Even before the delta variant of COVID-19 started sickening more children, doctors complained about the impact of the pandemic on young people. Now the American Academy of Pediatrics says doctors should screen for another set of symptoms linked to the coronavirus: mental and behavioral health problems.
If concerns or alarms are raised, the child should be assessed using science-based instruments.
The pandemic has magnified mental health problems for children, including anxiety, depression, grief and loss, according to new interim guidelines prompted by the emotional toll COVID-19 has taken on families. The academy notes that while all children have disrupted their education and family life to some degree, as many as 40,000 American children have lost a parent to the pandemic.
“Before the pandemic, we already had a mental health crisis in our children and teens,” said Dr. Lee Savio Beers, president of the academy, in announcing the updated advice. The crisis deepened into the pandemic. But Beers said that “many children can get through these difficult times if they have a close and supportive relationship with an adult,” noting that children show resilience when appropriately supported, which can come from parents or other people. adults, including teachers and coaches.
“The impact of COVID-19 on the functioning of children and adolescents in this country is enormous,” said Dr. Carol Weitzman, a developmental pediatrician at Boston’s Children’s Hospital and president of the Society for Developmental and Behavioral Pediatrics, told Deseret News. She and two other experts wrote the academic guidance.
“The nation’s safety net wasn’t great to begin with around children’s mental health,” she said. In COVID-19, “suddenly it wasn’t there.”
Places where adults would normally watch and spot children’s problems were closed, including schools, religious institutions and doctors’ offices. Weitzman said the number of children in crisis in the emergency room, some with suicide attempts, has risen dramatically.
More emergency room visits doesn’t mean there were more suicides, she said, “but it means the kids were suffering and they had nowhere to go.” The amount of loss and trauma and grief that children have experienced is enormous. The level of isolation, loneliness, the learning gap, the stress for families is enormous and they are not going away just because we declare that a pandemic is over.”
Children’s emotional health is “closely linked to their parents’ well-being,” Beers said, while pediatricians are a “safe and supportive resource for the entire family.”
Sometimes parents are overwhelmed, Weitzman said. “If parents are out of a job, or parents are struggling with substance use, their own mental health issues, domestic violence, food insecurity, housing insecurity, they don’t have the bandwidth to care for their children’s well-being and emotional needs.”
The academy wants paediatricians to screen children, but also ask parents about the well-being of the children and their own well-being. Doing it regularly will likely remove some reluctance to deal with problems that may not be as temporary as they seem.
A helping hand
The Aspen Institute recently teamed up with sports management and communications software maker TeamSnap, Utah State University and Louisiana State University to examine how the pandemic affected youth and also sports participation. The effort is part of the Project Play initiative, based on finding ways for sports to “serve the public interest” — including boosting children’s mental health.
The survey also found that children’s mental health and well-being have deteriorated since the start of the pandemic. More than half of the parents reported a decline in both mental health and physical fitness. In addition, 48% said their children had less emotional control, while 45% said their social well-being was declining.
“The amount of loss and trauma and grief that children have experienced is enormous. The amount of isolation, loneliness, the learning gap. And the stress for families is enormous, and they don’t go away just because we declare a pandemic over,” Weitzman said.
She said teens tell people when they are upset but often go unheard because they may not be using words to express themselves. “We have to listen differently.”
Appetite or sleeping patterns may change. Kids can stop enjoying things they care about. Signs of emotional stress include withdrawal, difficulty concentrating, decreased interest in school and family, mood and behavior changes, and appearing to feel hopeless.
Adults can promote resilience and well-being by providing coping strategies and encouraging habits that are helpful for well-being, such as sleep, exercise, exposure to nature and mindfulness, she said. But professional help may be needed.
Weitzman thinks children need personal school, but warns that it must be done carefully so they are safe. Vulnerable populations, including children in foster care, people with disabilities and children in low-income households, may not be able to learn well virtually or their families may lack the necessary digital tools, she said.
Schools should also screen for mental health, as older children don’t often see a pediatrician, although screening is important when they do. The academy says children should be checked for behavior problems and well-being at least annually: “We know that 1 in 6 children has some sort of mental health problem. If you knew 1 in 6 had asthma, wouldn’t you screen for it? would you do that,” Weitzman said.
Great circle of need
Many pediatricians need more training to do the job properly. They need to know what to look for and how to talk to families about findings and refer to. It’s not fair, Weitzman said, to add a big job to their jobs without more resources, help and compensation.
They need care coordinators, as well as mental health specialists. She said some parents and doctors are reluctant to screen because only 38% of schools report providing school-based mental health treatment and screening. Communities don’t have enough mental health experts and the waiting lists are ‘terrible’.
Challenges go far beyond individuals. Society has work to do.
Weitzman admits that screening and care cost money, but said we are already investing in ways that are expensive, both in terms of money and human capital, by building prisons and justice systems.