الفهرس 
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Abstract
Coronavirus disease 2019 (COVID-19) is a novel severe acute respiratory syndrome, which is highly infectious, spread quickly and widely throughout the world. It has a serious impact on health and wellbeing of children. In addition, the pandemic’s serious psychosocial stressors. Identifying coping mechanisms during stressful moments can help with early, efficient interventions that lower the likelihood of developing psychiatric issues in the future. Thus, pediatric nurses are essential in educating the children and their caregivers, particularly in the prevention of infectious diseases and limiting the transmission of false information related to disease outbreaks.
The aim of this study isto identify the psychosocial stressors among school-age children and coping strategies during COVID-19 pandemic. The study was conducted at the Pediatric Outpatient Clinics in Smouha Specialty Hospital and Alexandria University Children Hospital at El- Shatby. A convenience sampling of 200 school-age children and their mothers who fulfilled the following criteria and comprised the study subjects:
Age of children ranges from 6 to 12 years.
Free from COVID-19 manifestations.
Free from acute diseases.
Have awareness about corona virus (COVID-19) pandemic.
Three tools were used for data collection.Tool one: children and their mothers’socio-demographic characteristics and children’s clinical data questionnaire sheet. Tool two: Interview Schedule about Psychosocial Stressors among School-age children during COVID-19 Pandemic. It included two categories that involved psychological stressors, and social stressors. The total score of psychosocial stressors ranged from 0-33 for each stressors. Children had severe stressors when their scores were 24 to 33, moderately severe stressors were 19 to 23,moderate stressors with 12 to 18 scores, mild stressors when their scores were 7 to 11and no stressors were 0 to 6.
While, tool three: The Coping Inventory of Stressful Situation (CISS),it is a self-report scale. The scale comprises three subscales, 16- items in each subscale, that empirically assess three basic dimensions of coping namely; task-oriented, emotion-oriented, and avoidance-oriented coping style. The total score of each subscale ranged from 1-80 scores. Children had high coping when their scores were 60 to 80, moderate coping with 38 to 59 scores, and low coping when their scores were 16 to 37.
The main results of the present study were as follows:
Part I (A) Socio-demographic characteristics and Clinical Data of Children.
• It was observed that 56.0% of the studied children had 10-12 years with a mean age 9.73 ± 1.77.
• More than half of children were male and living in rural areas (56.0%& 58.0% respectively).
• Nearly one quarter of children (23.5%) were in the grade 6, while the lowest percentage of studied children were in grade 1 (11.5%).
• More than half of children (59.5%) had 2- <4 sibling.
• More than half of children were nuclear family (59.5%).
• More than one third of the studied children were second birth order (36.5%).
• More than three quarters of the studied children (76.0%) were admitted to hospital for investigation & Lab tests
• More than two thirds of the studied children (67.7%) spent <3 days in the hospital.
Part I (B) Socio- demographic characteristics of Mothers.
• Two thirds of mothers (66.0%) were between the age 30–<40 years old with the mean age 35.26 ± 5.38.
• More than one third of mothers (37.0%) were secondary school, and the majority of them (81.0%) were housewife.
Part II: Psychosocial Stressors among School-Age Children during COVID-19 Pandemic.
A. Related to psychological stressors:
• The majority of studied children were always afraid of losing family members and illness of family members (88.5% & 84.0% respectively).
• Two thirds of children were always afraid of infection (66.0%) and 65.5% of them were always afraid of dying.
• More than half of children reported that their needs were sometimes met (55.0%).
B. Related to social stressors:
• More than half of studied children (51.5%) were always being socially stressed due to distance from their extended family.
• Less than half of children (44.5%, 43.5% respectively) were always stressed due to lack of leisure activity, and faced problems related to access to school-based health care services.
• Nearly one quarter of children (24.0%) were rarely being socially stressed due to distance from teachers, lack of physical activity, and using internet most of the time.
• About half of studied children (49.5%) were sometimes being socially stressed due to distance from colleagues.
• Regarding Psychological stressors, more than two thirds of children (69.5%) had severe stressors.
• Concerning Social stressors, more than half of the children (53.0%) had moderately severe stressor.
Part III: The Coping Inventory of Stressful Situation (CISS)
A. Related to task- oriented coping:
• About half of studied children (48.5%) were very much staying away from the crowd.
• 47.0% of children were many times doing their best to protect their family and friends.
• Less than half of children (42.0%) were many times staying at home most of the time, and learning from their mistakes in order to keep their family and friends away from harm.
• More than half of studied children (54.5%) were sometimes following all the news about corona virus.
• 53.5% of children were sometimes doing exercise at home, and dealing with the current situation to prove that they were capable of taking responsibility.
• Less than half of children (48.5%) were sometimes focusing on the problem, if the injury occurs, and seeing how they can solve it.
• Less than half of children (47.0%) were sometimes cleaning and disinfecting their room.
• 46.5% of children were sometimes trying to understand the situation when they hear bad news about the COVID-19 pandemic, and deciding what to do and implement it with their family.
B. Related to emotional- oriented coping:
• Less than half of studied children (42.0%) were preoccupied many times with their grief over what happened to their family when one of them was infected with the corona virus.
• 44.5% of studied children were sometimes hoping to change the situation and change the feeling controlling them.
• Less than half of children (43.0%) were sometimes worried because they can’t handle the situation.
• Small percentage of children (1.5%) was very much becoming violent when interacting with others.
C. Related to avoidance- oriented coping:
• Nearly one third of studied children (30.0%) were very much watching TV.
• Small percentage (1.5%) of children were very much denying the existence of corona virus.
• Nearly half of children were thinking of their happy memories many times with their friends, thinking of their school days and their memories with their teachers and classmates (48.0% & 47.5% respectively).
• More than one third of children were sometimes trying to sleep, and calling their friends (36.5% & 37.0% respectively).
• The mean percentage score of task-oriented was 60.47 ± 14.45
Part IV: Correlation between Psychosocial Stressors among School-Age Children during COVID-19 Pandemic and Socio-demographic characteristics of Children
• There was a statistically significant difference between children’s age and psychological stressors (2 =11.654 P=0.054).
• Statistically significant differences was found between level of education and their psychological and social stressors (2 =40.365 P< 0.001, 2 =39.515 P< 0.001 respectively).
• Statistically significant differences was noted between birth order and psychosocial stressors (2 =19.113 p=0.013, 2 =20.042 P=0.009 respectively),
Part V: Correlation between Psychosocial Stressors among School-Age Children during COVID-19 Pandemic and Socio-demographic characteristics of Mothers.
• There were statistically significant differences between marital status and social, and overall stressors (2=12.622 P=0.018, 2=20.276 p <0.001 respectively).
• A statistically significant difference was observed between the age of mothers and overall stressors(2= 15.613 P=0.012).
• More than one third of mothers (38.1%) who were secondary school had severe psychological stressors, while had mild social, and overall stressors (80.0%, and 75.0% respectively).
• The highest percentage of mothers (90.9%) who had moderate psychological stressors were housewife.
• Mothers who had 5 –<7 family members had severe psychological, social, and overall stressors (64.0% 57.5%, and 50.0% respectively).
Part VI: Correlation between Coping Inventory of Stressful Situation (CISS) and Socio-demographic characteristics of Children
• Statistically significant differenceswere found between the children’s age and emotional-oriented, avoidance-oriented and overall CISS (2=18.516 P<0.001, 2= 23.175P< 0.001, 2=18.924 P=0.001 respectively).
• A statistically significant difference was found between the children’s gender and task-oriented (2= 12.095 P=0.002).
• There were statistically significant differences between the place of residence and emotional-oriented, avoidance-oriented and overall CISS (2=11.762 P=0.003, 2=8.270 P=0.016, 2=8.246 P=0.012 respectively).
• There were statistically significant differences between the level of child education and emotional-oriented, avoidance-oriented and overall CISS (2=21.718 P=0.007, 2=46.479 P<0.001, 2=21.620 P=0.001 respectively).
• There were statistically significant differences between the number of sibling and task-oriented, emotional-oriented, avoidance-oriented, and overall CISS (2= 14.462, 15.243, 11.201, and 8.270 P= 0.003, 0.003, 0.018, and 0.053 respectively).
• There were statistically significant differences between birth order and task-oriented, avoidance-oriented and overall CISS (2=15.136 P= 0.013, 2=15.862 P= 0.010, 2=13.901 P= 0.012 respectively).
Part VII: Correlation between Coping Inventory of Stressful Situation (CISS) and Socio-demographic characteristics of Mothers.
• There was a statistically significant difference between age of mothers and emotional-oriented coping (2=9.380 P= 0.041).
• There were statistically significant differences between level of education of mothers and task-oriented, and avoidance-oriented (2=26.227 P= 0.004, 2=20.852 P= 0.018 respectively).
• There was a statistically significant difference between mother’s occupation and overall CISS (2= 6.337 p= 0.029).
• (88.9%) of housewife mothers used high avoidance-oriented.
• The majority of housewife mothers (90%) used low task-oriented.
• There were statistically significant differences between number of family members and task-oriented, emotional-oriented, and avoidance-oriented (2= 16.692 p= 0.001, 2= 14.139 p=0.005,2= 10.565 p= 0.024).
• A statistically significant difference was found between family incomes and emotional-oriented (2= 7.094 P=0.029).
Conclusion
Based on the findings of the current study, it can be concluded that COVID-19 pandemic has a negative outcomes on children, and their parents’ health and wellbeing. The majority of children exhibited severe psychosocial stressors during the COVID-19 crisis. In addition, school-age children used various coping styles to cohabit with the pandemic.
Recommendations
Based upon the findings of the current study, the following recommendations are suggested to be applied in different settings that serve school-age children:
1. Implementing counseling programs about COVID-19 for healthy, quarantined children and their caregivers to improve their awareness about the disease manifestations, complications and proper management approaches.
2. Providing manual booklet involving updated guidelines about COVID-19 modes of transmission, manifestations, and safety issues.
3. Conducting continuous training and health education sessions using simplified brochures and leaflets including COVID-19 preventive measures.
4. Educating children and their caregivers about the COVID-19 process through mass media.