Effects of Online School on Children's Health According to a Pediatrician

18 Feb 2022

The Covid-19 pandemic has affected the daily lives of everyone. Undoubtedly, one group of people that have been seriously affected by the situation are children. The consequences for them have many dimensions, both in the short and long term. According to UNESCO, schools in Bulgaria have been completely or partially closed for 47 weeks from the beginning of the pandemic to the end of December 2021. Despite the recommendations of the European Center for Disease Control (ECDC) that school closures should be used only as a last resort because the harms outweigh the benefits. Bulgaria was one of the EU countries with the longest e-learning period.

The closure of schools and sports halls isolates children in their homes and deprives them of the opportunity to communicate, learn effectively and play sports. If for businesses the lockdowns have only financial consequences, for children the limitation of movement and the increase of time in front of screens hide other risks. By learning about these dangers, one can be able to prevent them.

Effects on mental health

Psychiatrists and psychologists have tried to bring attention to the mental health of children in isolation numerous times. Last autumn, UNICEF published a large-scale study warning of the deteriorating mental health of children during the pandemic. A high percentage of children suffer from anxiety, irritability, and depression. They have difficulty falling asleep, close themselves off, tend to be irritable, and have difficulty talking. Kids became the silent witnesses of all the problems that the pandemic brought to their families, such as job loss, stress, domestic violence. The whole situation will leave a lasting mark on the mentality of many.

Weight problems

Due to the limitation of sports options for a long time and the almost complete absence of movement during distance learning, many children gained weight. Moreover, what made it even worse was the constant access to the fridge and the snacks cupboard. A big amount of children have become overweight, and some even obese. During online learning, pupils spend 7 to 8 hours a day in front of the screen. High weight in childhood is a major risk factor for obesity in adulthood, as well as all for the following problems - hypertension, type 2 diabetes, hypercholesterolemia, vascular issues. In addition to weight problems, many of them also developed vision problems. Ophthalmologists have repeatedly warned of the progression of near-sightedness in children as well as the dry eye syndrome, associated with e-learning and long staring at the screen, which puts a lot of strain on the visual system.

How to improve eating habits

If you notice that your child’s weight has increased excessively, you can follow some simple rules, which are also suitable as preventive measures for excess weight.

  • Don’t buy more than one snack a day. Children love to eat in front of the screen and often eat huge amounts of sweets.
  • Replace junk food with fruits and vegetables. Cut apple, carrot, cucumber into thin strips and put them in a cup. If your child loves potato chips, replace it with fruit chips, there are options in health stores.
  • Give your child soup or other liquid foods at least once a day.
  • Divide the plate into 4 as 2/4 of it is fresh salad, 1/4 carbohydrates (potatoes, rice), 1/4 protein (meat, egg, cheese).
  • Minimize juices and fizzy drinks because they have loads of sugar. Teach your child to drink water or kefir, and if this is difficult, offer fruit-flavored water.
  • Blend fruit and make shakes. Besides being healthy, they pretty filling too.
  • Involve the child in the cooking process, explain to them the various different ingredients, their benefits or flaws.
  • Eat all together, so the child follows your example.

Complications of poor posture

On normal school days, students spend recess away from their desks. However, during online school, this doesn’t happen as they use this time to catch up with friends online or to play video games. Prolonged sitting in front of electronic devices, especially in the wrong position as well as the lack of physical activity, are two major risk factors for prominent poor posture and the development of spinal deformities.

Delayed action on this matter can deepen the problem and lead to serious health complications such as kyphoscoliosis which leads to back and limb pain, herniated discs, respiratory and cardiac issues. Improper posture can cause muscle imbalance as a result of which the child ends up with a back bent. The spine bends forward, and the shoulders are tilted to the side.

Symptoms of spinal changes

The initial changes can be easily corrected with therapeutic exercises - games and motor control exercises. Well-trained, paravertebral muscles and a strong anterior abdominal wall prevent spinal deformities. Let our children walk upright and with their heads proudly raised. Here are the main signs of spinal problems to look out for:

  • The shoulders are not at the same level
  • The head is not straight, tilted in one direction or another
  • The two halves of the body are not symmetrical
  • When the child leans forward when viewed from the back, one side of the chest is higher than the other

As the distortion deepens, it is no longer a problem of the spine, but of the whole body. It affects the musculoskeletal, cardiovascular, and respiratory systems, and even mental health. Knowing the risk factors and making small but daily efforts can easily prevent, detect and correct minimal problems in child development.

How to prevent bad posture?

Our task as parents is to remind children to have a proper posture and to make them rest actively. Remind children to tighten their backs to correct spontaneous slouches. The shoulders should be symmetrical, the head and arms should not be tilted forward, and the pelvis should be in line with the shoulders. Remember that a constant slouched position can lead to curvature of the spine.

Make sure that the height of the chair and desk are appropriate for the child’s height. Poor ergonomics of the desk or chair may be a precondition for the child to take a more comfortable but incorrect position. The proper posture is for the child to be symmetrically positioned to the computer, not one-sided. The same goes for reading, writing homework, or eating. It’s important to include light exercise during in-between breaks. For example, the child can:

  • Arch their back up and down like a cat
  • Grab the left handle of a chair with their right hand and bend to stretch the back, repeat on the other side
  • Stretch their arms up
  • Bend their torso to both sides
  • Stand next to a wall while touching it with their head and shoulders and breathe deeply for 30-40 seconds.

Children learn from the example of their parents, so try to spend time together going on walks or doing outdoor sports. Ride a bike, rollerblades, or scooter, be their motivation for movement and sport.


All this information is only part of the whole spectrum of consequences for children related to isolation. It is no coincidence that in most European countries, schools and kindergartens have remained open, despite the introduction of strict restrictive measures. We must not forget that the main purpose of the virus is to spread, not to kill its host. This is one of the hypotheses why each subsequent Covid wave has a milder clinical course than the previous one and despite the high number of infected, a lower percentage of patients need hospitalization. I hope that the Covid pandemic will soon be behind us and that the only thing to remain from it will be the good habit for children to wash their hands.

Author: Dr. Tanya Andreeva, pediatrician & rheumatologist