Study of Impact of COVID-19 Infection and Lockdown on Mental Health, Nutrition, and Lifestyle Practices in Children: A Cross-sectional Study in a Tertiary Hospital in Kerala
Authors: Pillai Swapna K , Nair Rekha S , Sundeep S 
Published: May 2024

Introduction:
COVID-19 disease and the subsequent lockdown imposed to curb the disease affected the lives of children in an unprecedented manner. Various isolation and social distancing strategies were adopted to protect from the risk of infection. The closure of educational institutions disrupted the normal lives of children, causing many psychological issues in them. A sedentary lifestyle, increased screen time, and lack of healthy leisure activities can lead to psychological problems, obesity, and overweight in them. The present study aims to analyze these aspects and also examine the various lifestyle changes and coping mechanisms in children and its effects on the overall physical and mental well-being of children.

Aims:
(1) To identify the prevalence of psychological and nutritional abnormalities in children with COVID-19 infection. (2) To identify the association between risk factors such as increased screen time, lack of physical activity, lack of hobbies, consumption of junk food to overweight, obesity, psychological problems, and defective scholastic performance in children. (3) To identify whether hobbies and other positive lifestyle changes were protective in children against psychological problems.

Methodology:
This cross-sectional study was conducted in the outpatient unit of a Tertiary Medical College Hospital in Kerala from December 2020 to June 2022. All consecutive children in the age group 4–12 years whose parents consented to the study were included. A structured questionnaire was filled out after interviewing the parent and the child. Psychological problems were assessed with components of behavior checklist. The anthropometric evaluation was done, and values were plotted in the WHO and Indian Academy of Pediatrics growth charts. Statistical analysis of the data was performed using unpaired sample t-test, and correlation was tested with a Chi-square test, using the Statistical Package for the Social Sciences (SPSS). The variables were expressed as mean and standard deviation. Chi-square and odds ratios were used to test the strength of association.

Results:
In our study, 19.7% of children had hyperactivity, 19% had depression, 16.8% had anxiety. 21.4% showed tempertantrums, 18% had fear, and 17.4% had sleep disturbances. Six percentage had self-injurious behavior and 11.6% had destructive behaviors. 7.5% of children had overweight, and 34.2% had obesity. Total screen time of more than 5 h was significantly associated with obesity (28.8%) versus 14.5% in normal children (P = 0.007). 16.8% of obese children had anxiety symptoms versus 8% in normal (P = 0.029). A significant increase in junk food intake was seen in obese children (90.8% vs. 44.6% in normal children) with a P < 0.00001. Doing gardening, helping with household chores, and talking to friends for up to 1 h were associated with less incidence of anxiety and depressive symptoms.

Conclusion:
Psychological problems such as anxiety, depression, hyperactivity, and sleep disturbances were noted with increased frequency in the study sample. Obesity and overweight are seen in a large number of study participants. Identification of risk factors and protective factors will help to implement lifestyle changes to mitigate these problems.