrieval System Online (Medline), Elsevier ScienceDirect, Elsevier Scopus and Scientific Electronic Library Online (SciELO). The search was independently and simultaneously conducted by two of the researchers in January and February 2022. Given the novelty of the theme, the research was only carried out in English, using DeCS and MeSH to select the descriptors: “child development,” “growth and development,” “parenting,” “teleworking,” “infant care,” “home nursing,” “social isolation,” “coronavirus infections,” and “COVID-19.” These terms were combined one-to-one using the AND and OR Boolean operators to generate algorithms (presented in Table 1), and thus reach the maximum variability possible. Likewise, organization, selection and identification of duplicates regarding the information was managed in the Mendeley tool 25.
Table 1 Search Algorithms
| Concept | Boolean operator | Concept | Boolean operator | Concept |
| Child development | Parenting Teleworking Infant care Home nursing Social isolation | Coronavirus infections | ||
| Child development | AND /OR | Parenting Teleworking Infant care Home nursing Social isolation | AND /OR | COVID-19 |
| Growth and development | Parenting Teleworking Infant care Home nursing Social isolation | Coronavirus infections | ||
| Growth and development | Parenting Teleworking Infant care Home nursing Social isolation | COVID-19 |
Source: Prepared by the authors.
Additionally, the eligibility criteria included quantitative studies (observational, correlational, experimental, and cohort) and qualitative studies (descriptive, phenomenological, case, and ethnographic studies) published in scientific journals and addressing the direct effects of the pandemic on the child population aged from 0 to 5 years old, even if the manuscripts included other age groups. The exclusion criterion was applied to articles corresponding to dissertations, monographs, editorials or letters to the editor, as well as to publications whose populations were comprised of children with diagnosed developmental disorders or disabilities.
Employing this strategy, the two researchers who conducted the search initially identified 4486 documents. In addition, another researcher manually sought research studies in the references from those included. However, no publications were added with this strategy. The detailed information flow is presented in Figure 1.
Source: Adapted from the PRISMA statement 23.
Figure 1 Flowchart Corresponding to the Articles Included in the Study
The third phase, Information assessment, was performed independently by three researchers. One of them assessed eligibility and discarded the documents that failed to meet the requirements established, whereas the other two researchers read the studies, evaluating their quality and pertinence regarding the phenomenon under study. Any discrepancies were solved by consensus, with a fourth reviewer available in case no agreement was reached.
For each study, the critical assessment tools proposed by the JBI 26 were considered, which include a checklist with the following answer options: Yes, No, Unclear, and Does not apply. The level of evidence was established according to the recommendations set forth by the Oxford University Centre for Evidence-based Medicine 27.
The data were extracted by two independent researchers who resorted to the data extraction tool proposed by the JBI 26 to summarize and organize them, materials with which an emptying matrix was prepared where the year, title, objective, design, population, main results, discussion, conclusions, limitations, and recommendations from each of the publications were detailed. Consequently, visualization was eased, which served as the starting point for data interpretation.
The next step consisted of coding, categorizing and summarizing the data to produce answers to the research question. This practice corresponds to the fourth phase: Analysis of the information. A second matrix was designed to present the relevant information from each article included in the analysis (Table 2), which was grouped according to the effects found in the child population.
Iteratively, the research team made comparisons between the groupings to identify patterns in common that allowed defining the categories organized for their presentation. In the fifth and last stage, the emerging categories are presented, and the results of this document are described.
The bioethical principles applied to the context of an integrative review were met. Authorship of the studies and publications included was respected at all times, and the materials acquired from indexed scientific journals. This paper has academic purposes, with the intention of knowing the current situation around child development and the actions that health professionals should take.
Results
The search process yielded a total of 4,486 documents; however, 4,451 articles were removed after applying the inclusion and exclusion criteria. The main reasons for this were document duplicity, not being research studies, not belonging to the knowledge area of interest or not answering the research question.
Once this stage was concluded, 35 productions were analyzed in their entirety and 18 of them were discarded because they were not connected to child development and, thus, failed to answer the research question; therefore, 17 scientific productions were included in this integrative review. Figure 1 shows the flow to select the studies.
When characterizing the studies according to their origin, most of them (n=8) were developed in North American countries (United States, Mexico and Canada), followed by Asia (n=5) (Indonesia, Japan, Korea and China), the European continent (n=3) (Spain, United Kingdom and Portugal) and, finally, South America (n=1) (Brazil).
According to the knowledge areas, most of the studies are grounded on Psychology, Psychiatry or Neuropsychology (n=7), followed by Human Development (n=3), Children’s Health (n=2) and Parenthood and Family Support (n=1), as well as on academic disciplines such as Nursing (n=1), Public Health (n=1), Social Work (n=1) and Education Sciences (n=1). In addition, according to the methodology implemented, 15 articles following quantitative methods and 2 qualitative studies were included. Table 2 presents a synthesis of the main elements from the studies that comprise the final sample of this review.
Table 2 Characteristics of Included Studies According to the Effects on the Child Population
| Authors / Year | Objective/Problem | Design | Participants | Main results | LE* |
|---|---|---|---|---|---|
| Torres-González C, Galindo-Aldana G, García-León IA, Padilla-López LA, Álvarez-Núñez DN, Espinoza-Gutiérrez YI. / 2020 18 | To characterize the effects of voluntary social isolation due to COVID-19 on socio-family behaviors at the personal level and on the children’s activities in the house. To determine the vulnerability predictors to undergo a negative isolation experience. | Descriptive and crosssectional | 365 participants, adult parents of children aged between 1 and 12 years old. | Family well-being during isolation is a complex and multifactorial phenomenon, which also exerts specific effects on socio-family behaviors. In the child population, correlations were found between personal experience regarding isolation and changes in sleep quality, irritability, emotional control, hopes about the future, motivation, attention capability and problemsolving. | 2c |
| Hails KA, Petts RA, Hostutler CA, Simoni M, Greene R, Snider TC, et al. / 2021 13 | To determine whether the families’ COVID-19-related anguish is associated with young children’s emotional/behavioral functioning through negative parenting and whether these relationships vary according to events undergone by parents who have faced adverse child experiences (ACEs)†. | Descriptive and crosssectional | 267 parents of children aged from 1.5 to 5 years old. | Family anguish related to the pandemic was significantly associated with the increase in children’s emotional/behavioral problems. The parents that reported higher anguish levels were more prone to resorting to negative parenting practices (hostility, physical control and lax control), which in turn were associated with more emotional/behavioral problems in the children. | 2c |
| Riany YE, Morawska A. / 2021 16 | To develop and examine a model to explain how the factors identified in the literature are associated with children’s non-adaptation and skills during the pandemic. | Descriptive and crosssectional | 354 mothers/ fathers with at least one child showing atypical development and aged from 2 to 10 years old. | The families with psychosocial functioning problems perceived fewer positive family interactions and more non-adaptation in the children during the pandemic. Therefore, the parents’ mental health problems derived from the pandemic affected everyday care activities, resulting in significant problems among the children (such as aggressiveness, conduct problems, and emotional/behavioral problems). | 2c |
| Mochida S, Sanada M, Shao Q, Lee J, Takaoka J, Ando S, et al. / 2021 20 | Research question: Were there changes in children’s psychological and physical stress during the COVID-19 pandemic and, if any, how did they manifest in children’s behaviors? | Descriptive and crosssectional | 1,030 main caregivers of children aged between 1 and 6 years old (mean of 3.8). | It was possible to identify that the mothers’ (main caregivers) schooling level and family income were related to lower stress signs in the children. There were also lower stress signs in the children that continued to attend daycare centers or kindergarten. Warm or permissive parenting protects children from presenting more stress signs, whereas punitive parenting increases them in children. | 2c |
| Waller R, Powell T, Rodriguez Y, Corbett N, Perlstein S, White LK, et al. / 2021 28 | To examine the associations between exposure to COVID-19, the parents’ concerns about the pandemic, strict and warm parenting practices and the children’s behavioral problems (CPs)§ and insensitive-unemotional (CU) traits||. | Descriptive and crosssectional | 303 children aged between 3 and 10 years old. | Afro-American and Hispanic parents, as well as those earning lower monthly family incomes, reported greater exposure and concern in relation to COVID-19. High levels of strict parenting were related to higher CP§ and CU|| traits in children, whereas lower levels of warm parenting are only linked to high CU|| traits. | 2c |
| Huang P, Zhou F, Guo Y, Yuan S, Lin S, Lu J, et al./ 2021 29 | To investigate the association between the coronavirus pandemic experience and neurodevelopment in children aged 6 months and 1 year old and to explore the differences in this association by birth order. | Cohort study | 831 children (exposed group) and 5,223 children (unexposed group). | In 2020, the pandemic experience was associated with a higher risk of delays in the Fine Motor Skills and Communication domains during the first year of life. The association between the pandemic experience and communication delays at one year of age was only found in first-born children, not in those born afterward. No associations were observed in any domain among the 6-month-old children. | 2b |
| Diniz E, Brandão T, Monteiro L, Veríssimo M. / 2021 30 | To examine the direct effects of marital adjustment on children’s behavior and to test if the parents’ self-efficacy mediated this association during home confinement due to COVID-19. | Descriptive and crosssectional | 163 children aged between 2 and 12 years old (mean of 6.09) and their caregivers (mothers and fathers). | Greater marital adjustment (the mutual process by which gratification is developed in a couple for achieving common objectives) was related to lesser aggressive behaviors in the children. The parents’ self-efficacy played a key role in explaining the association between marital adjustment and child development, contributing to increasing social competence and to reducing children’s aggressiveness and emotional withdrawal during this challenging situation. | 2c |
| Fitriahadi E, Priskila Y, Suryaningsih EK, Satriyandari Y, Intarti WD. / 2021 (31) | To perform a sociodemographic analysis of young children’s growth and development during the COVID-19 pandemic in Yogyakarta, Indonesia. | Descriptive and crosssectional | 30 young children and their parents. | The sociodemographic data significantly linked to growth and development in children aged less than 5 years old were maternal schooling (**p=0.001) and family income (**p=0.000). It was determined that having Higher Education allows people to be more rational when handling life problems, resorting to more effective coping strategies. In addition, young children’s development is negatively affected when their parents fail to participate directly or stimulate them. The higher the maternal schooling level, the better the knowledge about the need to stimulate child development. | 3 |
| Cardoso de Sá CS, Pombo A, Luz C, Rodrigues LP, Cordovil R. / 2021 32 | To identify how Brazilian families with children aged less than 13 years old faced social distancing during the COVID-19 pandemic, mainly concerning the time devoted to physical and intellectual activities, games, activities in the open air and screen time. | Descriptive and crosssectional | Families of 816 children aged from 0 to 12 years old. | The parents consider that the time children devote to practicing physical activities was reduced and that the time spent behind screens and in family activities was increased. Differences between the genders were found for screen time (boys ††> girls) and for games with no physical activity (girls ††> boys); there were effects in all the categories analyzed according to the children’s age, with a trend towards an increase in the total time of sedentary lifestyle and a reduction in the time devoted to physical activity as age advanced. The increase in these activities favors the early onset of chronic diseases and changes in young children’s behaviors. | 2c |
| Gibson LY, Lockyer B, Dickerson J, Endacott C, Bridges S, McEachan RRC, et al. / 2021 33 | To understand the experience and impact of the initial lockdown due to COVID-19 in young families with children aged less than 4 years old. | Qualitative | 903 participants, Origins (n=400, Australia) and Born in Bradford (n‡=503, United Kingdom) cohorts. | The most common concerns were as follows: a) financial and employment insecurity: b) health anxiety due to COVID-19; c) children’s education and care; d) current and future impacts of COVID-19 on society: e) child development and well-being; f) mental health; and g) not seeing friends and family members. “Positive” or enjoyable aspects were also reported, such as spending more time with the family, leading a calmer life and practicing more physical exercises. | 3 |
| Jáuregui A, Argumedo G, Medina C, BonvecchioArenas A, RomeroMartínez M, Okely AD. / 2021 34 | To investigate the correlations of the changes in the movement-related behaviors before and after the first stages of the confinement period due to COVID-19 in a nationwide sample of infants and preschool children from Mexico. | Descriptive and crosssectional | 631 caregivers or parents of children aged from 1 to 5 years old. | During the confinement period, only one out of three preschool children and infants met the physical activity recommendations and less than 4 %|||| complied with the screen time guidelines. The data showed that only 1.3 %|||| of the children included in this study met the movement recommendations during this period. | 2c |
| Baiden Ph, LaBrenz CA, Findley E. /2021 35 | To examine the association between adherence to the social distancing measures and the feeling of concern/ anxiety in female caregivers of children aged from 0 to 5 years old. | Descriptive and crosssectional | 358 mothers of children aged between 0 and 5 years old. | The caregivers that strictly complied with social distancing were 1.86 times more likely to feel concerned/anxious (ORa ¶¶=1.86, 95%||||CI***=1.07-3.24). The caregivers that were upset for having to distance themselves from their activities of interest were 4.11 times more likely to feel concerned/anxious (Ora¶¶=4,11, 95 %||||CI***=2.32-7.24). The stress, concern and anxiety experienced imposed problems in childcare. | 2C |
| Lozano-Blasco R, Quilez-Robres A, Delgado-Bujedo D, Latorre-Martínez MP. / 2021 36 | Research questions: Has the consumption of YouTube channels targeted at early childhood increased during the COVID-19 pandemic? What types of resources have been most used? Has the consumption of educational content increased or, to the contrary, has playful content prevailed? | Longitudinal | Analysis of diverse social networks. | The results not only indicate an increase in the use of YouTube channels by children. Social distancing increased the consumption of visual recreational content as a behavioral containment measure and reduced the promotion of traditional games. Use and consumption of content through screens implies possible risks (with changes in the learning system among them), which may not only generate addiction but also subsequent problems with attention and memory. | 2C |
| Russell BS, Tomkunas AJ, Hutchison M, Tambling RR, Horton AL. / 2022 15 | To examine the longitudinal impacts on the relationships between parents and children and the caregivers’ burden in the context of the parents’ reports on resilience, stress (both general and COVID-19-specific), depression and anxiety, as well as closeness and conflicts with their children. | Descriptive and crosssectional | 271 parents, over 18 years old and with children aged less than 18 years old (between 0 and 5, n‡=103). | The parents’ depression symptoms are producing more challenging effects on their parenting experiences. The parents also reported higher perceived stress rates in the children. The unemployment rates affected the female gender more than the male gender during COVID-19, and women reported worse mental health symptoms and care burdens at the beginning of the pandemic. | 2C |
| Stienwandt S, Cameron EE, Soderstrom M, Casar M, Le C, Roos LE / 2022 17 | To examine how the home factors and the changes related to COVID-19 increased or reduced the chances to take part in didactic activities to support development (“hands-on play”) and other similar ones (non-educational screen time) between parents and children. | Descriptive and crosssectional | 708 parents, over 18 years old and with at least one child aged between 2 and 8 years old. | The parents that meet the childcare needs and present lower parental stress levels reported more time devoted to hands-on play in all children’s age groups. The parents that meet the childcare needs and experienced higher parental stress levels reported more screen time among preschool children. | 2C |
| Park J-H, Park J-Y, Jin K-S / 2022 37 | To explore the effects of the COVID-19 pandemic and the social distancing practices related to family life, the childcare burden on the parents and the children’s everyday life, during the initial stage of the pandemic in South Korea. To evaluate the negative impact of the pandemic on parents’ and children’s stress levels. | Descriptive and crosssectional | 288 adults, parents of at least one child aged between 1 and 12 years old. | The time devoted to childcare by the main caregivers significantly increased during the pandemic. For children, the time devoted to screens (h¶=1.76) and to online interactions (h¶=0.95) was significantly increased, whereas the in-person interaction time (h¶=4.17) and the time devoted to learning (h¶=2.16) were significantly reduced. In addition, the parents’ and children’s stress levels were significantly increased during the pandemic. | 2C |
| Snyder K, Chaudhary P, Pereira A, Masuda K, Niski J, Dinkel D. / 2022 38 | To explore the perceptions of health workers, parents and childcare providers about the influence exerted by the pandemic on how they interacted with infants to promote physical activity, muscle strength and communication. | Qualitative | 37 participants: parents (n‡=12), caregivers of children (n‡=12), health professionals (n‡=13). | The caregivers identified concerns related to the following: limitations in social interactions (especially mask use, which affects communication), lack of access to peer modeling, fewer opportunities for physical exploration and the need for creative activities in various environments (e.g., §§, home/daycare centers), to promote child development during and after the pandemic. | 3 |
* LE = Level of Evidence from the Oxford Centre for Evidence-based Medicine; †ACEs = Adverse Child Experiences; ‡n = Absolute number; §CPs = Conduct Problems; ||CU = Callous Unemotional; ¶h = Hours; **p = Non-arbitrary minimum significance level (p-value); ††> = Greater than; §§e.g. = For example; ||||% = Percentage; ¶¶ORa = Adjusted Odds Ratio; ***CI = Confidence Interval.
Source: Prepared by the authors.
The analysis of the studies allows classifying the findings into three categories that present the effects suffered by the child population aged less than 5 years old and their caregivers throughout the pandemic, as well as the connection of such consequences with child development.
The first category is Exposure to risk stimuli, which responds to the increase in parental stress during the pandemic and to excessive screen use by children. The second category is called Deprivation of stimuli and is related to the change in the families’ habits and to the absence of games, accompanied by increased sedentary lifestyles and even with parents resorting to punitive parenting practices. The last category, Exposure to protective stimuli, alludes to the existence of opportunities during social distancing to preserve positive coexistence and closely track developmental milestones.
Discussion
Based on the question set out, it might be stated that the effects of social distancing and the parents’ remote work during the pandemic on the development of children aged less than 5 years old are related to the deprivation of stimuli that protect development and also to the continuous exposure to risk stimuli, to the detriment of opportunities to implement protective stimuli.
In this sense, the findings of this integrative review would make it clear that the parents are a key component in children’s micro-systems 7,39, especially in the age group between 0 and 5 years old. Therefore, when the environment is so abruptly modified as it was during the pandemic, the bond between caregivers and their children can be impaired and, consequently, exert an impact on child development. The main effects will be presented according to the emerging categories.
Exposure to risk stimuli
Compellingly, the findings indicate how the pandemic years (2020 and 2021) have represented a major challenge for families around the world, especially for those that raise very young children, as parents are expected to look after their safety, health, nutrition, leisure and rest. Added to these responsibilities, they experienced circumstances such as increased workloads, job loss, lower social interaction and increased house chores 16,29.
All these changes in everyday life favor the onset of risk stimuli for children in full development. One of these risks would be high parental stress levels, which in turn hinders understanding the children’s needs and conditions and the possibility of positively responding to them. Stress in caregivers is accompanied by other changes in mental health, such as anxiety, depression, frustration and irritability 16,35. The studies describe that, in this panorama, parenting practices are usually negative (punitive) and associated with emotional/behavioral problems in children, such as difficulties externalizing emotions 12,13,37. For example, one of the studies sets forth that fewer experiences of gratifying interactions with parents (demonstrations of warmth and affection) imply fewer opportunities to imitate, practice or develop behaviors related to social connections, cooperation and affiliation with others 28.
As a last element for this category, we should mention an important number of publications indicating the increased exposure to screens among children aged less than 5 years old 29,32,36,37,40,41. According to the World Health Organization 40, children should not be exposed to electronic devices before the age of 2, whereas screens may be used for a maximum of one hour a day after that age. During the pandemic, parents resorted to electronic devices to mitigate the childcare burden 37, the reason why these gadgets became the primary entertainment or distraction resource, even for more than 2.5 hours a day 29,32,36. Use and consumption of contents through screens carries with it possible physical and intellectual risks, such as changes in cognitive processing and in learning the primarily expressive language, in addition to a reduction in some executive functions such as attention and memory 37,41,42.
In a longitudinal study, it was verified that screen use during the pandemic was due to the need to mitigate the lack of activities in the open air and, consequently, the consumption of audiovisual materials was mainly focused on leisure and not on academic purposes 36.
Deprivation of stimuli
During the pandemic years, it has been understood that parents were stressed and focused on meeting the household and work demands, the reason why they have found it difficult to generate interactive playful intervals (use of blocks, puzzles and imaginary role play, among others) with their children 17. In addition, the evidence highlights that most of the population lives in apartments, which generally lack suitable spaces to practice physical activity. They live in overcrowded places in some cases and, given the restrictions imposed by the pandemic, it was not possible to access recreational parks 32,34.
Regarding play, it is of vital importance to note that they are normal and expected behaviors for childhood, and it is indispensable that children enjoy constant playful periods 18. Added to this, modeling is crucial for children’s learning; however, given the restrictions imposed by the pandemic, their recreational interaction was reduced, either with their parents or with other family members, and they had no contact with other children in most cases 31,36.
Therefore, increased sedentary lifestyles and the limited opportunities for games and physical exploration, as well as lack of access to modeling by groups of peers, suggest lesser participation in muscle strength and learning activities and scarce bonding 29,32,34,37,38. In terms of child development, we might be facing a negative impact on the motor, cognitive, language and socioemotional areas 42-44.
In parallel, children’s everyday routines changed, as some of them ceased to attend educational centers and had their recreational activities suspended, which resulted in an increase in boredom and irritability levels. Finally, until the usual balance of routines is resumed, the changes in the eating, sleep and rest habits may continue to be a reality in most homes 16,34,45,46.
To close this category, we again mention punitive parenting practices, as the evidence indicates that the combination of parental stress and children’s irritability sometimes results in the use of aggressive measures as a control resource. On the contrary, to ensure healthy emotional development, acceptance and negotiation in the face of children’s behaviors are recommended, with no severe punishments 1,2,13,20,30,46-48.
Exposure to protective stimuli
An aspect that has been highlighted by the research studies is the families’ socioeconomic level and how it influenced each household’s dynamics during social distancing. For example, the families with no financial difficulties reported “staying home” as a positive experience through which they spent quality time among all its members, devoted time to stimulate and/or educate their children, and carried out collaborative activities such as playing, eating, and doing the house chores 16.
Likewise, other positive elements were reported, such as the opportunity to lead a calmer life and, consequently, paying more attention to the developmental milestones gradually reached by young children 33,48,49. The importance of maintaining good quality interpersonal relationships to favor well-being and socioemotional skills in children stood out 30,50.
To conclude, it is to be mentioned that, between birth and the age of 5, children go through a critical time window to establish increasingly complex functions in the different developmental domains. Finally, as already mentioned, optimum development depends on the stability of the interconnected systems that comprise the environment. Consequently, the COVID-19 pandemic years represented a drastic change for very young children’s micro-, meso-, exo- and macro-systems, in addition to exerting negative impacts in at least one area of their development.
This review has its limitations. Despite the rigorous search strategy and the selection of articles, there is a prevalence of cross-sectional surveys, which, due to their design characteristics, restrict extrapolation of the results and making causal inferences; however, the phenomenon under study forces research studies to follow such design. In addition, the studies were developed during the pandemic months, reason why access to the participants was via digital means, which reduced and exerted an impact on the possibility to recruit families that lacked electronic devices or Internet connections.
As a strength, it is noted that the review is focused on child development. Although children’s physical and mental health is important for the Nursing discipline, it becomes necessary to turn to look at the new generations’ development skills, as the nations’ potential and future productivity depend on them, as well as the elaboration and effective implementation of policies for child development.
Among the implications for Nursing, as well as for those involved in child development would be the creation of family monitoring programs during the first years of the children’s life since, according to their training and due to the ability to implement care actions around growth, development and childcare, the professionals from the Pediatric field are the ones with the ideal competencies for their implementation. These programs should be included in the development of surveillance systems that include the participation of different health professionals in all existing levels of healthcare, with Pediatric Nursing among them and in a central position.
The findings of this study allow for generating hypotheses for future primary research studies that include broad sociodemographic diversity and assess child development through standardized instruments; in addition, from there, it becomes necessary to develop new secondary research studies that investigate the new family dynamics, the parenthood experiences and parental-child attachment, among other topics.
Conclusion
The studies reveal the following as the main effects caused by the COVID-19 pandemic: increased parental stress, changes in family habits, absence of games, and increased sedentary lifestyles, which in turn reduce the interactions that promote development in children aged less than 5 years old. Therefore, social distancing may be one of the main causes for the onset of delays in child development, in its motor, language, cognitive and socioemotional areas.
