**6. Children affected by COVID-19**

The second wave of the Indian COVID-19 situation was certainly alarming compared to the first wave in 2020, as many more pediatric cases were reported across the country. Several children, including infants, are at greater risk of acquiring

and spreading the infection. However, their condition remained under control and seldom turned fatal [41]. Notwithstanding, as per the Government of India [42] Protocol for Management of COVID-19 in the Pediatric Age Group indicates, a small percentage of children who are symptomatic may need hospitalization. Moreover, 1–3% of infected children may manifest severe symptoms necessitating intensive care treatment.

Nevertheless, a substantial number of families are undergoing a persistent sense of despair due to losses of livelihood, financial security, social support networks and threatened loss of loved ones. Such complexities tend to impact the quality of family cohesion and relationships among children and parents. The current pandemicrelated uncertainties, fears, and worries certainly launched other crises among children which complicate and potentially hinder their developmental outcomes.

**School** - As the pandemic led to nationwide school closures beginning 16, March 2020, more than 290 million children were left to participate in education through virtual mode technology (e.g., smartphone, television, or computer). Although lessons pivoted to web links and TV, only 1 in 4 students have access to digital learning. Further, electricity and connectivity also present challenges for many students, highlighting the digital divide [43]. Across 23 states, 12% of school children do not have access to smartphones or basic phones [44], rendering education unattainable. Moreover, in Maharashtra, "only 50 percent of public-school students from classes I to VIII could access digital learning" [45]. Parents and teachers grappled with their own low levels of technology and digital literacy, further complicating education delivery. With such educational limitations, the incidence of school dropout risk increases significantly [46].

**Child Protection** - Issues of child protection have also seen a spike during the COVID-19 pandemic. In addition to families plunging further into poverty, violence against children (as with women) has also increased. CHILDLINE (a telephone helpline for children in distress) has received 4 million distressed calls from children requesting assistance; 92,000 calls reporting abuse and violence in just the early days of the 2020 lockdown [47]. As families come under duress responding to the pandemic, child labour, marriage and institutionalization are on the rise. With access to education compromised as described above, children are pressured to join the labour force and contribute to the family income [48]. Research demonstrates that during emergencies and crises, children are at higher risk for physical, verbal, and sexual abuse, as well as exploitation and trafficking [43, 49]. The case vignette below illustrates the desperation that can lead to child exploitation.

#### **COVID-19 and the Increase in Child Labour**

Despite it being a cognizable offense to employ a child as per the law, the last census indicated that "10 million of India's 260 million children "are child labourers [50]. The lockdown has caused parents to grapple with the decision to offer their child to human traffickers when they have gone for months with virtually no income. For example, Mr. L made the heart wrenching decision to offer his 13-year-old son to work in a bangle factory 1,000 km away from home after traffickers refused to bring Mr. L because they needed "nimble" fingers and an adult was "of no use." He told reporters that his children were going hungry and he felt he was left with no choice [50].

Considering children and adolescents' cognitive and emotional development, their inability to fully understand the pandemic and communicate their feelings fosters additional risk of mental health issues. Protective factors such as socialization and physical activity have all but come to a standstill. Social media, with its flood of information and misinformation further contributes to "anxiety, depression, sleep disturbance, and loss of appetite" [21, 51].

#### *Psychosocial Effects and Public Health Challenges of COVID-19 Pandemic in India DOI: http://dx.doi.org/10.5772/intechopen.99093*

Children, particularly girls, have also seen a significant rise in their domestic workload responsibilities [52]. School-aged girls have become more vulnerable to child marriage in order to defray household expenditure. During the lockdown, 5,584 CHILDLINE interventions were related to child marriages (ToI, 27 June 2020). In addition, menstrual hygiene was also compromised during the pandemic. Menstrual hygiene products, such as sanitary napkins, were not initially designated as essential items and therefore inaccessible for menstruating girls, potentially leading to unhygienic practices that could have serious health consequences (such as toxic shock syndrome, infections, and vaginal diseases [45, 53].

Child malnutrition is also a concerning ramification of the pandemic [21, 54]. Not only with food insecurity on the rise in homes that have been economically hit by the pandemic, but children have also been hit with an additional blow as access to government food programmes have been disrupted in some states. And despite increased food insecurity, the risks of weight gain and other additional adverse physical effects of a sedentary lifestyle have increased. For example, children's average daily screen time has increased from 3.5 hours to 5.12 hours, leading to associated loss of physical fitness, increased psychosocial problems, ophthalmic issues, sleep disruption and decline in academic achievement [55–57].

In addition to these issues of malnutrition and childhood weight gain resulting from the shift to a more sedentary lifestyle living in a restricted mobility environment, it is also essential to consider the 486,000 children living in alternative care [21]. For these children, residential or institutional environments further increase their risk for poor outcomes during the pandemic. As Roy, S., [58] points out, nonresidential care providers were unable to provide in-person services and therefore children have had to further rely on overworked residential staff for activities facilitation, schooling and therapeutic services. Overcrowded institutions are also challenged by finding adequate quarantine space for children infected with the virus. Issues of technology constraints (especially accessible learning materials for children with disabilities), understaffing, inadequate food, hygiene and medical supplies, and physical distancing with limited social connectivity are all prominent for children in childcare institutions and further exacerbate their anxiety and fear of the pandemic. For those children aging out of the system, limited options, concurrent with the inability to prepare for discharge during the pandemic, can hinder their ability to successfully transition into independent living and predispose them to exploitation, violence, and further adverse consequences [59].

On an encouraging note, however, immediately after the Ministry of Women and Child Development reported 577 children had been orphaned during the second wave, the Prime Minister (PM) announced support under the PM CARES for Children's scheme. Such support includes financial aid and free education for all COVID-19 orphans, the surviving parents, legal guardian or adoptive parents. In addition, the PM assured that the "GOI stands in solidarity with these families" [60].
