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Children’s Drawings of Coronavirus
Laetitia Martinerie, MD, PhD,a,b Delphine Bernoux, MD,c Lisa Giovannin-Chami, MD, PhD,d,e Alexandre Fabre, MD, PhDc,f
To understand how children perceive severe acute respiratory syndrome coronavirus
OBJECTIVES: abstract
2 (SARS-CoV-2) in relation to public representations and to evaluate their interpretations.
METHODS:Children’s perceptions of SARS-CoV-2 were evaluated by asking 103 French children,
aged 5 to 17 years old, first to draw a coronavirus and then to identify SARS-CoV-2 in a series
of 16 images during summer 2020.
RESULTS:One hundred three children were included in the study, either during outpatient visits
at the hospital (in Marseille and Paris) or through the authors’ social network, and were
grouped in terms of age, parents’ occupation, mode of recruitment, and recollection of having
previously seen a representation of a coronavirus. Half of the children drew the coronavirus
as circular in shape, and almost all included a crownlike feature. One-third of the drawings
had anthropomorphic features. Although the pictorial representations of the virus were fairly
accurate overall, the children’s interpretations of the crownlike structure were imaginative.
The explanations the children gave for their drawings were in some cases surprising. Among
the 16 pictures they were shown, the children correctly identified those of SARS-CoV-2, other
than the electron micrograph, in more than two-thirds of cases.
CONCLUSIONS: Children of all ages, even the youngest, and both sexes had a relatively accurate
perception of SARS-CoV-2, as evaluated through their drawings and their ability to recognize
it among other pictures. The children’s drawings of the coronavirus were colorful and had a
less frightening tone than expected in the light of media coverage, suggesting that they had
developed coping mechanisms.
a
Pediatric Endocrinology and Diabetology Department, Robert Debre Hospital, Assistance Publique–H^opitaux de WHAT’S KNOWN ON THIS SUBJECT: The SARS-CoV-2
Paris, Paris, France; bUniversite de Paris, Paris, France; cPediatric Multidisciplinary Department, Timone Enfant pandemic and the school closures and lockdowns that
Hospital, Assistance Publique–H^opitaux de Marseille, Marseille, France; dPediatric Pulmonology and Allergology
have been imposed to control it have dramatically altered
Department, H^opitaux Pediatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France; eUniversite de
Nice-Sophia Antipolis, Nice, France; and fINSERM, MMG, U1251, Aix Marseille Univ, Marseille, France children’s lifestyles across the world. To our knowledge,
children’s representations of SARS-CoV-2 have never
Drs Martinerie and Bernoux conceptualized and designed the study and collected data; Dr previously been studied by analyzing their drawings.
Giovannini-Chami collected data; Dr Fabre conceptualized and designed the study, designed the
data collection instruments, collected data, performed the statistical analyses, and drafted the WHAT THIS STUDY ADDS: Our study suggests that
initial manuscript; and all authors and reviewed and revised the manuscript, approved the final children, even the youngest, had fairly accurate
manuscript as submitted, and agree to be accountable for all aspects of the work. perceptions of SARS-CoV-2, both in their drawings and in
their capacity to recognize it among other pictures.
Data, the statistical code, questionnaires, drawings, and technical processes are available from
the corresponding author. The sources of the pictures shown to the children and all the data
collected are provided in the Supplemental Information. Dr Fabre affirms that the article is an
honest, accurate, and transparent account of the study being reported; that no important
aspects of the study have been omitted; and that any discrepancies from the study as planned
have been explained.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships
relevant to this article to disclose.
FUNDING: No external funding.
To cite: Martinerie L, Bernoux D, Giovannin-Chami L, et al.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts Children’s Drawings of Coronavirus. Pediatrics.
of interest to disclose. 2021;148(1):e2020047621
DOI: https://doi.org/10.1542/peds.2020-047621
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PEDIATRICS Volume 148, number 1, July 2021:e2020047621 ARTICLE
Although children tend to have study how children depicted the whether the children remembered
milder forms of coronavirus disease coronavirus in relation to public having seen a coronavirus (in a
2019,1 the pandemic and the representations and to evaluate picture, movie, video, etc). Children’s
lockdowns imposed to control it their interpretations of the perceptions of SARS-CoV-2 were
have dramatically altered their pandemic. The objective of the study evaluated in 2 ways. They were first
lifestyles and well-being.2,3 School was to evaluate children’s asked to draw a coronavirus in a
closures have severely limited knowledge and understanding of 170 160-mm frame. The children
children’s social interactions. In SARS-CoV-2 through their drawings. were given the following written
France, schools were closed for 2 instructions: “Draw a coronavirus,
months in spring 2020, and the METHODS as you imagine it, without any
lockdown has since been replaced In the following sections, the term model or example (draw it large
by specific infection prevention “coronavirus” refers to the enough, even if it really is very
measures and general unease, children’s representations, whereas small).” They were invited to
notably in schools, where the “SARS-CoV-2” refers to the virus comment on their drawing. For the
wearing of face masks is mandatory, itself. second evaluation, they were shown
hand-washing is performed at a series of 16 images simultaneously
regular intervals, and physical Participants and were asked to indicate which
distancing rules include a ban on Children aged 5 to 17 years were images represented a coronavirus
direct contact, even for the youngest recruited either during outpatient (by circling them) and which did not
children. These new behavioral visits to 2 pediatric hospitals in (by crossing them out) or if they did
requirements have all arisen France (La Timone Enfants in not know. The 16 pictures were the
because of an invisible threat that Marseille and Robert Debre in Paris) red and gray three-dimensional (3D)
children may struggle to or through the authors’ social illustration of a SARS-CoV-2 virion
conceptualize. One way to help network. released by the CDC; a black
children make sense of difficult bacteriophage; a brown bat; a silver
concepts is through drawing: “S’il Participants were recruited from sardine; a cartoon picture of a green
vous pla^ıt … dessine-moi un mouton!” July 15, 2020, to August 31, 2020. anthropomorphic coronavirus
asks The Little Prince in the famous particle; a black and white electron
novella.4 Drawing is a natural and, Procedure microscopy image of an HIV virion;
perhaps, the most fundamental form Children were enrolled in the study a brown pangolin; a purple and blue
of human expression and can be after they and their parents had 3D image of a SARS-CoV-2 virion; a
used to explore concepts and provided informed consent. The red and blue 3D representation of
experience, to promote self-analysis purpose of the study, as explained an HIV virion; a green olive tree; a
and dialogue, and as an investigative to the children and their parents, brown and green 3D illustration of a
tool.5,6 Illustrations of severe acute was to evaluate the children’s SARS-CoV-2 virion; a black and
respiratory syndrome coronavirus 2 understanding and representations white electron microscopy image of
(SARS-CoV-2) have been a of SARS-CoV-2 through their a human papillomavirus (HPV)
ubiquitous feature of the drawings and their ability to virion; a blue on red background
coronavirus disease 2019 pandemic, recognize images of the virus. electron microscopy image of an
as exemplified by the widely Ebola virus particle; a gray and red
reproduced image released by the Separate consent was requested cartoon picture of a SARS-CoV-2
Centers for Disease Control and from the children and their parents virion; a red on yellow background
Prevention (CDC).7 Drawing can be to publish their drawings. The 7 electron microscopy image of a
used to give shape to the virus8 and parameters recorded were Salmonella typhimurium bacterium;
grasp the realities underlying the department (departement) of a red, yellow, and green on black
pandemic. On the other hand, residence; mode of recruitment; background electron microscopy
Byrne9 found that young children whether a parent was a health care image of a SARS-CoV-2 virion; and a
seldom represent microorganisms worker; parents’ occupation, silver sardine. All images except for
accurately and often give them an categorized according to the Institut the cartoon representation of a
animal or fantastical appearance. National de la Statistique et des green anthropomorphic coronavirus
How did the children envision SARS-
Etudes
Economiques (INSEE) (the particle were obtained from
CoV-2 Was it still a natural object, French national statistics institute) Wikimedia commons (list and origin
or had it become more mythical? It occupational classification; self- in Supplemental Fig 5 and
therefore seemed interesting to reported age; self-reported sex; and Supplemental Table 3). These
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2 MARTINERIE et al
images were chosen either randomly Parameters were compared between the 101 French departments, mostly
among images representing SARS- 6 subgroups defined by sex (girl or from the areas around Marseille (35
CoV-2, randomly among other virus- boy), age (5–6, 7–8, 9–10, 11–12, children) and Paris (24 children),
es, because they were similar in and 13–17 years), parents’ with on average 5.2 children per
shape to SARS-CoV-2 virions, or be- occupation (health care worker or department (SD 7.4). The mean age
cause they had another factor in other), mode of recruitment (social of the participants was 9.1 years; 59
common with the virus. Finally, the network or outpatient visit), and (57.3%) reported their sex as male
children were asked to give their recollection of having previously and 44 (42.7%) as female. Thirty-
opinions of the questionnaire. No seen a representation of a five (33.9%) had a parent who was a
predetermined time limit was im- coronavirus (yes or no). health care worker, and 38 (36.9%)
posed; the only restriction was on of the children were enrolled during
Statistical Analyses
the 5 colors used for the drawings: outpatient visits. Two hundred
black, red, green, yellow, and blue. Statistical analyses was performed parents provided their occupation
To avoid interactions between par- with R (http://biostatgv.sentiweb. (Table 1). The distribution between
ticipants (in particular, between sib- fr/) by using nonparametric tests INSEE categories differed
lings), the instructions were given (Wilcoxon rank test and Kruskal- significantly from that of the general
and the tests were conducted in a Wallis test). Results were considered population,10 both for the study
private area, and the children could statistically significant at P < .05. group as a whole (P < .001) and for
therefore not see the other drawings each of the subgroups considered
Patients and Public Involvement
or exchange with other participants (data not shown), except for
about what they wanted to draw. Parents could leave their e-mail outpatients (P 5 .14).
address (on a separate sheet to
Data Analyses preserve anonymity) if they wished The subgroups girl and boy, age
The drawings were analyzed by to receive the results of the study. (categorized into 5 subgroups: 5–6
using the method developed by They will receive an abstract written years old, 7–8 years old, 9–10 years
Reiss et al6 and used by Byrne.9 The in French for the layperson. old, 11–12 years old, 13–17 years
drawings were first analyzed old), children with at least 1 health
Ethical Approval
qualitatively to identify a set of care worker parent and other
characteristic features, and these This study was registered locally children, social network–enrolled
parameters were then analyzed under 20_265. All children and their children and outpatients, and self-
quantitatively (frequency and parents, or legal representative with reported antecedent of seeing a
percentage) in the drawings. The parental authority, provided representation of a coronavirus and
parameters considered were the informed consent to participate in no self-reported antecedent of
number of virus particles; body the survey. Because the study was seeing a representation of a
shape (circular, oval, humanlike, or completely anonymous and involved coronavirus did not differ
other); presence of a crown, defined no biomedical data, no ethics significantly in terms of age or self-
as a structure around the central committee approval was required reported sex. As expected, the
shape; when present, the under French law. children of health care workers
characteristics of the crown (lines, were more likely to have been
spikes, circles, mushroomlike, halo, RESULTS recruited through the authors’ social
or square) and whether it had a The results of the study are network (P 5 .011), and their
single (simple) or multiple presented in 4 parts: the parents’ occupational profile
components (complex); presence of characteristics of the study differed significantly from the rest of
anthropomorphic features; 3D population, the characteristics of the the study group (P < .001), as did
effects; main (>50%) color of the drawings, the results of the image occupational distributions of the
body (red, green, yellow, blue, black, identification tests, and, finally, the outpatient-recruited and social
or multiple); main (>50%) color of children’s assessment of the study. network–recruited subgroups (P <
the crown (red, green, yellow, blue, .001) (Supplemental Table 4).
black, or multiple); presence of text; Population
and presence of components other All eligible participants agreed to Characteristics of the Drawings
than the virus in the drawing. The participate in the study. One The median number of virus
children’s comments explaining hundred three children from 73 particles drawn was 1 (range, 1–60),
their drawings were analyzed families participated in the study. the most frequently occurring shape
qualitatively. The participants came from 20 of was a circle (52.4% of drawings),
PEDIATRICS Volume 148, number 1,Downloaded
July 2021 from www.aappublications.org/news by guest on September 17, 2021 3TABLE 1 Characteristics of the Children Enrolled in the Study
All 5–6 y Old 7–8 y Old 9–10 y Old 11–12 y Old $13 y Old P
n 103 19 31 20 19 14
Sex, male/female 59/44 11/8 16/15 10/10 11/8 11/3 .31
Age, y, mean (SD) 9.1 (2.8) 5.7 (0.5) 7.3 (0.5) 9.7 (0.5) 11.4 (0.5) 13.4 (1.4) .26
Way of enrollment, n (%) .11
Social network 65 (63) 13 (68) 23 (74) 12 (60) 9 (47) 8 (57)
Outpatients 38 (37) 6 (32) 8 (26) 8 (40) 10 (53) 6 (43)
Socioeconomic category of parents, n (%) .82
At least 1 parent a health care worker 35 (34) 8 (42) 10 (32) 6 (30) 4 (21) 7 (50)
Other 68 (66) 11 (58) 21 (68) 14 (70) 15 (79) 7 (50)
Socioeconomic category of parents according to INSEE, n 200 37 59 39 38 27 .17
1 farmers, n (%) 14 (7) 2 (5) 5 (9) 1 (3) 4 (10) 2 (7)
2 craftsman, shopkeeper and large retailer, chairman, 15 (7.5) 3 (8) 2 (3) 1 (3) 5 (13) 4 (15)
and managing director, n (%)
3 senior executive, managers, and higher intellectual 83 (41.5) 21 (57) 29 (49) 9 (23) 14 (37) 10 (37)
professions, n (%)
4 intermediate jobs, n (%) 49 (24.5) 7 (19) 16 (27) 15 (38) 6 (16) 5 (19)
5 low-grade white collar, n (%) 21 (10.5) 4 (11) 0 8 (20) 6 (16) 3 (11)
6 blue collar, n (%) 10 (5) 0 3 (5) 4 (10) 3 (8) 0
7 retired, n (%) 0 0 0 0 0 0
8 unemployed, n (%) 8 (4) 0 4 (7) 1 (3) 0 3 (11)
and 88.4% of the drawings featured extra drawn elements (in 6 cases, this 3). The other non–SARS-CoV-2 images
virus particles with a crown, the was a human being). Interestingly, were improperly identified as SARS-
majority of which (56.1%) had the virus was represented as the Devil CoV-2 in 70% of the children, the only explanations involved 5 main
drawings (12.6%) featured text exception being the electron themes. There were comments on
(mostly “coronavirus” or “the micrograph, which was only correctly the way they had represented the
coronavirus”), and 20 (19.4%) had recognized by half of the children (Fig virus itself: the coronavirus was
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4 MARTINERIE et alTABLE 2 Characteristics of the Drawings
5–6 y Old 7–8 y Old 9–10 y Old 11–12 y Old $13 y Old
All (N 5 103) (n 5 19) (n 5 31) (n 5 20) (n 5 19) (n 5 14) P
No. viruses represented, n (minimum to 1 (1–60) 1 (1–2) 1 (1–38) 1 (1–1) 1 (1–60) 1 (1–1) —
maximum)
Shape of the virus(es), n (%) .37
Circle 54 (52) 9 (48) 13 (42) 12 (60) 11 (58) 9 (65)
Oval 38 (37) 8 (42) 13 (42) 8 (40) 7 (37) 2 (14)
Humanlike (body) 5 (5) 1 (5) 3 (10) 0 0 1 (7)
Other 6 (6) 1 (5) 2 (6) 0 1 (5) 2 (14)
Body color, n (%) .73
Red 18 (17) 3 (16) 7 (23) 5 (25) 2 (11) 1 (7)
Green 27 (26) 3 (16) 9 (29) 4 (20) 4 (21) 7 (50)
Yellow 7 (7) 2 (10) 2 (6) 1 (5) 2 (11) 0
Blue 4 (4) 0 3 (10) 0 0 1 (7)
Black 11 (11) 2 (10) 4 (13) 2 (10) 3 (16) 0
Multiple 6 (6) 1 (5) 2 (6) 2 (10) 0 1 (7)
None 30 (29) 8 (43) 4 (13) 6 (30) 8 (43) 4 (29)
3D representation, n (%) 23 (22) 2 (10) 5 (16) 6 (30) 5 (26) 5 (36) .047
Anthropomorphic feature, n (%) 38 (37) 9 (47) 14 (45) 9 (45) 2 (10) 4 (28) .032
Elements drawn other than the virus, 20 (19) 4 (21) 6 (19) 2 (10) 5 (26) 3 (21) .86
n (%)
Text accompanying the drawing, n (%) 13 (13) 0 4 (13) 3 (15) 3 (16) 3 (21) .074
Maximum length of the drawing,a 83; 95.5 (44.8) 14; 101.1 (55.5) 21; 90.9 (41.2) 17; 100.9 (44) 18; 93.2 (46.6) 13; 89.8 (35) .95
n; mean (SD), mm
Presence of a crown, n (%) 91 (88) 18 (95) 25 (81) 18 (90) 17 (89) 13 (93) .78
If yes, n (%) .84
Simple 84 (92) 18 (100) 22 (88) 15 (83) 17 (100) 12 (92)
Complex 7 (7) 0 3 (22) 3 (17) 0 1 (8)
Shape of crown,b n 98 18 28 21 17 14 .61
Line, n (%) 13 (13) 3 (17) 3 (11) 3 (14) 2 (12) 2 (14)
Spike, n (%) 13 (13) 3 (17) 3 (11) 3 (14) 2 (12) 2 (14)
Circle n (%) 6 (6) 3 (17) 1 (3) 1 (5) 1 (6) 0
Mushroomlike, n (%) 55 (57) 8 (44) 15 (53) 12 (57) 11 (64) 9 (65)
Halo, n (%) 6 (6) 1 (5) 3 (11) 1 (5) 0 1 (7)
Square, n (%) 5 (5) 0 3 (11) 1 (5) 1 (6) 0
Color of crown(s), n 91 18 25 18 17 13 .30
Red, n (%) 16 (18) 2 (11) 5 (20) 1 (5) 5 (29) 3 (23)
Green, n (%) 29 (31) 6 (33) 8 (32) 5 (28) 6 (35) 4 (31)
Yellow, n (%) 7 (8) 1 (6) 1 (4) 2 (11) 1 (6) 2 (15)
Blue, n (%) 10 (11) 2 (11) 4 (16) 1 (6) 1 (6) 2 (15)
Black, n (%) 16 (18) 2 (11) 3 (12) 6 (33) 4 (24) 1 (8)
Multiple, n (%) 13 (14) 5 (28) 4 (16) 3 (17) 0 (0) 1 (8)
For purposes of clarity, parameters according to sex are not represented because they were never statistically different. —, not applicable.
a
Twenty of the 103 drawings were excluded from the size analysis because they had been done on a nonstandardized sheet of paper.
b
Seven drawings had >1 crown; therefore, the number of “shape of crown” (n 5 98) is larger than the number of drawings with presence of a crown (n 5 91).
compared with a millipede (by a function of the crown: the spikes 7-year-old boy and a 9-year-old
5-year-old girl), a mushroom (by a were qualified as sticky (by a 7- girl); as being evil (by 2 boys aged 7
9-year-old boy) and a porcupine (by year-old girl and and 9 years and 2 girls aged 6 and 9
an 11-year-old boy). They also 7-, 9-, and 10-year-old boys) and as years); as being mortal (by a 13-
commented on the way they had able to detect humans (by a year-old girl); as making people sick,
imagined the crownlike protrusions: 13-year-old boy), contaminate (by a incurable, or dead (by a 6-year-old
as tentacles (by a 10-year-old boy), 9 -year-old girl), or suck blood and boy); and as floating in the air (by 2
branches (by a 13-year-old boy), project bacteria (by a 7-year-old boys aged 7 and 12 years). One girl,
suction cups (by a girl and 2 boys boy). Finally, some children included aged 5 years, described SARS-CoV-2
7 years of age), mushrooms (by a more general considerations in their as being sad because it had lost its
7-year-old boy), and spikes (by an comments, mostly about the virus’s family, and one boy, aged 16 years,
8-year-old boy and 7- and 9-year- impact on humans. The virus was said that it had both negative and
old girls). The children also described as the “king of germs” (by positive aspects, two of which being
explained how they imagined the a 7-year-old boy); as the Devil (by a population reduction and improved
PEDIATRICS Volume 148, number 1,Downloaded
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The coronavirus drawings of 94 children of the 103 who participated in the study (9 did not consent to their drawing being published). The drawings are
arranged by age from top to bottom and left to right, with the youngest child’s drawing at the top left-hand corner and the oldest child’s drawing in the bot-
tom right-hand corner.
adherence to infection control answered that they were mostly red or green circle with a crown
guidelines in the general population. satisfied: 38 children found the composed of mushroomlike surface
Eight drawings showed the study good; 6, interesting; 4, easy; 3, projections. This is a good
coronavirus interacting with humans funny; 1, important; and 1 child approximation of the common
or the environment (Fig 4). Three of described it as extraordinary. Five representation of SARS-CoV-2
the 4 children who had drawn the children said that it was strange. particles in the media and in the
coronavirus interacting with humans Only a handful expressed a negative scientific literature. Moreover, with
commented that their aim was to opinion: 3 children found the study the exception of the electron
show the coronavirus being difficult, 2 did not like it. Finally, one micrograph, the 5 remaining
defeated or scared. child said, “Thank you to all the illustrations of SARS-CoV-2 virions
health workers.” were correctly identified by >70%
Children’s Assessment of the Study of the children. This suggests that
When asked about their assessment most of the children were aware of
of the study after completing it, 62 DISCUSSION the archetypal representation of
of 103 children expressed an A majority of the children in this SARS-CoV-2. Interestingly, although
opinion. Fifty-seven children study represented SARS-CoV-2 as a older children were more likely to
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6 MARTINERIE et albranches to detect its victims or “supervirus” either in discussions or
even pump for blood and bacteria to in the drawings themselves
go into or out of the virus. (superhero muscles, an actual
Furthermore, as reported by Byrne,9 crown, other viruses being rejected
the children did not clearly by the coronavirus, the king of
distinguish the virus from bacteria. viruses with secret weapons, or the
In contrast with Byrne’s9 findings, virus that blows up the Earth).
however, the representations were However, in the 4 drawings that
consistent with the accepted shape showed interactions between
of SARS-CoV-2, and no obvious humans and the coronavirus, the
animallike shapes were drawn latter was only shown in a
(whereas one-third of the threatening attitude in 1 case (and
FIGURE 2 illustrations in Byrne’s study had even in this case, the face mask is
Ages of children according to their drawings in animallike features). Some children present in the drawing, possibly as a
Fig 1. drew the mode of transmission support to fight the virus), whereas
(airborne) and infection protection in the 3 others, the coronavirus was
correctly identify the simple measures (hand-washing and face being chased away either with a
masks). face mask, hand-washing, or magic.
illustrations of SARS-CoV-2 particles,
they were less likely than younger One-quarter of the children drew
Viruses come in many different
children to identify the the coronavirus smiling, most
shapes and structures (spheres and
anthropomorphic representation as representations were colorful, and
rods, icosahedral, helical or complex
SARS-CoV-2, and only the oldest only 11% drew the coronavirus in
symmetries, enveloped or not).12
children identified the brown bat as black, the color typically used for
Among the non–SARS-CoV-2 images
SARS-CoV-2. This may be because negatively characterized figures.13 It
shown to the children, Ebola and
they confused the virus with its therefore appears that the children
bacteriophage, nonspherical viruses,
presumed animal source. Indeed, the seem to be relatively unafraid of the
were identified as SARS-CoV-2 in
children also identified the pangolin virus.
13 years
SARS-CoV-2 by more than half
than the other children did. of age are underrepresented. In
(64%) of the children, much less
Regarding the children’s illustrations addition, although all occupational
frequently, nevertheless, than were
of SARS-CoV-2, the differences in categories are represented in the
the 3D representations of SARS-CoV-
terms of 3D effects and study group, higher-level
2 itself (by 84.5%, 80.6%, and 79.6%
anthropomorphic features can be of the children). Similarly, the occupational backgrounds (INSEE
linked to the development of the electron microscopy image of HIV group 3, senior executives and
internal mental models associated was less frequently recognized as knowledge workers) were
with visual realism at 8 years of SARS-CoV-2 than was the electron overrepresented compared with the
age.11 micrograph of SARS-CoV-2 (5.8% vs general population, probably
48.5%, respectively). This suggests because recruitment was partly
Although the children’s overall that, as a rule, the children were through the authors’ social network.
pictorial representations of SARS- able to discriminate between However, because there were no
CoV-2 were fairly accurate, the representations of different viruses. meaningful differences between
different components of the virus subgroups (notably between social
were interpreted with imagination. Some children represented the network–recruited and outpatient-
The crownlike spikes, for example, coronavirus as the Devil or as recruited children, whose parents’
were imagined as suction cups; destroying the Earth, highlighting occupational distribution is more
arms, legs, feet, or tentacles to hang the frightening aspects of the representative of the general
humans; picks to contaminate pandemic, and some children population), our results can be
people or hurt the body; and described the virus as being a considered representative of how
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Supervised heat map representing the results of the identification of 16 images by the children of the study. Each column defines a figure that is shown at
the top. Each line corresponds to 1 child’s answers; lines are grouped according to age and sex. Blue characterizes the figures that were identified as
SARS-CoV-2 by children; red, those that were identified as non–SARS-CoV-2; and white, those that were left with no answer. The first 6 images starting from
the left are correct representations of SARS-CoV-2. The percentage of figure recognition as SARS-CoV-2 appears at the bottom of each column. As an exam-
ple, the first image, which represents SARS-CoV-2, was identified as so by 84.5% of the children.
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8 MARTINERIE et alFIGURE 4
Eight drawings showing the coronavirus interacting with humans or the environment and the descriptions given by the children. Drawing 1: an 11-year-old
boy drew the coronavirus as a giant black squid destroying the Earth. Drawing 2: a girl, aged 10 years, described the coronavirus as having been spilled
down onto the Earth by an airship. Drawing 3: a boy, aged 8 years, drew the coronavirus being exhaled through a man’s mouth. Drawing 4: a 13-year-old boy
drew the coronavirus alongside 7 icons representing (1) a computer running the software Zoom because “I studied using this application during lock-
down,” (2) a face mask “because it’s mandatory,” (3) the void as “what I felt during lockdown,” (4) a school report “because there were none,” (5) Netflix
“because I watched it during lockdown,” (6) a hamburger “because I ate those a lot,” and (7) a “thank you” message “for all health care workers.” Drawing
5: a 5-year-old girl mentioned that Aldebert (a French singer) could use his magical powers to make hair grow on the coronavirus. Drawing 6: a girl, 10
years of age, showed the coronavirus being killed by water. Drawing 7: an 11-year-old boy drew the coronavirus running away from a masked man and say-
ing, “Not the mask.” Drawing 8: a 13-year-old boy showed 2 humans with face masks fleeing the coronavirus and the word “important” written nearby.
French children perceive SARS-CoV-2. microorganisms (reviewed by pediatricians could use drawings as
The main limitations of our study are Byrne9) and is the first ever study a starting point to discuss the
that participants were recruited by of children’s representations of pandemic with children and its
convenience, potentially leading to a viruses. Thus, the results should be effects on them. This study could
nonrepresentative sample; that considered in light of its indeed be used as a basis for
participants included multiple exploratory nature. It is unclear, for further prospective studies. To
siblings, a possible source of bias; the instance, whether the results are better evaluate the psychological
ad hoc nature of the viral recognition specific to France or similarly effects the pandemic has had on
test; the descriptive nature of the representative of other countries or them, children could be offered
analyses; and the absence of populations. It is notable in this semistructured interviews to talk
semistructured interviews and of a context that even young children about their drawings, which could
deeper evaluation of the psychological identified the main characteristics
be analyzed qualitatively,
meaning of the drawings. It is also of SARS-CoV-2. It would be
potentially to therapeutic ends, as
important to remember that this interesting to use similar
described previously in other
study was realized after the first and experiments in schools to foster
traumatic contexts.14
before the second wave of SARS-CoV- children’s interest in biology and
2 infections throughout Europe. explain the diversity of viruses, but
they could also be used as CONCLUSIONS
This study is, to our knowledge, one compelling social and psychological We found that children of all ages
of just a handful focused on tools, particularly in the ongoing and of both sexes were able to
children’s drawings of pandemic. We think that depict and recognize SARS-CoV-2
PEDIATRICS Volume 148, number 1,Downloaded
July 2021 from www.aappublications.org/news by guest on September 17, 2021 9fairly accurately, probably because ACKNOWLEDGMENTS
of the massive media coverage of ABBREVIATIONS
We thank all the children and their
the pandemic. The children in this parents. We are grateful to Mathilde 3D: three-dimensional
study were also able to discriminate Bernard, Valentine Brunet, Dr Aline CDC: Centers for Disease Control
representations of SARS-CoV-2 from Cano, Adrien Chalancon, Ivan and Prevention
those of other viruses, animals, and Chevallier, Anaïs Corgier, Morgane HPV: human papillomavirus
bacteria. Qualitative analysis Duffosset, Dr Anne Fabre-Chalancon, INSEE: the Institut National de la
revealed that although the virus was
Statistique et des Etudes
Marion Gostinicchi, Dr Herve Caci,
in some cases represented as a
Economiques
Vean-Eng Ly, Daphnee Karila,
supervirus, the drawings were Benedicte Lachat, Pauline Perreard, SARS-CoV-2: severe acute
colorful and less frightening in tone and Lucille Tardy for their help respiratory
than expected, suggesting that the recruiting children. We thank syndrome
children may have developed a Sebastien Denis for computing the coronavirus 2
coping mechanism. Just as The Little drawings in a figure. Finally, we
Prince ultimately tamed the fox, thank Paul Guerry (Green Grow
drawing SARS-CoV-2 may help Scientific) for editing the article.
children better conceptualize the
virus and its consequences and thus
become less frightened of it.
Address correspondence to Alexandre Fabre, Pediatric Multidisciplinary Department, Timone Enfant Hospital, Assistance Publique–H^opitaux de Marseille, 264, Rue
Saint-Pierre, 13385 Marseille Cedex 5, France. E-mail: alexandre.fabre@ap-hm.fr
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright # 2021 by the American Academy of Pediatrics
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10 MARTINERIE et alChildren's Drawings of Coronavirus
Laetitia Martinerie, Delphine Bernoux, Lisa Giovannin-Chami and Alexandre Fabre
Pediatrics originally published online June 1, 2021;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/early/2021/05/28/peds.2
020-047621
References This article cites 8 articles, 1 of which you can access for free at:
http://pediatrics.aappublications.org/content/early/2021/05/28/peds.2
020-047621#BIBL
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Downloaded from www.aappublications.org/news by guest on September 17, 2021Children's Drawings of Coronavirus
Laetitia Martinerie, Delphine Bernoux, Lisa Giovannin-Chami and Alexandre Fabre
Pediatrics originally published online June 1, 2021;
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
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