Even before the delta variant of COVID-19 started sickening more children, doctors bemoaned the pandemic’s impact on youths. Now the American Academy of Pediatrics says doctors need to screen for a different set of symptoms associated with the coronavirus: mental and behavioral health problems.
If concerns or red flags are raised, the child should be assessed using evidence-backed tools.
The pandemic has amped up mental health challenges for children, including anxiety, depression, grief and loss, according to new interim guidance prompted by the emotional toll COVID-19 has taken on families. The academy notes that while all children have had their educations and family lives disrupted to some degree, as many as 40,000 U.S. children lost a parent to the pandemic.
“We were already experiencing a mental health crisis in our children and teens before the pandemic,” Dr. Lee Savio Beers, academy president, said in remarks announcing the updated advice. The crisis deepened in the pandemic. But Beers said that “many children can get through these hard times when they have a close and supportive relationship with an adult,” noting children show resilience when they’re appropriately supported, which can come from parents or other adults, including teachers and coaches.
“The impact of COVID-19 on the functioning of children and adolescents in this country is enormous,” Dr. Carol Weitzman, a developmental pediatrician at Boston’s Children’s Hospital and president of the Society for Developmental and Behavioral Pediatrics, told the Deseret News. She and two other experts wrote the academy guidance.
“The nation’s safety net was not great to begin with around children’s mental health,” she said. In COVID-19, “all of a sudden, it wasn’t there.”
Places where adults might normally pay attention and spot children’s challenges were closed, including schools, religious institutions and doctor offices. Weitzman said the number of children in crisis at emergency rooms, sometimes with suicide attempts, rose dramatically.
More emergency room visits don’t mean there were more suicides, she said, “but it means the kids were suffering, and there was nowhere to go. The amount of loss and trauma and grief that kids have experienced is huge. The amount of isolation, loneliness, the learning gap, the stresses on families are huge and they don’t go away just because we declare a pandemic to be over.”
Children’s emotional health is “tied closely to their parents’ well-being,” Beers said, while pediatricians are a “safe and supportive source for the whole family.”
Sometimes parents are overwhelmed, Weitzman said. “If parents don’t have jobs, or parents are struggling with substance use, their own mental health issues, violence in the home, food insecurity, housing insecurity, they don’t have the bandwidth to attend to their children’s well-being and emotional needs.”
The academy wants pediatricians to screen children, but also ask parents about the children's and their own well-being Doing it regularly will likely remove some reluctance to address issues that may not be as temporary as they seem.
A helping hand
The Aspen Institute recently teamed with sports management and communication software maker TeamSnap, Utah State University and Louisiana State University to survey how the pandemic impacted youths and also sports participation. The effort is part of its Project Play initiative, based on finding ways sports can “serve the public interest” — including boosting children’s mental health.
The survey also found children's mental health and well-being worsened since the pandemic began. More than half of parents reported a decline in both mental health and physical fitness. Additionally, 48% said their children had less emotional control, while 45% said their social well-being dropped.
“The amount of loss and trauma and grief that kids have experienced is huge. The amount of isolation, loneliness, the learning gap. And stresses on families are huge, and they don’t go away just because we declare a pandemic to be over,” Weitzman said.
She said teens tell people when they’re upset, but are often not heard because they may not use words to express themselves. “We have to listen differently.”
Appetite or sleep patterns may change. Kids can stop enjoying things they cared about. Signs of emotional distress include withdrawal, difficulty concentrating, less interest in school and family, mood and behavior changes and appearing to feel hopeless.
Adults can promote resiliency and well-being by providing coping strategies and boosting habits helpful to well-being, like sleep, exercise, exposure to nature and mindfulness, she said. But professional help may be needed.
Weitzman thinks kids need in-person school, but warns it has to be done thoughtfully so they are safe. Vulnerable populations, including kids in foster care, those with disabilities and children in low-income households may not learn well virtually or their families may lack needed digital tools, she said.
Schools should also screen for mental health, as older kids don’t see a pediatrician often, though screening is important when they do. The academy says children should be monitored at least yearly for behavioral issues and well-being, “We know that 1 in 6 kids have some kind of mental health problem. If you knew 1 in 6 had asthma, wouldn’t you screen for it? Of course you would,” Weitzman said.
Big circle of need
Many pediatricians need more training to do the job well. They have to know what they’re looking for and how to talk to families about findings and where to refer. It isn’t fair, Weitzman said, to add a large task to their job without more resources, help and reimbursement.
They need care coordinators, but they also need specialists to provide mental health care. She said some parents and doctors are reluctant to screen because Just 38% of schools report providing school-based mental health treatment and screening. Communities don’t have enough mental health experts and and waiting lists are “appalling.”
Challenges go far beyond individuals. Society has work to do.
Weitzman admits screening and care costs money, but said we already invest in ways that are expensive both in terms of money and human capital, by building prisons and court systems.