Article Text

Download PDFPDF

350 Visual supports to enhance COVID-19 related healthcare encounters for children
  1. Sze Kiat Alan Ong,
  2. Min Sung,
  3. Mae Yue Tan,
  4. Ying Qi Kang,
  5. Aishworiya Ramkumar,
  6. Tammy Lim
  1. Singapore


Background Consequent to the COVID-19 pandemic, healthcare visits have heightened infectious disease protocols and COVID-19 testing. These can result in additional stress and anxiety for children who have limited understanding of the rationale for these changes. Isolation protocols, unfamiliar appearance of healthcare workers with personal protective equipment and the discomfort of nasopharyngeal swabs are among the many new but potentially distressing experiences.

A ‘Special Care Kit’1 was created to provide resources to support children (both neurotypical children and those with developmental needs), as well as their caregivers during their visit to healthcare facilities for COVID-19 related issues. The kit comprises a series of visual supports in the form of visual schedules, social stories, pictorial boards and animated videos with the aim of illustrating and explaining the different COVID-19 processes in a simple and clear manner. The kit was published online, and hard copies were distributed to general practitioner clinics managing COVID-19 suspects, ambulances and hospital emergency departments.

Objectives The objective of the study is to assess the effectiveness of the ‘Special Care Kit’ in improving the experience of children and caregivers during their COVID-19 related healthcare encounters in an emergency department setting.

Methods The effectiveness of the visual supports was assessed through voluntary, anonymous surveys completed by parents or caregivers who had a COVID-19 related healthcare consult at a tertiary children’s emergency department. All children had been shown a relevant aspect of the special care kit prior to or during their medical encounter. Information collected included demographic data, developmental diagnosis, communication method of the children, as well as qualitative feedback. Descriptive statistics were used to analyse results.

Results A total of 46 caregivers took part in the study. The mean age of patients was 5.14 years. Six (13%) patients were known to have developmental difficulties, with half of them being pre-verbal (using pictures or pointing and gestures to communicate).

Almost all (98%, 45/46) caregivers felt that the visual supports helped their child have a better healthcare experience, with 39% (18/46) of them noting that their child was calmer and took the whole experience better than expected. 61% (28/46) of the caregivers felt that their child had a better understanding of what was going to happen during the encounter, and 28% (13/46) felt that the visual supports helped with the communication between the medical team and the family.

The majority (91%, 42/46) would like to have access to other visual supports during their child’s future healthcare visits.

Conclusions The use of visual supports in young children is potentially effective in improving their healthcare experience during the COVID-19 pandemic. The supports may allow for better understanding of the processes, reducing the anxiety of the encounter and may improve communication between the medical team and the family. In crisis or acute situations like a pandemic, efforts should be made to communicate in a developmentally appropriate manner to both neurotypical and non-neurotypical children to reduce the stress related to a new healthcare experience.


  1. COVID-19 Special Care Kit for Special Needs Individuals. (2020, June 1). Retrieved from

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.