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COVID-19 transmission fears could lead to toxic stress in children :

August 21, 2020

Letters to the Editor may be sent to Anne Hegland, editor in chief, at

As children face returning to school, I believe a major stressor that has not been discussed significantly is the toxic stress they face as they worry about contracting COVID-19, with or without symptoms, and spreading the disease to family or friends with serious or even fatal consequences.

Most children over the age of 5 or 6 are very aware of the dangers of coronavirus due to widespread discussions in the media and among their family and friends. They know they can transmit the disease to others even if they have no symptoms and that attending school greatly increases the likelihood of their contracting the illness. They, therefore, fear that they could cause a relative or friend to become sick with COVID-19, leading to significant guilt about their role in in transmitting a serious illness.

This fear, if prolonged and not addressed, could lead to toxic stress with long-range consequences, similar to other adverse childhood experiences. Therefore, it is important for parents, caregivers, teachers, social workers, etc. to be attuned to subtle signs and symptoms that children are worried about transmitting COVID-19 to others and counsel the child to relieve this anxiety, thereby preventing long-term problems.

Thomas K. McInerny M.D., FAAP

AAP past president (2012-’13)

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