As we come up on a year after initial school closures and nationwide lockdowns due to the COVID-19 pandemic, we can reflect on the psychological and social effects these changes have had on children and adolescents. It has become evident to the pediatricians working in clinics, emergency rooms, and hospitals that our youth have experienced a mental health crisis. We must remain vigilant of the evolving health needs of our patients and adapt our practices to best serve those in our care.

The symptoms of this crisis can vary by age and developmental group. In one review, researchers found that children ages 3-6 are more likely to experience increased clinginess and fear of family members being infected with SARS-CoV-2, the coronavirus that causes COVID-19 disease (Singh 2020). However, children ages 6-10 are more likely to experience inattentiveness (Singh 2020). Certain themes have also been seen across all age groups: increase in disturbed sleep and nightmares, poor appetite, agitation, and separation-related anxiety (Singh 2020). Females of any age specifically saw a three-fold increase in rates of depression during the COVID-19 pandemic (Hawes 2021). Nearly half of female participants experienced elevated generalized anxiety during the pandemic (Hawes 2021). Various studies have found that certain factors predispose a child to have increased mental health challenges regardless of gender (Li 2020). These factors include having the infection, home confinement, concern of their basic needs being met, and prior mental health or behavioral challenges (Li 2020).

What can be done to help our children and adolescents come out of this pandemic as healthy, resilient individuals? A study looking at anxiety and depression prevalence in adolescents found that face-to-face communication and engaging in enjoyable hobbies such as exercise correlated with lower rates of anxiety and depression (Li 2020). Encouraging children to find an activity that brings them joy and partaking in that activity daily or a few times a week can be protective against developing worsening anxiety or depressive symptoms. Examples of activities that my patients have reported to me are learning to play guitar via YouTube videos, regular exercise such as outdoor running or lifting weights in a home gym, and baking.

Another study found that children having discussions with a parent or trusted adult about COVID-19 led to less mental health challenges in children and adolescents (Tang 2021). Parents and trusted adults can have a significant impact on how children and adolescents perceive and adapt to challenging situations. Adults should tailor these conversations to the age and developmental stage of the child to avoid overwhelming them with information that may be difficult to understand or rationalize. The conversations should be open, fact-driven, and conducted in a calm manner.

For teenagers specifically, social media and video games can be both protective and place them at an increased risk for anxiety and depression (Hawes 2021). These online activities allow them to maintain a sense of social connectedness where they otherwise may feel isolated from their peers. It allows for continued formation and exploration of friendships and relationships. However, in excess, social media can foster a negative environment of comparison and a “fear of missing out”. Teenagers may not know how to evaluate information and news that they encounter.

Creating a family media plan with time limits and age-appropriate supervision that all members of the family adhere to is a recommended solution (Hawes 2021). A family media plan should be tailored to each individual family’s situations and include specific time limits on TV, computer and video games, as well as social media sites. These types of plans allow teenagers the freedom to socialize while mitigating the negative effects of too much screen time and social media. To learn more about family media plans, you can follow this link to a separate post:  https://pedsadvocacy.com/2020/11/17/creating-a-family-media-plan/

Finally, keeping a structured routine can be beneficial in protecting against negative mental health consequences from the disruption of the pandemic (Hawes 2021). This is especially important for young children and children who have ADHD or other developmental and learning disabilities. When increased uncertainty exists, younger children can feel that stress even if they do not fully comprehend what is causing it. By maintaining a routine – wake up time, meal times, learning time, play time, bedtime – they are given a sense of stability and safety. Specifically, a structured bedtime routine can mitigate some of the negative effects stress can have on sleep, such as difficulty falling asleep.

As our world begins to move forward and eventually past this pandemic, it is important to continue to have these discussions about mental health with each other and our loved ones. Discussions about our emotions, what we are seeing on the news, and what steps we can take to keep ourselves and our families safe can help stabilize our lives. Furthermore, being available to listen to those are struggling with anxiety, depression, or another mental health concern can help keep our loved ones safe. If a child or teen does come forward with mental health concerns, share resources with their parent and caregivers, such as those listed below.

Hopefully, by implementing these various strategies, we can provide the support our children need to adapt and continue to grow into healthy, resilient adults.

Resources:

• HelpWhenYouNeedIt.Org over 350,000 listings for social services, mental health, substance use, legal and financial assistance.
• Psychology Today offers a national directory of therapists, psychiatrists, therapy groups and treatment facility options
• The Suicide Prevention Lifeline connects callers to trained crisis counselors (800-273-8255)
• Mental Health Crisis Line for Dallas County: North Texas Behavioral Health Authority (866) 260-800
• Crisis Text Line: Text 741741, free service available 24/7

References:

1. Hawes MT, Szenczy AK, Klein DN, Hajcak G, Nelson BD. Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic [published online ahead of print, 2021 Jan 13]. Psychol Med. 2021;1-9. doi:10.1017/S0033291720005358
2. Li W, Zhang Y, Wang J, et al. Association of Home Quarantine and Mental Health Among Teenagers in Wuhan, China, During the COVID-19 Pandemic. JAMA Pediatr. 2021;175(3):313–316. doi:10.1001/jamapediatrics.2020.5499
3. Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion. J Affect Disord. 2021;279:353-360. doi:10.1016/j.jad.2020.10.016
4. Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Res. 2020;293:113429. doi:10.1016/j.psychres.2020.113429

Erin Finnerty, MD