The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identified in the Chinese city of Wuhan in December 2019; a lockdown in Wuhan and other cities in surrounding Hubei failed to contain the outbreak and it quickly spread to other parts of mainland China and around the world. The World Health Organization (WHO) declared a Public Health Emergency of International Concern on 30 January 2020 and a pandemic on 11 March 2020. Multiple variants of the virus have emerged and become dominant in many countries since 2021, with the Alpha, Beta and Delta variants being the most virulent. As of 30 October 2021, more than 246 million cases and 4.99 million deaths have been confirmed, making it one of the deadliest pandemics in history [1].

Several research and case studies concluded that lockdown is effective at containing the spread of Covid-19 and minimizing the death rate [1-3]. This is why countries and territories around the globe imposed various restrictions such as curfews, quarantine, lockdown and other ordinances to minimize community transmission [4]. To date, the first lockdown happened in China's Hubei province in January 2020 and various forms of lockdowns continued to be implemented in many countries throughout 2020 and 2021 [5].

Aside from containing the spread of the Covid-19, there are other benefits of implementing large-scale lockdown. According to Arora et al. 2020 [6], "The imposition of quarantine stopped all the commercial activity that greatly affects the various important environmental parameters which directly connected to human health. As all the types of social, economic, industrial and urbanization activity suddenly shut off, nature takes the advantages and showed improvement in the quality of air, cleaner rivers, less noise pollution, undisturbed and calm wildlife." On the other hand, the prolonged imposition of lockdown has a negative effect on the world economy. According to Gopinath [7], the pandemic has resulted in severe social and economic disruption around the world, including the largest global recession since the Great Depression in the 1930s. The economic crisis affected millions of people around the world which created a significant impact on their mental health that leads to depression and a high rate of suicide cases according to Silva et al. [8], Uutela [9] and Marazziti [10]. Moreover, based on several research studies, the pandemic-induced lockdown has a severe impact on the physical and mental health of the general population (from adults to children). The objective of this paper is to discuss the negative effects of lockdown on the overall health of children and young individuals and cite some possible solutions and recommendations from various research studies available during the time of its writing.

Positive Impact of The Covid-19 Pandemic and Lockdown

To have a deeper understanding of the impact of pandemic-induced restrictions and lockdown, citing the advantages and disadvantages are essential. Aside from limiting the spread of the covid-19 virus, there are also some notable benefits to consider lockdown as a viable solution to the Covid-19 pandemic. Take for example in the result of the study of Herrman et al. [11], he mentioned that when families complete the initial transition phase, the absence of external stressors such as personal and business appointments, guests, business trips can bring rest and relaxation into family life. Mastering the challenges of the COVID-19 crisis together may strengthen the sense of community and cohesion among members of the family. Moreover, according to Yeasmin et al. [14], that positive parenting and problem-focused coping strategies can use this crisis into a chance. Parents can use this time as a unique opportunity to spend quality time with their children, improve positive interaction between parents, children and siblings and strengthen family bonds. Most importantly, the ADHD children found the house environment less challenging and plenty of them had improvement in symptom profile. The same result appeared on the online survey conducted by Bobo et al. [15], during the Covid-19 confinement period to 533 French children and adolescents with ADHD. According to the parents, the majority of participants experienced either a stable general psychological state or better well-being. The decreased symptoms of agitation were probably the result of the increased family time between parents and children and the reduction of anxiety was due to the interruption of the ‘tailor-made’ rhythm and face-to-face schooling of the pre-COVID-19 era. Some other notable findings were the following: Parents became better aware of their children’s difficulties, improved self-esteem due to a reduction in negative signals sent back to the child due to ADHD and decreased academic and social constraints, other groups of children found the family environment more conducive for their chores and showed improvement in their inattention. Meanwhile, Gupta and Jawanda [16], emphasized that children's education is anticipated to be badly suffering from school closures. This is why UNESCO has actively promoted distanced learning solutions as an alternative to the traditional teaching method and this includes digital teaching aids. According to Gupta and Jawanda, those children who have access to those teaching aids are given the chance to be told and experience alternative types of educational methods and new teaching approaches that may benefit them later in life. They may also become involved in exceedingly different physical, learning and artistic activities during school closures that may help them to develop new skills.

Negative Impact of Lockdown to Children’s Physical Health

The dramatic reduction of physical activity due to mandatory homestay is perhaps one of the most apparent consequences of complete lockdown Lippi et al., [17], being physically active is inherently challenging for citizens residing in lockdown areas, as movements outside one’s residence are almost totally banned. In a study conducted by Xiang et al. [4], on 2,426 children and adolescents (6–17 years) before and during the pandemic showed that participants drastically reduced overall Physical Activity from an average of 540 to 105 min per week, while an increased Screen Time (e.g., watching TV, playing online games, using of gadgets, etc.) from an average of 170 to 450 min weekly was found. Moreover, Zenic et al. [19], concluded in their study that there was a significant decrease in the Physical Activity of adolescents living in urban areas. According to Orgiles et al. [20], lockdown paired with an inactive lifestyle like spending more time watching screens including iPads, TVs, mobiles or computers and less time performing physical activity contributes to the deterioration of the overall health. This was further emphasized in the result of the cross-sectional study conducted by Al Agha et al. [21] in Jeddah, Saudi Arabia and a separate study conducted by Pietiläinen [22] in Finland and Di Renzo et al. [23] in Italy. Their research concluded that a significant increase in Body Mass Index and body weight during lockdown was found, leading to the conclusion that there is a high correlation between the risk of developing obesity and the prolonged lockdown due to physical inactivity.

Negative Effects of Lockdown on the Children’s Mental Health

Mental Health includes our emotional, psychological and social well-being. It affects how we think, feel and act. It also helps determine how we handle stress, relate to others and make choices MentalHealth.gov [24]. This is why maintaining Mental health is very important to achieve optimum health particularly in times of crisis. As Grover et al. [25], emphasized in their study. “It is important to understand that the impact of COVID-19 pandemic extends beyond that of physical illness and in fact, we would say that, it has mental health impact on a greater number of people than those experiencing the physical health impact”. The following section discusses the negative impact of pandemic/lockdown on the mental health of children and adolescents:

Duan et al. [26] conducted a cross-sectional online questionnaire survey constituting 3,254 adolescents and 359 children in China. The results were the following: Around 22% (adolescents) and 7% (children) of participants were found to be suffering from depressive and internet addiction symptoms; 10% and 13% of males and females had symptoms of smartphone addiction. Nonetheless, both children and adolescents had a significant level of anxiety in which adolescents were more affected. This may be due to the fact that participants considered that their learning and graduation were affected by the pandemic/lockdown. Surprisingly, based on the result of his study, females living in urban regions are more susceptible to increased risk of developing anxiety and depression. Meanwhile, aside from anxiety and depression, Brooks et al. [27] cited other negative impacts of lockdown and quarantine such as irregular sleep patterns, confusion and anger.

Magson et al. [28] identified Covid-19 related factors that may increase or decrease the risk of adolescents developing mental health problems during the pandemic. Some of those worries are related to online learning, increased family conflicts and the disruption of their social interactions and activities. Whereas, concerns about contracting or getting ill due to the virus were very low. This, leading to the idea that the restrictions put in place to reduce the spread of the virus, rather than the virus itself are causing adolescents the most distress. These results are consistent with the theory of the importance of peers during the adolescent period. Meanwhile, Marklara et al. [29], also conducted a cross-sectional survey of 1,232 Greek parents of children and adolescents aged < 18 years to investigate the impact of the pandemic and the lockdown on children’s and adolescents’ mental health in Greece. Results showed that approximately one-third (35.1%) out of 1,232 parents reported that the psychological health of their children was considerably affected. The foremost significant concern was social isolation. Duan et al. [26], emphasized that the socioeconomic inequalities, increased family conflicts and the deteriorating health of family members have a significant impact on the mental health of children. In the worst-case scenario, parental death is one of the most significant factors of Children developing depression and other behavioral disorders according to Nader and Salloum [12] and Gray et al. [33].

Contrary to the result of the research study conducted by Bobo et al. [15] and Yeasmin et al. [14], that children with underlying health conditions particularly ADHD patients benefited from the pandemic/lockdown and showed better behavioral conditions, the meta-analysis conducted by Panda et al. [30] suggested different results. The results showed that children with pre-existing behavioral problems like autism and ADHD have a high probability of worsening their behavioral symptoms. A separate study by Colizzi et al. [31] supported the latter; "around 75%, 78%, 23% and 31% of parents faced difficulties managing structured activities, free time, child’s meals and autonomies, respectively during daily routine; around 41% and 35% of children had an increase in the frequency and intensity of behavioral problems, respectively." They concluded that the presence of prior behavioral co-morbidities is associated with an increase in the frequency and intensity of behavioral problems during the lockdown.

The following are some possible solutions and recommendations from various research studies to address the negative effects of Covid-19 pandemic-induced lockdown and restrictions discussed in this paper:

• Consuming nutritionally deficient food and being physically inactive are directly linked to numerous chronic non-communicable diseases, such as metabolic diseases, hypertension and tumors. Reported studies have shown that sedentary behaviors, such as television-watching time, are related to higher risks of obesity and cardiometabolic diseases in children and adolescents. Therefore, identifying the perturbing trends in health behaviors related to social lockdown and providing necessary emotional, financial and nutritional support to vulnerable groups such as children, adolescents, pregnant women and the elderly is important to reduce the disease burden [32-34].

• There is a need to ameliorate children and adolescents' access to mental health services by using both face-to-face as well as digital platforms. A collaborative network of parents, psychiatrists, psychologists, pediatricians, community volunteers and NGOs is required. There is a need for ‘tele mental health compatibility’ and its accessibility to the public at large. This would be crucial to prevent during and post-pandemic mental challenges in the most vulnerable and underprivileged section of society. The focal point of the health care system and policymaking should be prevention, promotion and interventions corresponding to the public mental health system to meet the mental health needs of the population at large by taking the regional contextual parameters into account [35].

• Identification of normal emotional reactions, engagement in dialog and social exchange, maintaining social contacts, avoiding illegal drugs, alcohol, cigarettes/tobacco and other vices, seeking out health workers' help when necessary, seeking information from reliable sources, limiting exposure to the media and developing strategies for emotional regulation is the most appropriate lifestyle to maintain optimum health [36]. 

• Parents are the closest and most evident help for their own children. Therefore, positive reinforcement and consistent emotional support from parents and family members are another simple yet effective step to relieve the stress and the negative effects of depression of children and adolescents [37-39].

• Children who are separated from their parents should be given special care. Their nutritional needs should be taken care of, their communication with parents should be increased via phone and their access to mental health services should be improved [40]. 

• Interventions to mitigate the negative effects of Covid-19 induced restrictions and lockdown can be divided into a few subdivisions like educational interventions (effective online learning, provision of psychosocial support and healthy lifestyle motivation through educational portals), information dissemination (accurate information, limited but adequate exposure with news, discussion with children about what they heard or saw), behavioral therapy complemented with sleep hygiene, exercise and healthy eating, utilizing telehealth to provide counseling/support to children at risk and to help parents coping with family issues, ensure positive parenting and social connectivity and seeking the help of professional when needed. Schools and teachers also need to be actively involved in achieving all these targets. Education and public health officials need to work together to decide on the content of effective online learning, minimizing exposure to social crowding and ensuring a safe return to school at the earliest possible [41]. 

• The Covid-19 pandemic could provide the opportunity to introduce innovative approaches to delivering mental health services through telepsychiatry thus possibly may lead to efficient use of available resources. It will remain to be determined through appropriate research which modalities prove indeed effective and safe [42]. 

• Helping young people to identify valued alternative activities and build structure and purpose into periods of involuntary social isolation may help to provide a wider range of rewards [43].

• Governmental regulations regarding lockdown pose a serious mental/social health threat on children/adolescents that should be brought to the forefront of political decision-making and mental healthcare policy, intervention and prevention. Furthermore, children and adolescents from families with certain risk factors (e.g., single-parent families) are more vulnerable to mental and social health problems. Therefore, these children and adolescents should be in sight of the health care professionals [44].

• One interesting aspect is that smartphones and social media, which were previously despised by most parents, have now become the only media for entertainment, information and education for children. Although many authors are favoring their use in mitigating the stress and depression of children, the parents need to have control over the judicious and reasonable use of electronic media and the content of the programs their children are viewing [41,45].

“Vulnerable individuals are at higher risk for experiencing negative outcomes during the course and possibly also at the aftermath, of the COVID-19 pandemic. Both family risk factors, like parental unemployment, psychological distress or family conflict and individual risk factors, like preexisting physical health conditions, contribute substantially to the vulnerability of youngsters and adolescents to the adverse effects of the new coronavirus outbreak and its containment measures. Well-designed public health policies should concentrate on specific population groups with the aim of ameliorating risks, when possible and enhancing resilience” stated by Marklara et al. [29].

Based on the data and various research studies presented in this paper, we found out that there are conflicting research results on the effect of the pandemic lockdown on children with pre-existing health problems. Some studies concluded it improved the health of children while other studies emphasized that the imposition of lockdown worsens the condition of children and adolescents with comorbidities. Therefore, further research and validation are still needed. Moreover, there are still no comprehensive and well-established studies on the effect of Covid-19 pandemic/lockdown on the health of children in respect of the following criteria: Family's social   and economic status, type of family structure and most importantly, the comparison of the impact or effect of Covid-19 lockdown based on the different level of government restrictions (e.g., full lockdown, partial lockdown and other types of restrictions). Nonetheless, the imposition of government restrictions to contain the spread of the Covid-19 virus has a positive and negative impact on the lives of all people. Therefore, the government should consider these factors in their decision-making for the benefit of the general population.

1. Perra, Nicola. "Non-pharmaceutical interventions during the COVID-19 pandemic: a review." Physics Reports, 2021.

2. Flaxman et al. "Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe." Nature, vol. 584, no. 7820, 2020, pp. 257–261.

3. Lau et al. "The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China." Journal of Travel Medicine, 2020.

4. Huang, Xuelian et al. "The impact of lockdown timing on COVID-19 transmission across US counties." EClinicalMedicine, vol. 38, 2021, p. 101035.

5. Gettleman, Jeffrey and Kai Schultz. "Modi orders total lockdown of 21 days." The New York Times, 24 Mar. 2020, https://www.nytimes.com/2020/03/24/world/asia/india-coronavirus-lockdown.html.

6. Arora, Shikha et al. "Coronavirus lockdown helped the environment to bounce back." The Science of the Total Environment, vol. 742, 2020, p. 140573. https://doi.org/10.1016/j.scitotenv.2020.140573.

7. Gopinath, Gita. "The Great Lockdown: Worst economic downturn since the Great Depression." IMFBlog, 14 Apr. 2020, https://blogs.imf.org/2020/04/14/the-great-lockdown-worst-economic-downturn-since-the-great-depression/.

8. Silva, M. et al. "Impact of economic crises on mental health care: a systematic review." Epidemiology and Psychiatric Sciences, vol. 29, 2020, https:// doi. org/ 10.1017/ S2045796018000641.

9. Uutela, Antti. "Economic crisis and mental health." Current Opinion in Psychiatry, vol. 23, no. 2, 2010, pp. 127–130. https://doi.org/10.1097/YCO.0b013e328336657d.

10. Marazziti et al. "Impact of economic crisis on mental health: a 10-year challenge." CNS Spectrums, vol. 26, no. 1, 2021, pp. 7–13.

11. Herrman et al. "What is resilience?" The Canadian Journal of Psychiatry, vol. 56, no. 5, 2011, pp. 258–265.

12. Nader, Kathleen and Allison Salloum. "Complicated grief reactions in children and adolescents." Journal of Child & Adolescent Trauma, vol. 4, no. 3, 2011, pp. 233–257.

13. Gray et al. "Depression in children and adolescents two months after the death of a parent." Journal of Affective Disorders, vol. 135, nos. 1–3, 2011, pp. 277–283.

14. Yeasmin, Sabina et al. "Impact of COVID-19 pandemic on the mental health of children in Bangladesh: a cross-sectional study." Children and Youth Services Review, vol. 117, 2020, p. 105277.

15. Bobo, Eric et al. "How do children and adolescents with attention deficit hyperactivity disorder (ADHD) experience lockdown during the COVID-19 outbreak?" Encephale, 2020, pp. S85–S92.

16. Gupta, Sanjay and Manmeet Kaur Jawanda. "The impacts of COVID-19 on children." Acta Paediatrica, vol. 109, no. 11, 2020, pp. 2181–2183.

17. Lippi, Giuseppe et al. "Health risks and potential remedies during prolonged lockdowns for coronavirus disease 2019 (COVID-19)." Diagnosis, vol. 7, no. 2, 2020, pp. 85–90.

18. Xiang, Mei et al. "Impact of COVID-19 pandemic on children and adolescents' lifestyle behavior larger than expected." Progress in Cardiovascular Diseases, vol. 63, no. 4, 2020, pp. 531–532.

19. Zenic, N., R. et al. "Levels and changes of physical activity in adolescents during the COVID-19 pandemic: contextualizing urban vs. rural living environment." Applied Sciences, vol. 10, no. 11, 2020, p. 3997.

20. Orgilés, Mireia et al. "Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain." Frontiers in Psychology, vol. 11, 2020, p. 2986.

21. Al Agha et al. "Impact of COVID-19 lockdown on glycemic control in children and adolescents." Saudi Medical Journal, vol. 42, no. 1, 2021, p. 44.

22. Pietiläinen et al. "Physical inactivity and obesity: a vicious circle." Obesity, vol. 16, no. 2, 2008, pp. 409–414.

23. Di Renzo et al. "Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey." Journal of Translational Medicine, vol. 18, 2020, pp. 1–15.

24. "Mental Health." MentalHealth.gov, 28 May 2020, https://www.mentalhealth.gov/basics/what-is-mental-health.

25. Grover et al. "Why all COVID-19 hospitals should have mental health professionals: the importance of mental health in a worldwide crisis!" Asian Journal of Psychiatry, vol. 51, 2020, p. 102147.

26. Duan, Lili et al. "An investigation of mental health status of children and adolescents in China during the outbreak of COVID-19." Journal of Affective Disorders, vol. 275, 2020a, pp. 112–118.

27. Brooks, Samantha K. et al. "The psychological impact of quarantine and how to reduce it: rapid review of the evidence." The Lancet, vol. 395, no. 10227, 2020, pp. 912–920.

28. Magson et al. "Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic." Journal of Youth and Adolescence, vol. 50, no. 1, 2021, pp. 44–57.

29. Magklara et al. "Impact of COVID-19 pandemic and lockdown measures on mental health of children and adolescents in Greece." MedRxiv, 2020a.

30. Panda et al. "Psychological and behavioral impact of lockdown and quarantine measures for COVID-19 pandemic on children, adolescents and caregivers: a systematic review and meta-analysis." Journal of Tropical Pediatrics, vol. 67, no. 1, 2021, p. fmaa122.

31. Colizzi et al. "Psychosocial and behavioral impact of COVID-19 in autism spectrum disorder: an online parent survey." Brain Sciences, vol. 10, no. 6, 2020, p. 341.

32. Faigenbaum et al. "Effects of detraining on fitness performance in 7-year-old children." The Journal of Strength & Conditioning Research, vol. 27, no. 2, 2013, pp. 323–330.

33. Poitras, Veronica J. et al. "Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth." Applied Physiology, Nutrition and Metabolism, vol. 41, no. 6, 2016, pp. S197–S239.

34. Tremblay et al. "Systematic review of sedentary behaviour and health indicators in school-aged children and youth." International Journal of Behavioral Nutrition and Physical Activity, vol. 8, no. 1, 2011, pp. 1–22.

35. Singh et al. "Impact of COVID-19 and lockdown on mental health of children and adolescents: a narrative review with recommendations." Psychiatry Research, vol. 293, 2020, p. 113429, https://doi.org/10.1016/j.psychres.2020.113429.

36. "Coronavirus disease (COVID-19) Situation Report – 136." World Health Organization, 4 June 2020, https:// www. who. int/ docs/ default- source/ coronaviruse/ situation-reports/ 20200604- covid- 19- sitrep-136. pdf? sfvrsn= fd36550b_2.

37. Sharawat et al. "Caregiver satisfaction and effectiveness of teleconsultation in children and adolescents with migraine during the ongoing COVID-19 pandemic." Journal of Child Neurology, 2020, https:// doi. org/ 10. 1177/ 0883073820968653.

38. Wang et al. "Mitigate the effects of home confinement on children during the COVID-19 outbreak." The Lancet, vol. 395, no. 10228, 2020, pp. 945–947, https://doi.org/10.1016/S0140-6736(20)30547-X.

39. Gudmundsdóttir et al. "How does the economic crisis influence adolescents’ happiness? Population-based surveys in Iceland in 2000–2010." Journal of Happiness Studies, vol. 17, no. 3, 2016, pp. 1219–1234.

40. Thakur et al. "Effect of the pandemic and lockdown on mental health of children." The Indian Journal of Pediatrics, vol. 87, no. 7, 2020, p. 552.

41. Kudchadkar et al. "Using social media for rapid information dissemination in a pandemic: #PedsICU and coronavirus disease 2019." Pediatric Critical Care Medicine, vol. 21, no. 8, 2020, p. e538.

42. Fegert, Jörg M. et al. "Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality." Child and Adolescent Psychiatry and Mental Health, vol. 14, 2020, pp. 1–11.

43. Pass et al. "Brief behavioural activation (Brief BA) for adolescent depression: A pilot study." Behavioural and Cognitive Psychotherapy, vol. 46, no. 2, 2018, pp. 182–194.

44. Luijten et al. "The impact of lockdown during the COVID-19 pandemic on mental and social health of children and adolescents." Quality of Life Research, 2021, pp. 1–10.

45. Saxena, Rajesh and Sunil K. Saxena. "Preparing children for pandemics." Coronavirus Disease 2019 (COVID-19), 2020, pp. 187.

46. Magklara et al. "Impact of COVID-19 pandemic and lockdown measures on mental health of children and adolescents in Greece." MedRxiv, 2020b.