Kelly Morse entered her 4-year-old son’s pretend doctor’s office one day last April and asked him how she was doing. She was taken aback when he examined her with his toy stethoscope and responded, solemnly, “Not well, you’ve got coronavirus.”

A few months later, he started to brainstorm how a COVID-19 vaccine might work, theorizing “that what we needed is a vaccine made of tiny alligators that could be injected into the blood to eat up all the coronavirus,” says Morse, a mother of two in Norfolk, Virginia.

Not all parents who engage in imaginary play with their children are getting diagnosed with COVID-19 or brainstorming outside-the-box vaccine ideas. But coronavirus-themed play is increasingly common as living with the virus is becoming a long-term reality for children in the United States.

When my own young children began their extended stay at home in mid-March, and we assumed that COVID-19-related shutdowns would be short-lived, their play remained largely the same as it had been pre-pandemic: They built fairy houses out of sticks and leaves, spent hours hammering nails into old scraps of wood and delighted in riding their bikes and scooters around our neighborhood.

As the weeks stretched into months, though, and the precautions and restrictions designed to keep our community members safe began to more directly impact my children, I noticed a shift in their play. There were still acorn factories in the backyard and Play-Doh bakeries on the kitchen table, but the workers at the factory began wearing masks, and the bakery became “curbside-pickup only.”

My 3-year-old sanitized his doll’s hands with an imaginary squirt of Purell after each outing to the backyard. And my 6-year-old reminded his action figures to remain socially distanced from one another as they went about their escapades.

Children respond to stress in different, individualized ways, but experts say that processing new and challenging situations through play is normal.

“Adults process stress verbally,” says Laine Young-Walker, the chair of psychiatry at the University of Missouri School of Medicine. “They’re able to talk to their loved ones about their fears and concerns. But young children don’t have that ability, so you’re more likely to see a behavioral response to stress or see the stressful or traumatic event coming into their play.”

A behavioral response might mean regression in sleep or toileting patterns, clinginess or a general irritability. And a play response might involve kids integrating stressful occurrences or reenacting stressful events in their everyday make-believe.

The specifics will differ based on the age and developmental stage of the child as well as their family’s norms and patterns. Preschool-aged children and children in the early elementary years will often experience a combination of behavioral and play-related responses to stress and trauma.

“While children may exhibit age-appropriate speech and language skills, they may require time and guidance to nurture their emotional intelligence or ability to monitor their own emotions and link these to preceding situations and resulting behaviors,” says Leela R. Magavi, an adult, adolescent and child psychiatrist and the regional medical director for Community Psychiatry, California’s largest outpatient mental health organization.

“Consequently, rather than directly speaking with their parents about sadness, anxiety and anger due to COVID-19, children may express their feelings by using their trusted toys.”

If a child has been most impacted by social restrictions related to the pandemic, they’re likely to mimic what they see in everyday life, such as masking, social distancing or temperature taking, in their play. “Enacting stressful events through play allows children to understand their emotions and gain a sense of security due to the ability to take control of the story and its ending,” Magavi says.

Children who have been more directly impacted or traumatized by COVID-19, say by the hospitalization or death of a loved one, might reenact the traumatic event as they saw or imagined it. Kids might act out imagined hospital scenes, death or a funeral, sometimes over and over, as they come to terms with what has happened and try to integrate it into their life experience.

As a child ages, their ability to verbalize their fears and worries typically matures. By the time children are in late elementary school or middle school, they’re often talking more about their fears and struggles, though they still may have behavioral responses to stress.

Magavi offers some basic advice for parents on how to respond to COVID-19-themed make-believe. Start by asking open-ended questions, she says. That allows parents to better understand what their child might be thinking or feeling without jumping to conclusions.

Some examples would be, “What are your dolls doing now?” or “How does your action figure feel?” Then move on to what Magavi calls “interpretive statements,” such as “It looks like your doll is feeling scared,” or “You seem sad when you’re taking care of your patients.” These sorts of observations help kids open up about their feelings.

It’s important to recognize that this sort of play is normal, and young children integrating scary or stressful things into play is actually a sign of healthy coping. “As long as the play is not interfering with their daily routine, and they’re able to maintain positive relationships with family members and accomplish the tasks they need to accomplish each day, there’s generally not cause for concern,” Young-Walker adds.

Parents also can offset environmental stress by creating a safe space at home and keeping routines in place as much as possible, says Nicole Beurkens, a child psychologist and author of “Life Will Get Better.” “Mealtime, bedtime and getting ready are important routines,” she says.

“The more that we can embed those pockets of consistency in a kid’s day and life, the more we can help them feel secure and in control.” Beurkens also recommends that parents try to create an opportunity for kids to exercise every day.

As the number of new COVID-19 cases continues to grow, and social conditions shift to reflect new precautions and responses, it’s likely that parents will continue to see the coronavirus make an appearance in their children’s imaginary games.

In addition to responding with curiosity and making themselves available for play, Young-Walker suggests that parents help their children develop tools to cope with adverse events. “Drawing, writing, reading, being physically active and engaging in mindfulness activities are all great options for children who are learning to cope with stress.”

In Morse’s case, her kids are having a tough time with the uncertainty surrounding a partial return to school, but they’re playing fewer games involving COVID-19. “Over time, they’ve played less about coronavirus,” she says. “I think it’s because being at home has been normalized more or less.”