“I couldn’t see my friends; the internet was bad, and I hardly went out” – insights into children’s and adolescents’ experiences of COVID-19 in Germany

ABSTRACT

Purpose

We explored children’s experiences of COVID-19 in terms of proximity and distance to significant others.

Methods

Our qualitative study with children in Germany (6–15 years of age) explored their views and experiences of COVID-19 times via drawings and face-to-face semi-structured interviews (n = 13). We analysed data thematically and used the socio-ecological model as the theoretical underpinning. Case studies contextualized how children dealt with the COVID-19 precautions.

Results

Salient motives in children’s drawings were school scenarios showing distance-keeping and mask-wearing as an expression of interpersonal distance; in the home-schooling context, loneliness was highlighted. Drawings also illustrated the impact of COVID-19 in terms of separation, illness and death. A dynamic perception of proximity and distance emerged from drawings and interviews. COVID-19 barred children from spending “real” time together with close friends. Bridging physical distance virtually was easier for adolescents than for children.

Conclusion

To bolster children’s mental and social resilience in future epidemics, participants’ plea for maintaining social and physical interactions with significant others and for keeping schools open should be heeded by policy-makers. Our study also highlights the benefits of conducting direct research with children and using non-verbal methods of data collection.

KEYWORDS:

• Covid-19
• children
• adolescents
• distance
• proximity
• drawings
• interviews
• socio-ecological model
• resilience

Introduction

COVID-19 and its related precautionary measures have affected practically all parts of the world and all population groups to varying degrees. Children and adolescents have been identified as a particularly vulnerable group, not in terms of severe outcomes of a SARS-CoV-2 infection, but in terms of suffering from precautionary measures socially, with repercussions on their mental health, education, and social behaviour (Chaabane et al., 2021; Ma et al., 2021; Viner et al., 2022; Werner & Wößmann, 2022).

Literature reviews—drawing heavily but not exclusively on European and US studies—highlighted a rise in depressive symptoms, child abuse, and increased consumption of unhealthy food due to confinements (Rajmil et al., 2021; Stavridou et al., 2021; Viner et al., 2022). A decrease in physical activity was found to be more significant for boys and older children (Yomoda & Kurita, 2021), whereas female adolescents reported more mental health problems (e.g., anxiety and depressive symptoms) than their male counterparts (Guazzelli Williamson et al., 2022; Magson et al., 2021). In an Australian longitudinal study, adolescents perceived physical distance from friends due to COVID-19 regulations as a greater burden than the fear of acquiring COVID-19 (Magson et al., 2021). School closures, in particular, have been identified to exacerbate already pre-existing social inequalities (Armitage & Nellums, 2020; Lancker & Parolin, 2020; Rajmil et al., 2021). The first nationwide longitudinal survey study in Germany also found negative impacts of COVID-19 precautionary measures (e.g., lockdowns, physical distancing, and home-schooling) on the psycho-social well-being of children and adolescents (Ravens-Sieberer et al., 2021). More specifically, children from families with lower socio-economic status (e.g., families with a migrant background, lower educational level, or crowded living conditions) were particularly burdened (Ravens-Sieberer et al., 2021).

Lockdowns and school closures “forced” children and adolescents to spend more time at home, leading to greater physical proximity with nuclear family members and greater physical distance from friends, schoolmates, teachers, or acquaintances. At the same time, it also led to greater physical distance from the wider family, particularly grandparents, who often could not be visited (Pediconi et al., 2021). While many studies underscore the difficulty of children being physically separated from their friends and peers (Cornaggia et al., 2022; Magson et al., 2021; Vogel et al., 2021), physical closeness within the nuclear family can create either emotional closeness or intensify family conflicts, estrangements and enhance emotional distance (Hopkinson & House, 2021; McNeilly & Reece, 2020). Studies further distinguish the experience of children who are generally more focused on the family (Christner et al., 2021) and adolescents who look for emotional support increasingly outside the family (Larson et al., 1996). The forced physical distance from friends during lockdowns (Banati et al., 2020) could be especially critical for adolescents due to their developmental stage, where autonomy and peer group become more significant (Patton et al., 2016).

The understanding of why some people emerge from extreme situations relatively unscathed while others suffer from adverse effects (i.e., the study of coping and resilience) has progressed from focusing solely on the “invulnerability” of the individual to seeing the individual embedded in a social context and drawing on relationships and interactions with others (Cefai, 2021). During COVID-19, the key role of the family in bolstering children’s resilience has been upheld (Luthar et al., 2021; Prime et al., 2020), not only in terms of parental support, space and equipment to cope with a home-learning environment (Simm et al., 2021) but also in terms of parents’ own resilience (Pugliese et al., 2022). In addition, support from outside the family through teachers, friends and peers interconnects with family support (Guazzelli Williamson et al., 2022; Masten & Motti-Stefanidi, 2020; Ungar et al., 2019). Our understanding of resilience follows this “dynamic” view (Ungar et al., 2019) of not locating resilience in the child or individual alone or the family or school context but rather in the interplay of the individual with significant others, the school context, and the wider society, including the effect of policies on the individual. The interrelations between these contexts (from individual to society) can lead to positive or negative “cascading effects” when changes within one context impact on another (Masten & Motti-Stefanidi, 2020, pp. 99–100). Thus, resilience is an outcome of multi-faceted interactions based on the socio-ecological model (Bronfenbrenner, 1977; Glanz & Rimer, 2005). Interdisciplinary insights on resilience (Criss et al., 2015) and research on individuals, families, schools, and communities have paved the way for a “multisystem approach” (Masten & Motti-Stefanidi, 2020, p. 98) or “multilevel recursive processes” (Walsh, 2016, p. 322), in which “close relationships, psychological skills and capacities, and community-based supports” reinforce a more positive adaptation to emerging disasters (Masten & Motti-Stefanidi, 2020, p. 101).

In order to capture the view of children and adolescents in this prolonged emergency situation, we decided to conduct empirical research with children to learn about their experience and the issues they wanted to share through interviews and drawings (Cornaggia et al., 2022; Idoiaga Mondragon et al., 2022). This approach poses methodological and pragmatic challenges ranging from ethics (consent requirements in particular) to adapting to the respondents’ competencies in terms of language, communication, and cognitive and social-emotional skills (Gill et al., 2008; Malik & Marwaha, 2022). Involving children directly, however, offers a unique and emic perspective of their experiences, preferences and views (Gill et al., 2008; Lima et al., 2018; Rankin et al., 2018), rather than an outsider’s view by parents or teachers. It also aligns with article 12 of the UN Convention of the rights of the child to express their views on matters that affect them (UN General Assembly, 1989). To facilitate the process of interviewing children, interactive and visual approaches can be applied (Miller, 2016; Spratling et al., 2012; Trautmann, 2010). In our study, semi-structured interviews with children were accompanied by their drawings illustrating their experience of COVID-19 measures.

While the impact of political COVID-19 measures on children in the acute phase of the pandemic has been widely published (Rajmil et al., 2021; Yomoda & Kurita, 2021), our study explores how children and adolescents experienced the past two and half years of COVID-19 retrospectively and how they were coping with the measures. In this study, we will first present the pictures that the children drew before or after the interview and then analyse these in the interview context by providing interview excerpts and case studies.

Materials and methods

This qualitative exploratory study utilized semi-structured interviews with and drawings by children and adolescents who lived in Germany throughout the various pandemic waves. It is part of a family study in Germany on how parents and children coped with the COVID-19 pandemic, how they dealt with mandatory precautionary measures and their own exposure to COVID-19. An article juxtaposing children’s and adults’ perspectives, which draws on the whole dataset and excludes the pictures drawn, is currently under review. For the present article, we focus on the interviews with children and adolescents who furnished drawings (n = 13).

Interviewing techniques for children presuppose several considerations: making the child feel comfortable by choosing a location where the child feels at home (Spratling et al., 2012), establishing a “confidential, interactive relationship” (Kortesluoma et al., 2003, p. 438), offering the option of a parent being present at the interview (Spratling et al., 2012), giving the child time to answer, clarifying and rephrasing questions if the child does not understand the question (Gill et al., 2008), or asking questions in a way to activate the child’s memory (Trautmann, 2010). In our study, children’s and adolescents’ drawings facilitated the interview process and added another way for participants to express their experiences.

Data collection

We aimed for a heterogenous sample of families with children and adolescents by focusing on migrant families from diverse socio-cultural and economic backgrounds. Migrant families were (a) identified as one subgroup particularly affected by COVID-19 measures (Ravens-Sieberer et al., 2021) and (b) often not or only partially included in research activities (Etti et al., 2021). We understand the term “migrant background” in a broad sense (Will, 2016), not as othering (Pelizza, 2020) but as denoting the richness of the population in Germany with children growing up bilingually and feeling at home in more than one culture by having at least one immigrant parent. While we acknowledge that the term “migration” has negative connotations and is often misused (Will, 2016), it shows the heterogeneity of people living in Germany in our study. A migrant background was not correlated with the family’s economic status in our sample. Participants were recruited via various research colleagues through their personal networks covering different socio-economic and professional backgrounds. Colleagues informed eligible families with children aged 6 to 17 years about the study. The first and second author then phoned or wrote to the families, mostly the mother, and if she and other family members agreed, arranged a time for the interviews. In total, 11 families were approached by the authors. Two mothers declined for language reasons although translation back-up was offered. The study was conducted in southern Germany (Baden-Württemberg) between May and September 2022.

After discussing the experience of the first interviews, we decided to use drawings to learn more about children’s experiences and to ease the interview situation, an option mentioned in the study protocol. The present study only included interviews with children and adolescents who drew a picture (n = 13).

The first two authors conducted all interviews face-to-face, either at the family’s home or in a public place, based on the preference of the family. Conducting the interviews at home also allowed for participant observation by witnessing the interactions between family members and experiencing their living conditions. Interviews were conducted in German or English according to the participant’s preference. All interviews were audio-recorded. The interview duration ranged from 16 to 64 minutes.

Children and adolescents were asked about their life before the pandemic and during the implementation of COVID-19 precautionary measures with probes on schooling, home-schooling, leisure activities, and friendships (S14; S15). We also asked them to draw a picture about what comes to mind when thinking about COVID-19, or, for adolescents wanting to draw more abstractly, to draw important sites along a COVID-19 river or road (S14; S15).

Analysis

The first two authors have an anthropological and qualitative research background; all authors are experienced in qualitative analysis in the field of public health. Interview debriefings including observations were shared within the research team and informed subsequent interviews (McMahon & Winch, 2018).

In line with all qualitative studies (Creswell, 2013) and a thematic approach (Braun & Clarke, 2006, 2014, 2019), we familiarized ourselves with the data by transcribing the audio-recorded interviews verbatim. The first author quality-checked all interviews. Transcripts were read several times and discussed with the broader research team. The first two authors summarized the interviews independently and compared the summaries. Open inductive coding and partly deductive coding informed by the interview guide were employed. While the first author coded all interviews, the second author coded the interviews of six children and two adolescents. Comparing the coding of interviews showed a similar understanding of the contents and enriched the understanding of the data. In order to analyse data per participant, we used an additional mind-mapping approach for the drawings and the interviews (S1–13). The mind-maps constitute a thematic analysis of a) the drawing and the child’s explanation of it, and b) the rest of the interview. Comparing and fine-tuning our mind-maps helped to identify prominent themes within and across interviews. We also sorted the drawings according to their main subject matter.

In terms of analysing and interpreting children’s drawings, few methods exist (Billmann-Mahecha & Drexler, 2020). Pictures can be generally interpreted according to three different perspectives referred to by Umberto Eco as “intentio auctoris”, “intentio operis” and “intentio lectoris”: the intention of the drawer, the work itself in comparison with other works of a particular sub-culture and the reception of the beholder (Billmann-Mahecha & Drexler, 2020, p. 735). While we fully concede that the beholder’s interpretation is important and likely to differ from one person to the next, we were more interested in the “intentio auctoris” as far as this could be established. For interpreting children’s drawings, Billmann-Mahecha and Drexler (2020) recommend five aspects related to the child’s personal background and the creation of the drawing: the picture itself in comparison with other pictures, the child’s statements about the picture, the context of the drawing process (materials used, challenges encountered), the biographical and family context in which the child lives and the socio-cultural context. In our study, we analysed the drawings thematically in the form of mind-maps. We compared these with a thematic analysis of the entire interview. To present a more holistic picture of children’s COVID-19 realities, we provide case-studies, which summarize interviews and include interviewer observations. The socio-ecological model (Bronfenbrenner, 1977; Glanz & Rimer, 2005) served as the underlying theoretical framework for our analysis.

Results

Participant characteristics

Eight children (6–9 years old) and five adolescents (11–15 years old) provided data for this study (Table I). Most of the participants had siblings, except for two children. The average size of our participating families was bigger than the average family in Germany (M = 1.58 children).¹ More than 80% of our participants came from families where one or both parents had migrated to Germany from Western Europe (n = 4), Eastern Europe (n = 1), West Asia (n = 3), East Asia (n = 1), and West Africa (n = 2). Children and Adolescents will be referred to by study numbers, i.e., C1 or A5.

Table I. Socio-demographics.

Participants	Female (n)	Male (n)	Mean Age (SD*)	Form	Mean number of siblings (min–max)
Children (C)	5	3	7.9 (1.13)	1–3	1.6 (0–3)
Adolescents (A)	3	2	13.4 (1.52)	6–9	3.2 (2–4)

*Standard Deviation

COVID-19 perceptions: proximity and distance

Participants’ drawings illustrated their experience of COVID-19 measures (e.g., home-schooling, mask-wearing, testing) and their perceived physical or virtual closeness and distance to friends, family, teacher, and classmates. Under the overarching theme of proximity and distance, we identified two main themes: “The (home)-schooling situation — distance for some, (virtual) companionship for others” and “”Science and political regulations impacting on participants’ lives and views”. The school and home-schooling experience (Figures 2–8) stood out as prominent motives in the drawings highlighting the experience of loneliness, distance to others as well as virtual companionship through online meetings. Further important themes in their drawings were the virus and its impact in terms of severe outcomes (ranging from illness to death) and political decisions (i.e., precautionary measures) that impacted on participants (Figures 9–14). The virus appears prominently in some drawings and is implied in others in the form of COVID-19 measures, which indicated children’s increased exposure to scientific and health information and the confrontation with a dangerous virus, illness, and death.

The interviews provided rich accounts and background to the drawings highlighting episodes of participants’ lives and experiences. Overarching themes were children’s and adolescents’ new experiences of proximity and distance during the pandemic. Closeness was mostly seen as positive and enjoyable vis-à-vis distance and loneliness. Friends who were usually close became more distant. Siblings had to replace friends as playmates, but the amount of time spent together also led to more quarrels, as interviews showed. Siblings and neighbours featured more prominently in the interviews than in the drawings. Exceptions constituted the pictures by children with a Western European background showing the family (Figure 10) and the baby brother (Figure 5) respectively as their associations of COVID-19 experiences. Moving house during the pandemic increased playing opportunities for some children by having their friends as neighbours. Others also appreciated playing with neighbouring children but distinguished neighbours and friends in relationship terms. This information emerged from interviews rather than the drawings, as none of the children drew a neighbour.

Participants’ narratives further brought forth feelings of being restricted through COVID-19 precautionary measures, becoming more fearful, navigating one’s sense of proximity and distance with friends and family, teachers, and classmates, and learning to cope with changes by adapting to a new reality and acquiring a new perspective. Having to wear masks was seen not only as cumbersome and, at times, disgusting through sweating; it also created a barrier and, thus, a perceived distance between friends and classmates. Nevertheless, some adolescents (see case studies 3 and 4) appreciated mask-wearing as distancing oneself from others and making it harder to be recognized. While the temporary change from “real” to “virtual” relationships was predominantly felt to be a burden for the children and adolescents interviewed, some managed to bridge the physical distance to friends and family by collaborating virtually (see case study 2).

Overall, what emerges from the drawings and the interviews is a dynamic perception of proximity and distance with significant others across different levels of the socio-ecological model (Figure 1). The virus, testing, physical distancing and mask-wearing (i.e., the political context) impacted on participants’ lives and their relationships with parents, siblings, friends, neighbours, teachers, and classmates by spending more or less “real” time together. The school continued to play an elevated role for children throughout school closures, home-schooling and school re-openings.

Figure 1. Proximity and distance experienced by children and adolescents.

The following sub-sections are based on categorizing the main themes of the drawings in light of the interviews. It should be noted that differences in drawing styles, form, and size were partially caused by available materials and settings. Stylistic differences could not be attributed to gender, age, or family background.

The (home)-schooling situation—distance for some, (virtual) companionship for others

A popular theme of the drawings was a school or home-schooling scenario (Figures 2–8). While schools had long re-opened when we conducted the interviews, home-schooling had etched itself in some participants’ minds. Their experiences ranged from feeling alone and overwhelmed with school work to feeling happy to interact with classmates even when this was only through a teacher-facilitated session. While all welcomed the re-opening of schools, it came with its own rules and regulations, such as mask-wearing, physical distancing, and testing, which may lead to being sent home, thus intensifying a feeling of separation from significant others.

Figure 2. C3 home-schooling.

Figure 3. C6 home-schooling.

Figure 4. C4 home-schooling.

Figure 5. C2 associations of COVID-19.

Figure 6. A4 school as infection herd.

Figure 7. C8 school situation.

Figure 8. C5 school situation.

Figures 2–5 indicate home-schooling through the drawing of a house, a study setting or writing paraphernalia. The usage of space in Figures 2 and 3 and the dimensions of the drawings indicate a sense of solitude, despite both children having siblings. They also convey a feeling of being overburdened in the home-schooling context. C3, a child with a Western European background and C6, a child with a German background, strongly disliked this type of schooling in the interview. While C3 drew herself with a smile, she labelled the situation as “dumb” – the big letters emphasizing her sentiments. C6 mentioned self-consciousness about his drawing abilities. He had meant to draw himself in his room but instead drew a small stickman in a wide-open space. The interview with him provided more background on his experience of home-schooling: his mother helping him to operate the laptop, his dislike of “fake” background pictures when using the camera during online schooling and viewing virtual communication with friends as a setback. His preference for spending “real” time with friends emerged clearly from the interview:

I thought it [virtual communication] was also nice, but not nearly as nice as meeting them [friends] yourself, because there you just see them and they can’t touch or move anything or you can’t do anything with them. You can’t jump on the trampoline with them, you can’t climb onto the tree house with them, you can’t play Lego with them in my room or something like that. (C6)

Figures 4 and 5² show drawings covering the whole page. C4, a child with a West Asian background, drew himself as a big smiling figure between his laptop and his pet fish with an ongoing virtual class (Figure 4). The interview revealed that he enjoyed online schooling as he could at least see the other classmates and his teacher and communicate with them, even if he could not hear them so well. The interview added further components: enjoying time with the mother as she can now mainly work from home, becoming more autonomous in conducting internet research for a school poster, thus learning new skills and experiencing more “real” proximity with the mother and “virtual” proximity with classmates from time to time. For C2, a child with a Western European background, home-schooling was one aspect of his mixed COVID-19 experience. Positive experiences were: his father helping him with mathematics homework (Figure 5), school closure enabling him to sleep in and play more with the neighbour; the arrival of a baby brother during this period. On the negative side, he highlighted his dislike for wearing a mask and the fact that his family was busy and that he was often bored.

Situations of mandatory physical separation in a school context were drawn by three girls. A4, an adolescent with a West African background, portrayed the school as an infection herd (Figure 6), leading to separation from close friends because of a COVID-19 infection. She illustrated her feelings about isolation with a sad facial expression and text; yet two of the friends who also contracted COVID-19 seem to be smiling, perhaps reflecting the friendship rather than the separation.

C8, a child with an East Asian background, also focused on infection as a reason for physical distance from schoolmates and the teacher (Figure 7). She changed the facial expressions in her drawing according to her feelings: a negative test that allowed her to go to school was a reason for joy, a positive test and being sick a reason for being angry and sad as it meant separation from the teacher and classmates. Where the mask covered the face, she added text to emphasize her dislike of having to go to school alone when her parents contracted COVID-19. C8 also found it difficult to understand others with a mask and was annoyed about distancing requirements, which she perceived as a constant reminder of COVID-19:

R:

I find this sign boring.

I:

What is that?

R:

A sign for keeping distance (…)

I:

Mm. And why do you not like it?

R:

Well, I find it boring, because you see it almost everywhere. (C8)

C5, a child with an East European background, drew her classroom with everyone keeping their distance from each other (Figure 8). For C5, the distance was enhanced by having to wear a mask, which created a barrier for communication and interaction, as shown in the German writing in Figure 8 with the students saying: “We cannot understand anything.” - The teacher replies: “It’s all because of COVID-19. I will speak up.”

The school or home-school situation was thus a dominant motive in the drawings. It predominantly conveyed the feeling of distance and separation from others. Nevertheless, for some, it meant greater closeness to family members and the opportunity to stay close to friends and classmates through virtual meetings.

Science and political regulations impacting on participants’ lives and views

Another prominent theme emerging from the drawings and participants’ familiarity with scientific information about COVID-19 was the view of the virus as potentially life-threatening for people—whether one knew them or not. The virus could cause infection and severe outcomes leading to a permanent separation from those falling ill and dying. A further theme consisted of COVID-19 regulations impacting on one’s life and relationships with family and friends but participants perceived changes over time in the severity of these regulations. Although political measures to protect the vulnerable, such as testing and mask-wearing, were mostly adhered to, they were not particularly liked as they led to separation and distancing. Thus, Figures 9–14 illustrate exposure to a dangerous virus and the personal impact of precautionary measures.

Figure 9. C7 COVID-19 viruses.

Figure 10. C1 COVID-19 creating distance.

Figure 11. A2 people unaware.

Figure 12. A5 hospitalization.

Figure 13. A1 COVID-19 barriers.

Figure 14. A3 personal COVID-19 time-line.

C7, a child with a German background, was intimately familiar with how the SARS-CoV-2 virus looked and drew two viruses (Figure 9), the bigger one in red, most likely to indicate danger, as she did not like the virus “because they, it can infect everybody. I think, it is enough if one person gets it” (C7). The virus could thus threaten one’s (extended) family and significant others.

C1, a child with a Western European background, drew many scenes and evaluated them (Figure 10): Being close to/hugging family and friends received ticks; having to part and say good-bye was marked by a sad face; someone dying (a funeral) and her dislike of masks received crosses. Distance also included the professional distance of a scientist to study the COVID-19 virus that could lead to death.

Dire consequences of a COVID-19 infection were the subject of two adolescents’ drawings (Figures 11 and 12). A2, an adolescent with a West Asian background, conveyed the sentiment in both the picture and the interview that people underestimate or ignore the danger of COVID-19. She illustrated this as a stop sign and collapsed road with people falling and possibly dying (Figure 11); this view of COVID-19 and a warning that people should heed the call for safety measures also permeated the interview. A5, an adolescent with a West African background, associated COVID-19 with severe sickness as shown in an ambulance and hospital, which looks more like a prison with barred windows (Figure 12), thus showing the COVID-19 infection as taking people away from their normal lives. By contrast, the interview with A5 was mainly about failing to see much sense in life before or with COVID-19 and wanting more independence rather than being afraid of COVID-19 as a personal health threat, see case study 4.

Other adolescents (A1, A3) focused on the passage of time concerning COVID-19 and related precautionary measures. For A1, an adolescent with a Western European background, the tide of COVID-19 could be stemmed through effective measures such as masks and testing (Figure 13). Masks were symbolized as a blockage in a river that lets little water through, and the tree stood as a symbol for testing—both measures holding up the flow of COVID-19. Nonetheless, he found the measures to be “annoying”. While the drawing reflected his feelings towards wearing masks and testing, it had little to do with the personal interview, which was mostly positive and honed in on his resourcefulness and testing out new activities with friends and relatives, see case study 2.

A3, an adolescent with a West Asian background, linked the COVID-19 situation to her personal life and feelings about it over the last four years (Figure 14). The development from enjoying time with many friends before COVID-19, feeling isolated at home but getting to know the family better during the pandemic to making new friends and getting a deeper understanding of COVID-19 issues showed not only the personal journey of one participant but also highlighted the importance of distance and proximity.

Drawings—interviews in a nutshell?

The majority of children and adolescents created their drawing before the interview, often with the mother or other family members present; their drawings provided a snapshot of their COVID-19 associations. Two of the three children who drew the picture after the interview tended to summarize the interview (Figures 7, 10). The more abstract drawing by an adolescent of the COVID-19 measures (Figure 13) reflected his feeling towards wearing masks but otherwise had little to do with the personal interview, see case study 2.

Dominant issues emanating from the drawings and even more from the interviews revolved around loneliness, distance, and closeness to significant others. Both drawings and interviews highlighted situations and contexts in which proximity and distance were important to participants. The interviews created more depth and nuance and showed that life was not black and white, that the pandemic also provided the opportunity to try out new things, to spend more time with family and neighbours and in some cases to bridge the distance to far away relatives virtually. For some, it was a time for making new friends. Physical and emotional proximity thus did not have to correlate. Participants spoke affectionately of grandparents or the wider family, who were physically distant. At times, they spoke of parents telling them off or their quarrels with siblings, thus highlighting conflict with physically close family members. While the family abroad played a role in many of the interviews, it is interesting to note that they were not the subject of the drawings. More immediate concerns were mostly the subject matter of the drawings.

In the interviews, children and adolescents also talked about their vision for handling future epidemics, a theme not reflected in the drawings. The most salient issue was to meet with significant others. Other suggestions ranged from being able to go to school and move around freely, less distance-keeping, and having access to thinner masks and better internet connections to virus elimination.

We will highlight the connection between drawing and interview by presenting four case studies that reflect salient themes from the interviews and drawings (for all mind-maps of drawings and interviews, please see annexes S1C1 to S13A5). Case study 1 shows the increasing anxiety of a girl who is highly empathetic with family and friends and suffers from having to keep distance from friends and family abroad. Case study 2 highlights resilience and adaptation to a new situation by seeing the bright side of the COVID-19 situation, which also emerged as a more prominent theme in male participants. Case study 3 elucidates the process of growing up, re-evaluating priorities at different points before and during the pandemic, and appreciating parents and family more. By contrast, case study 4 showcases the struggles of an adolescent for whom life has already got enough challenges without COVID-19: puberty and identity issues including colour of skin. COVID-19 seemed to function as a background motive, if it played any specific role at all. In case studies 2 and 4 the drawings differed from the main themes of the interview as will be pointed out in more detail.

Please note that all names in the case studies have been changed to protect the identity of the children.

Case study 1 – Rebecca’s life changing from being a happy to being a concerned child

Rebecca’s mother is originally from a Western European country—when Rebecca speaks of her relatives on her mother’s side, she uses the term “family” which specifically refers to the relatives abroad.

The meeting with Rebecca took place after school in an open space in the city. Her siblings and mother were also there, but the interview was conducted apart from them. Her story starts with being a happy and carefree girl before COVID-19.

No worries at all; I would just get ready for school. I would very happily see friends. I’d go to class and be happy about it (…) And like, I could always like, I could always like see my family, so like if they wanted to come, they could always come. And it was just really nice cause I would have no worries about anything that could happen. And it was just a normal life and I didn’t know really what was coming. (voice drops)

The interview highlights fear of the virus, confrontation with sickness and death and having to keep distance from people important to her.

I was like a few months, maybe like a few weeks in first class and then, like when Corona came and I was like little, I was seven, and it was just really hard cause I never knew about being sick yet. When I looked at the news once, I saw how a family had gotten Corona and died lately [shortly] after that, and I didn’t know what it was and didn’t know how to deal with it. (soft spoken) It was just hard for me (…)

And I thought to myself: “Is this, is (it) going to be like this for a few months?” And in the end, it was like years. It was like two years. And now it’s nearly three. So, I felt bad because I couldn’t see my friends, because I had just made friends. And I couldn’t see them.

She also describes being concerned and scared for other people, particularly, her relatives abroad.

I:

Were you scared for yourself?

R:

No, I was scared for my family. I was scared because my family lives in (name of country), which is far away, and I didn’t know anything about them, how they were doing, about their life. At that time, they had gotten (name of cousin), I think. She is my cousin and we hadn’t seen each other for a year and then not to be able to see each other (…) When I didn’t see my family, I got scared and saw that we had a pandemic. Sometimes I would call my friends and they said, they were also shocked because they couldn’t see anyone yet anymore. So, it was just really scary.

Rebecca brought up the fear of the virus when speaking about online-schooling. “… we did have those sessions but like only in second grade … we would have face-times and say: ‘hi guys’ (high-pitched voice). They would always be like at home and someone would have Corona, and it was freakish.”

She found communicating via phone or electronic media not a viable strategy for her to overcome the physical distance to friends and described the virus as putting fear in herself and her friends:

Well, I guess, we made phone-calls or like I would ask the teacher if we could like have three minutes on the camera together but it didn’t work cause the parents were very strict, because they wanted their kids to be good at school. When the pandemic stopped, well, it has not stopped but when it got better, I could see them (voice higher) but only a little bit at the time. I asked my friend how she was, and she said, it was freaky for her because like barely anyone knew about Corona at the time. She went: “Dad, can I go and see my friends today?” And he would say: “No, we can’t. Sorry!” And she would be like: “Why?” And he would say: “There’s this thing around. And it’s not healthy.” And she would be like confused, scared and not really in the mood with those type of things. Cause when you are a kid, you don’t really, you don’t know what sickness is. It’s a burden for all of us.

She appreciated the re-opening of schools, but distance measures and mask-wearing was hard: “I couldn’t even hug my friends anymore. I would just be at a distance and say ‘hey’ (in high pitched voice) from far away.” While she missed her friends, she was aware that this period was difficult for others in her family and empathized with them.

Those times, I lived somewhere else, like I lived close to my friend’s house it was like – chip - and you were there. And then I would look out there and think: “Oh, I wish I could just be out there.” And like, and I would do my homework, and I would struggle, because sometimes I need help and there was like no-one. Well, my parents were there. I felt like, my brother was not even at school yet, he didn’t have anyone to play with because I was so busy.

Rebecca appears mature for her age, a socially aware person who can express herself well verbally. Comparing the interview with her elaborate drawing (Figure 10), which she furnished after the interview, the scientist in the drawing may have been an afterthought by her bringing in the necessary distance to a virus that she felt threatened by, as she did not mention a scientist in the interview. In both the interview and the drawing, proximity and distance were clearly dominant themes together with the fear of the virus. The empathy she felt for others—the brother who had nobody to play with, her friends who were also scared—came out more strongly in the interview compared to the drawing. The interview provided more background on her life before COVID-19 and how it changed during the pandemic.

Case study 2 – Tom engaging in new activities during COVID-19 times

Tom’s parents originally come from another Western European country. The interview was conducted in Tom’s own room. The first author wore an FFP2 mask in order to protect the family; despite disliking masks, as it emerged in the interview, Tom decided to wear one, too.

Tom likes reading manga comics and furnished own drawings of comic figures and animals that he showed the interviewer. He felt that COVID-19 and COVID-19 restrictions other than mask-wearing were tolerable. He also discovered that home-schooling was not so bad since there were no tests and one could do other things alongside virtual school meetings:

During the, ehm … Zoom meeting, I wanted to only play a video on the computer, and then I was told off because my parents found out and then I stopped but then it was really boring, the lesson. And because our teachers were not really very … very technically inclined, they didn’t know the functions and so on.

He explains that he got a computer when home-schooling started in fourth class and quickly learnt how to use it: “I could use the computer much better than my mother (…) but my father is still better than me”. Virtual schooling also offered new opportunities for cheating:

R:

Once it was funny: we had to learn a small French text by heart and then I could put the text below the camera and. Just read it (…) The other day, I talked with my friends; we talked about how funny it was during COVID-19 times, when you didn’t know the answer and you pretended as if you could not speak.

I:

How did you do that—did you mute yourself or not put on the mic or how did you do that?

R:

No, I put it on but then I only pretended to speak (moves his lips without making a sound)

The virtual world also offered the opportunity to meet with his friends and so being at home did not mean being isolated: „in fourth class, we met at 6 pm on Skype, watched YouTube and talked.” It further offered new opportunities to spend time together with far away relatives:

R:

So, with my grandmother, we wrote books together.

I:

You wrote books together? How did you do that?

R:

We wrote little books on the computer.

He also recounts playing chess with his grandfather on the computer. With his friends he produced a film about a cannibal showing further creativity in COVID-19 times. Moving house during this time also meant that he could see his friends more often than before—a change that may have had nothing to do with COVID-19 but made the time more pleasant as they could meet outside. When he contracted COVID-19, he said it was fine, “because one had a lot of time, that was good, we watched two films every day (laughs slightly). (…) And a friend of mine also had COVID-19, so we could play computer games together.” During his leisure time, he didn’t play much with his younger sisters, but liked playing video games, listening to music and drawing. He showed some drawings of comic figures and animals to the interviewer who commented “They look super! Better than the ones in the comic”.

Tom also mentions both parents working from home: “there were some days, where it was good and some that were not so good, it. was quite relative”. The good days consisted of watching TV series together, on the bad days, one had to keep a low profile. “So, each wrong step you took, it was: ‘What are you doing?’ or something like that”.

Tom seemed to see mainly the bright side of COVID-19 measures and was contented to spend time online with friends and relatives trying out new joint activities and enjoyed meeting friends when possible. The drawing does not reflect much of the interview. As an adolescent and a gifted drawer, Tom had been asked to draw COVID-19 as a river with the barriers he experienced, see also S15. The picture he draw (Figure 13) was an abstract way of looking at the last 2–3 years of his life.

Case study 3 – Aya growing up

Aya is from a West Asian country. Her family moved to Germany eight years ago. All girls share a room. The interview took place in the living room. Aya depicts her gradual recognition of the severity of COVID-19. She first belittled it, then became concerned about her relatives abroad when she heard from her mother that an infection could be lethal. Aya speaks of her life as “before” COVID-19 and “after”. Before COVID-19, she depicts herself as an energetic girl, dancing, singing, bike-riding, spending time and having many friends, being outside all the time; with COVID-19, she became quieter, more phlegmatic—“then. I hardly did anything. I was only at home.“She did not enjoy home-schooling but liked watching YouTube videos.

Home-schooling was a mixed bag. She struggled to understand the teacher and classmates when they spoke fast or when there were technical issues with the microphone and was glad to be offered hybrid teaching sessions for direct feedback and help.

R:

So, me and my sister sometimes went to school because, that’s such a help, if that [online schooling] doesn’t work for you, then you can go to school (…) And then we always went to school, and then we just showed that [the homework] to the teachers. But the others also had online class. So, we still did online classes, even in school (…)

I:

And how was that for you?

R:

Very helpful, yeah. Because, I did the assignments in front of him and then he just checked them in front of, yeah in front of me, indicated the mistakes, said “write down this much, or the right ones” and stuff like that. (…)

I:

Did you have the feeling that this situation with online teaching or this smaller class changed something in terms of your motivation in class or your performance?

R:

Yes, because there were two, they are also really close friends of mine and then we always sat together and sometimes we did assignments together. That was really good.

Offering this extra service, the school not only made it easier for Aya and others who struggled with technical issues and perhaps language issues, it also helped cement friendships as they could meet in person and learn together.

In terms of COVID-19 measures she did not mind wearing a mask and was even glad at times that this created a barrier between people:

in sport, you are so close together and we did this exercise where we had to be all so close and I don’t like this to be so close together and with one’s mouth open and such things, I don’t like this. So, the masks have helped, and it was still COVID-19 times and therefore it is not good to be so close together. And, ehm. the masks were also good when we went to (a neighbouring city), there we also wore masks.(…) There are so many people there and then it’s good to wear a mask, because then we do not mix our breaths and so on, then it is good to wear a mask.

The mask barred people from invading her private sphere. COVID-19 was also a time of personal growth for her: reflecting more about what one says, treating others with more respect and having a closer relationship with the parents and the wider family. While she had little contact during the acute phase of COVID-19, she now speaks to relatives when her mother rings them. Part of maturing entailed becoming more cautious for her:

I think it’s good that I slowly grew a bit older, that I understood that no matter where you are, the world is not always so good. You have to be careful. But the way I was, I was never careful. I went somewhere, and I trust everyone, I trusted everyone. But now I am more careful. I don’t trust everyone, I don’t talk to everyone.

Similar to Rebecca, we see a progression from a relatively carefree girl to a girl who thinks a lot and has become more cautious, whether this was a result of growing older or being more at home during COVID-19 or a bit of both did not entirely become clear. Her drawing (Figure 14) which combines writing and reflecting about the four years (before and during COVID-19) shows this progression in simplified form. The interview brought out more nuances on home-schooling and relating to other people.

Case study 4 – Ike going through difficult times

Ike is from a West African country. Along with his mother and siblings, he moved to Germany a few years ago. The family lives in a small flat. Interviews were conducted in the living room which contained a kitchen space. At the beginning of the interview, Ike seemed to be in a joking mood, trying to entertain his older sister and mother with his answers, which led the mother to asking her daughter to leave the room.

In contrast to his seemingly joking attitude, Ike highlighted the monotony of life—“I wake up, I go to the toilet, I sleep again, I wake up (…), yes, it is just simple. Every day is the same.” It seemed senseless to him: “Normally, I just think how life sucks, how I would die. We all die, so it’s just useless.“He did not attribute this view to COVID-19 but rather seemed to be talking about life in general. Topics that preoccupied him were his sense of self, the experience of being a “brown” boy (Ike’s own words) in Germany and the meaning of life. He portrays himself as being different from others and having no feelings or empathy: “Like I said, I’m weird, I’m different, very different.” He also expressed his indifference towards COVID-19: “Positive… actually nothing. Nothing good, nothing bad also, because I have no feelings, so, everything is the same. (sighs) I don’t understand you. I don’t understand your question. (…) Nothing. Nothing, nothing because everything is the same.”

Even though he was willing to share his thoughts on COVID-19 beforehand, he appeared more reluctant to answer questions during the interview and maintained to not understand the interviewer’s questions. He did, however, underscore positive effects of COVID-19 measures: wearing a mask created personal distance and anonymity for him. His face could not be recognized and he would, therefore, be perceived as a “normal boy”, as a “human being”. Furthermore, hiding his face behind a mask was an advantage when he got into trouble:

Actually good. I can just [deal] with anything, wait, wait, I’ll say this simply. Okay, when I wear a mask and then I hit a boy by mistake and then I go away, a, and b, and the boys or the father of the boy follows me and I take off my mask and then I throw it somewhere and then I just, um, run away from this man on the side, but he doesn’t notice me because he only saw me with the mask. (…) That’s why it’s good.

Home-schooling did not bother him, “school is like school”. On the contrary, the physical distance and the use of virtual means of communication provided the opportunity to insult friends without having to face consequences. Yet, not seeing friends meant spending more time at home. The thrill of school closures soon gave way to being annoyed with his siblings and wishing to go back to school. He was particularly irked about the expectation to spend time with his baby brother.

And then after COVID-19 I had a brother. And then I found them all annoying, really annoying. More annoying than before. (…) Because they give me my brother all the time, say “Give”, I know, um, so I’m my sister (imitating sister): “Take the kid! You’re a boy, he’s a boy! You must together,” how do you say, um, bond? Um, tttt. “bond together” (…) Then it’s annoying.

When schools reopened, he also experienced the positive effects of socializing, e.g., the fact that two other boys of colour joined his class, and he enjoyed testing in school because it led to funny situations like seeing his class mates sneeze.

Towards the end of the interview, he shared other concerns related to the family’s social standing that seemed unrelated to COVID-19.

I:

Hm. Is there anything you would like to see done differently in the future regarding COVID-19? (…)

R:

That I have a huge room, my own room, so that I don’t have to pass through here all the time. (…) Oh yes! And money, money, money! I want a job. (…) I want to buy something without my mother noticing.

The topics Ike addressed involved conflicts with friends, struggles with identity and life in general as well as financial concerns and the wish to be more financially independent from his mother. While the interview revealed his personal experience and reflected the reality of an adolescent boy going through puberty for whom COVID-19 was secondary to other concerns, Ike’s drawing of an ambulance and hospital (Figure 12) illustrated severe COVID-19 outcomes but did not reflect his own experience, as he did not know anyone who had been severely affected by the pandemic.

The four case studies showcase experiences of children of different ages, gender and backgrounds who are affected by COVID-19 and the measures in different ways. Rebecca, Aya and Ike felt home-schooling to be a burden for differing reasons ranging from finding it hard to study alone or to understand the teacher or the tasks to being annoyed by one’s siblings and being bound to the house. Tom, by contrast, highlighted innovative joint internet projects with friends and relatives which may not have happened without a lockdown and home-schooling. COVID-19 precautionary measures were also viewed differently. While Rebecca and Tom did not like wearing masks, Aya appreciated the fact that masks created a distance to people she did not want to get close to, and Ike liked hiding behind the mask as it obscured his identity; Ike also found testing an amusing activity in observing others. In Ike, we see adolescent concerns with identity and independence as well as issues of racism playing a bigger part than COVID-19 measures; Aya shares her growing up experience through the COVID-19 period which made her feel closer to her parents. Worries about her family abroad and others threatened by this virus with possible sickness and death had a torpefying effect on Rebecca who lost her happy and carefree way of looking at life. COVID-19 thus made children grow up more quickly by having to resort to their own devices and being confronted with issues that they may have been protected from for longer without the pandemic.

Discussion

This qualitative study explored children’s and adolescents’ retrospective narratives on their experience of COVID-19 and precautionary measures through drawings and semi-structured in-depth interviews. It highlighted the impact of COVID-19 measures (school closures and the shift to online schooling in particular) on children’s lives and relationships. Major themes from interviews and drawings evolved around perceived changes in proximity to and distance from significant others such as friends, classmates, teachers, parents and siblings, and the extended family.

The terms “proximity” and “distance” can be perceived on emotional or physical levels (Pediconi et al., 2021). Some studies show that increased physical proximity to others, such as parents, siblings, and neighbours, can increase emotional intensity and intimacy (Hopkinson & House, 2021; Van Boven et al., 2010), although intimacy can also be experienced negatively (Hopkinson & House, 2021). A personal feeling of “emotional proximity” (Pediconi et al., 2021, p. 32), perceived, for example, towards friends or extended family, can remain despite increased physical distance. Some adolescents managed to create emotional proximity with far-away family members through joint internet activities or phone calls during the pandemic. By contrast, for younger children, the internet or the phone was not a viable option for keeping in touch and bridging the physical distance to friends, teachers, classmates, or far-away family members. The categorization of these virtual interactions as “not real” because one could not touch others and not play together in person is also reflected in a French Canadian COVID-19 friendship study (Larivière‐Bastien et al., 2022) and echoed in a recent psychotherapy study (Benzel & Graneist, 2023). Meaningful interactions necessitated spending physical time together. Thus, neighbours and siblings replaced friends as playmates for study participants during COVID-19 restrictions, showing the importance of physical proximity. The significance of siblings has been described in other studies (Pediconi et al., 2021; Pelletier et al., 2021); Prime and colleagues underscored the key role of sibling relationships in situations of isolation from significant adults, such as grandparents or teachers (Prime et al., 2020). Although siblings and neighbours are perhaps not the first choices of a playmate for all children due to age or interest differences, they were physically available, whereas friends were not.

Participants in our COVID-19 study predominantly struggled with distancing measures, home-schooling, and loneliness. The perceived incision caused by COVID-19 elicited changes in emotional or behavioural traits in some children from being happy and extroverted to becoming more introspective, reflexive and concerned, as shown in case studies 1 and 3. This was also reflected in other studies that highlighted changes in children’s physical, mental and behavioural health (Ravens-Sieberer et al., 2021; Tso et al., 2020; Ye, 2020). Nevertheless, some children quickly adapted to COVID-19 as a new reality and reported more neutrally on positive and negative changes. Differing attitudes and experiences relate to different levels of resilience that children show in crisis or disaster situations.

Children’s resilience in a multi-system

Employing a multi-system approach, we see children and adolescents as individuals in relationships with significant others that extend beyond family and friends to the school environment and beyond. In addition, children and adolescents were directly exposed to and aware of COVID-19 related government policies and measures. This multi-system approach (Masten & Motti-Stefanidi, 2020) based on the socio-ecological model has been captured in Figure 1.

Cascading effects (Masten & Motti-Stefanidi, 2020) could be recognized across various interlinked contexts: Mandatory COVID-19 regulations as part of the socio-political context impacted on the school, the family and interpersonal context. A lack of movement and increased virtual time, the inability to visit one’s friends and extended family, the perception of significant others, such as a newborn sibling or family abroad, as being unsafe (case studies 1 and 3) constituted cascading effects. Interviews and drawings reflect the immense strain that especially scholastic measures (school closures and the home-schooling situation, including online classes) generated for children and adolescents. The negative cascading effect of school closures was experienced more strongly in cases where the school environment was very important for the individual in maintaining proximity to friends, classmates, and teachers and thus resulted in a discontinuation of life as one knew it (see case study 1). Yet, children and adolescents responded differently to the school-related COVID-19 measures in terms of showing resilience. Gender, age, own attitudes and resourcefulness, the upkeep and strength of relationships with significant others (family and friends) and a school support system seemed to play a role in this regard as has been shown in other studies (Martinsone et al., 2022). Positive experiences included spending more time with one’s family (Christner et al., 2021), sleeping in, seeing the friend next door more often, having more access to uncontrolled use of the internet and less school work (see case study 2) or being allowed to join hybrid classes physically (case study 3). Those who seemed to adapt better to the situation could draw on (the extended) family, friends, neighbours, and teachers through new routines and activities. These results align with other studies which found individual and interpersonal activities and their flexible adjustment to the circumstances to be relevant resources for children’s resilience during COVID-19 (Chen & Bonanno, 2020; Gayatri & Irawaty, 2022; Haffejee et al., 2023).

Case study 4 illustrated that facing other struggles may appear as if COVID-19 has less of an impact. While the emotional preoccupation with issues seemingly unrelated to COVID-19 might be a factor for reduced emotional intensity towards life changes associated with the pandemic (Van Boven et al., 2010), it could also be seen as making adolescents with pre-existing issues more psychologically vulnerable. Other studies have highlighted the greater likelihood of psycho-social problems for lower-income and migrant families (Ravens-Sieberer et al., 2021; Tso et al., 2020). This should be noted for future interventions. However, psychological problems reported in our study seemed to also stem from exposure to media reports, shared family views, and deep-felt concerns for others. This was irrespective of the family’s income. Psychological concerns in our study were linked to migration predominantly in terms of a concern for family members abroad, whom one could not visit in a pandemic rather than the participant feeling disadvantaged in a German context, which was a minor issue in our study.

Children’s drawings enriching interviews

Asking children and adolescents to draw their experience of COVID-19 and COVID-19 measures in addition to their verbal statements was based on various considerations: children’s familiarity with drawing as opposed to talking to an adult stranger, giving children space to express their own view without adult interference, and seeing them as “social actors in their own right” (Mitchell, 2006, p. 60). The drawing further eased the way into the interview by forming a relationship with the child (DiLeo, 2013) and added another dimension to the interview, as Diem-Wille’s study with managers showed (Diem-Wille, 2001). A Polish study found that children’s drawings on their first communion did not reflect children’s emotions but focused on “distant, safe and noncommittal” objects (Stokrocki & Samoraj, 2002). In our study, we noted that a number of participants drew self-portraits in a (home-)schooling situation which highlighted isolation and physical distancing with some adding emotions through words and facial expressions. Others drew more general images such as the virus itself, a hospital or the COVID-19 “river” being blocked by mask-wearing or testing (see Figure 13). As in the Polish study, these images did not by themselves reflect the drawer’s emotions or attitudes to the measures.

We found that children’s explanations of their own drawings and a consideration of their situational and socio-cultural environment (Billmann-Mahecha & Drexler, 2020) provided for rich data, especially when interviewing children in their home situation. While some authors acknowledge the limitation of not considering children’s own explanations of their artistic work (Darbyshire et al., 2005), others point out that even where asked, not all children expound on the drawings in minute detail (Mitchell, 2006). This tallies with our experience where children explained their drawings but mostly without providing dense accounts. The interview in general, by contrast, shed more light on the child or adolescent’s general experience of life and the COVID-19 measures. The combination of drawings and interviews enriched the understanding of children’s and adolescents’ experience with COVID-19.

Limitations

Our study has several limitations. The study took part in a phase of the COVID-19 pandemic (in the middle of 2022), which was not characterized by severe measures, so life had normalized to some extent. A recollection bias regarding when and how life had been before COVID-19 was evident, especially for younger children. Parents’ presence at some of the children’s interviews may have supported some but hindered other children from speaking freely; it further divided their attention between the interviewer and the parent. As the children often drew their pictures out of sight of the interviewer, we missed important information as to what was drawn first or what was erased or changed as we only saw the final work. While we managed to recruit many families with a migrant background and some with lower incomes, most of the parents held graduate degrees. They were thus better educated than the average family in Germany.

Conclusions

Our study highlighted the central importance for children and adolescents in Germany to spend time with significant others, particularly during the COVID-19 period. The nuclear family became the focus of their social life for a limited time and led to changes in the importance of siblings, neighbours, and parents. Our study also highlighted challenges in maintaining contact with friends, schoolmates, teachers, distant grandparents, and other members of the wider family. Physical and emotional proximity and distance did not automatically correspond: One could still feel close to family abroad and friends that one would not see very often. Creating proximity through joint virtual activities did only seem a viable option for adolescents, not for younger children.

Participants’ clear plea for maintaining social relationships with significant others was concretized in our study to allow social contact with a few close friends, keep schools open, and permit moving around without physical distancing. These social mitigation strategies echo the findings of other qualitative and quantitative studies (Christner et al., 2021; Idoiaga Mondragon et al., 2022) and should be considered for future epidemics within and beyond COVID-19. Further concrete optimizing measures could also alleviate burdens for children and adolescents, such as producing breathable masks and establishing faster internet connections.

In line with other studies, we conclude that it is crucial to include children’s perspectives in health research and health programmes (Amuyunzu-Nyamongo et al., 2011). While Amuyunzu-Nyamongo and colleagues suggested that “the children’s drawings and interpretation could be used in developing health education messages relevant to the communities” (Amuyunzu-Nyamongo et al., 2011), we stress the inclusion of children’s experiences and perspectives in informing policies for future epidemics, which, as the drawings and interviews showed, affect children and adolescents directly in their daily lives and development.

Author contributions

All authors have meaningfully contributed to the genesis and final version of the article. Conceptualization, TB, ABR; Data Collection, ABR, NB; Data Preparation, ABR, NB; Coding and mind-mapping, ABR, NB; Analysis, ABR, NB, KZ, JW; Interpretation, ABR, NB, KZ, JW, HH, LYL, TB; Writing—Original Draft, ABR, NB; Writing—Review & Editing, ABR, NB, KZ, JW; HH, LYL, TB; Visualization, ABR, NB, KZ, JW, HH, LYL; Supervision, TB, Funding Acquisition, TB.

Institutional review board statement

The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Heidelberg Ethics Commission (S-250/2022).

Informed consent statement

All participants were informed orally and in writing about the study and provided voluntary written consent. All children did so in writing their first name or, in some instances, their full names. The information sheet and consent forms used age-appropriate language for younger children and for adolescents. Consent was also obtained for the use of the children’s drawings in publications. All consent forms were signed by the children/adolescents and counter-signed by at least one of the parents as the legal guardians.

Acknowledgments

We express our sincere thanks to all study participants – children and adolescents – for sharing their experience with us. Further thanks go to Rasha Al Saie as well as colleagues at the Heidelberg Institute of Global Health for facilitating contact to eligible families in Southern Germany for this study, and to Mario Parstorfer for designing graph 1. Last but not least we would like to thank the anonymous reviewers for their insightful comments which helped to further improve the article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

According to the study protocol, the interview data can only be made available on reasonable request to researchers conducting research related to children and COVID-19.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17482631.2023.2271271

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The research was funded by the German Federal Ministry of Education and Research (BMBF) Network of University Medicines (NUM 2.0) through the CoverChild and Collpan programmes with the grant numbers D10021866 and D10021865. The Heidelberg Institute of Global Health also provided own means for conducting the study.

Notes on contributors

Astrid Berner-Rodoreda

Astrid Berner-Rodoreda finalized her PhD in October 2023 at the Heidelberg Institute of Global Health at Heidelberg University, Germany. She previously studied Social Anthropology and African Studies in Belfast and London (M.A., BA. Hons.) and worked for more than 20 years for a German development agency, primarily as global policy advisor on HIV. She has also worked as an anthropological consultant in Australia and as an instructor in social anthropology. Her current research interests include qualitative research in global health with a focus on gender and masculinities, innovative qualitative methods, implementation research on communicable and non-communicable diseases and health policies.

Nina Baum

Nina Baum is currently completing her Master’s degree in Social and Cultural Anthropology with a focus on South Asia at Heidelberg University. She is working as a research assistant at Heidelberg Institute of Global Health where she is involved in conducting qualitative research with children.

Kathrin Zangerl

Kathrin Zangerl is trained as a Specialist Pediatrician (Dr. med.univ.) and has a background in International Child Health. She is working as a researcher at Heidelberg Institute of Global Health in Germany and has a strong interest in conducting research with children, with a focus on qualitative methods and implementation design.

Jonas Wachinger

Jonas Wachinger has a background in Psychology (MSc) and Medical Anthropology (MA). He currently is a researcher at the Heidelberg Institute of Global Health in Germany where he focuses on qualitative design and implementation research.

Henriette Hoegl

Henriette Högl is a trained physician who specialized on child health for her doctorate. Since 2021 she has been the managing director of the association „Kindernetzwerk e.V. (knw), an umbrella body of self-help groups of families with chronically ill children in Germany. Her work involves patient-centred, cross-sectoral participatory care of affected children and families. Henriette shares her expertise in advisory bodies and in the context of research projects with children.

Lydia Yao Li

Lydia Yao Li (former Stuhrmann) is a trained psychologist (PhD, MSc) and a postdoctoral research associate at the Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Centre, Hamburg. Her main research interests include mental health in families, mentalization-related theories, parent-child relationship, social-emotional development and public health.

Till Bärnighausen

Till Bärnighausen is Alexander von Humboldt Professor and Director of the Heidelberg Institute of Global Health at the Medical Faculty of Heidelberg University. Trained as a medical doctor, he holds a PhD in the History of Medicine (1998), and in Population and International Health (2008) as well as MScs in Health Systems Management (2001), Financial Economics (2006) and Innovation and Entrepreneurship (2019). He is also full professor of Global Health at the Harvard T.H. Chan School of Public Health at Harvard University and senior faculty at the Wellcome Trust Africa Health Research Institute in South Africa. He has won numerous grants from NIH, the EU, the German Research Foundation, the German Ministry of Research and Innovation, USAID, WHO, UNAIDS, the World Bank and private foundations (e.g., Wellcome Trust, Else-Kröner Fresenius Foundation, Elton John AIDS Foundation, Clinton Health Access Initiative, Volkswagen Foundation, etc.). His research focuses on three areas: (i) establishing the causal impacts of large-scale global health interventions – such as HIV treatment, HIV prevention, and childhood vaccination – on health, economic and social outcomes; (ii) identifying and testing innovations to improve the delivery of global health interventions through public-sector health systems, and (iii) developing new methods for applied population-based health research. He has authored approximately 1000 publications.

Notes

1. Data from 2021, https://www.statista.com/statistics/1087303/number-of-children-per-woman-germany/ [accessed 24.11.2022]

2. the name of his brother in the top right corner was removed in order to protect the identity of the child.