Are My Kids All Right? Let's Ask the Pediatric Clinicians
Two years into the COVID-19 pandemic, the demand for psychological services is at an all-time high. At baseline, recent Center for Disease Control and Prevention (CDC) information shows the need was high - 21% of teens experienced a major depressive episode and 9% of children and adolescents experienced anxiety - even before the stress of the COVID-19 pandemic wreaked havoc on their lives. Emergency departments have seen a 24% increase in mental health-related visits among children ages 5 to 11, and 31% rise for children ages 12 to 17, according to the CDC.
It's a national emergency for children's mental health, declared The American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association in October 2021. The pediatric groups pleaded for policymakers to increase federal funding for mental health screening and treatment and strengthen suicide prevention efforts.
For children of color, the pandemic is having a disproportionate impact on their mental health, and they are less likely to ask for help than their peers, according to SAMHSA. Additionally, LGBTQ+ youth are four times as likely to attempt suicide in comparison to straight peers.
We asked Boston Medical Center’s Marilyn Augustyn MD, director of developmental and behavioral pediatrics, Jack Maypole, MD, primary care physician, and Andrea Spencer, MD, child psychiatrist to address the mental health concerns parents have as the pandemic continues to impact their children.
HC: Should parents of infants in childcare be worried that widespread mask wearing will delay the development of reading emotions and facial expressions?
Marilyn Augustyn, MD: The upper half of your face communicates a lot. Touch communicates a lot. How someone is holding that infant. What they're doing with them. How they're reading to them. All those things portray emotion, so I actually wouldn't be worried. Kids are sponges. They soak up every single thing. A 10-month-old is better at reading the quality of our voice that than someone in their thirties.
Jack Maypole, MD: We have a long-term sociological experiment going on in Asia, where for decades, people have been wearing masks. Kids are also taught to wear masks. We're just late to the party in that regard. We just don't see a giant developmental disordering in those societies. That should be very reassuring to all of us.
HealthCity: What signs of pandemic-related stress and anxiety should parents look for in children who are under 5 years old?
MA: In early childhood, stress and anxiety can play out in the extreme. Kids who were a little bit clingy may become clingier. They may have difficulty leaving the house or leaving their parents. Kids who were really active, constantly on the move, may become whirling dervishes. Or just the opposite: they may stop wanting to move or stop wanting to climb. But I would say the top symptoms that I'm hearing the most about from parents of young children are irritability, aggression, and clinginess.
I'm really worried about kids who went through toddlerhood into preschool during the pandemic because the whole goal of toddlerhood is mastery and independence. Some children weren't in childcare. Some children weren't in playgroups. How can you master anything or be independent if you never get to leave the house, and you never get to be around other kids?
Andrea Spencer, MD: We're seeing a lot more social withdrawal and sadness in young children. It's become normal to be less social or less interested in going out and doing things, because that's how they've grown up the past two years. Two years is a very long time for a young child, and most young children will not even remember what pre-pandemic life was like.
While the mental health effects of the pandemic are going to take time to resolve, we will re-establish a “new normal” for these young children. It may just take more time than we expect. It's about rebuilding a new normal for our kids that is going to take, probably, at least as long as the pandemic has lasted.
HC: How can parents talk with their child who may have friends struggling with serious mental health issues, even suicidal thoughts? How can that child know when to worry?
JM: Having a good dialogue between parent and child is foundational to everything else being successful. When a child can feel safe, heard, and seen, they're more likely to go to a caring adult who can help and coach them through complicated situations. Also acknowledging that this is hard for them and validate that. Help them understand that it's not their fault if something bad happens to their friends. Guilt is a powerful and self-destructive weapon when it's not managed.
AS: A teenager may think, "Oh, everybody is having these thoughts," but parents need to talk with them about how serious suicidal thoughts are, how somebody who's having those thoughts really does need the support of a mental health professional. Parents should tell their teen that they would want to know if they were having thoughts like that. Sometimes that thinking can become normalized in a friend group. Then parents really should make it known that this is something that you shouldn't deal with on your own.
I also think it’s a good opportunity to talk to teenagers about the National Suicide Prevention Lifeline. If they know about it, they can share it with their friends.
HC: How do you know if a teenager is showing symptoms of depression? For example, teens are known for sleeping long hours, but is trouble sleeping a symptom?
JM: Teens are continuously evolving and changing physiologically. Kids who used to get up with the birds easily sleep through lunch. And that would be typical. What could be troubling is if teens who used to be champion sleepers are now having trouble sleeping or staying asleep. A loss of enjoyment or engagement is also cause for concern. Primary care can be helpful in beginning the conversation and starting to get at what might be a depression diagnosis.
HC: You're a parent concerned about the mental health of your 18-year-old, who is now away at college after two years of pandemic life at home. How can you communicate with them if they are hesitant to talk about it?
AS: College students tend to get their medical and their mental health supports at home. When they go away to school, they no longer have them. While most schools have some level of mental health support on site, I've found that my patients in college access it much later than I'd like. So, I encourage students and their families to connect with those services early on, even if they're not worried about their mental health.
Another piece of advice for parents: use multiple modes of communication with a college student. Are you trying to talk on the phone but texting or emailing would be a more comfortable space for them to express those thoughts? Are you doing phone calls but a video call would feel more personal? Are you doing video calls but actually another mode would be more conducive to opening up? Consider all the options before making the connection.
If you or someone you know is having thoughts about suicide or a mental health crisis, you can call the National Suicide Prevention Lifeline 24/7 at 1-800-273-TALK (1-800-273-8255). In some areas, you can now dial 988 to be connected to the Lifeline.