Intervention Begins with Recognizing Stress and Anxiety in Children
I, like many of my medical colleagues, having been seeing a marked spike in the number of office visits for anxiety and depression in the pediatric population since the beginning of the Coronavirus pandemic. Except in pediatrics, children don’t generally come in and say, “I’m depressed” or “I’m anxious.” It’s more often the case that their parents have booked an appointment to discuss their child’s headaches, or stomach aches or inability to get to sleep. Of course I listen carefully to the history, from both the child’s perspective and the parent’s. I do a thorough physical exam. If warranted, I might even order a lab test or an imaging study. But more often than not these days, by the time I’m done with my history and physical, I have a pretty good idea of what the cause of the issue is.
And so do they.
When I share my observation that the onset of symptoms coincided with our state-mandated lockdown, then carefully broach the possibility of Covid-related stress and anxiety, I am often greeted with sighs of relief as parent and child lock eyes and nod.
“Bingo!” one parent even recently exclaimed. We are finally talking about what everyone has suspected the issue was all along.
This is hardly surprising news. Spikes in major depressive disorders have been well-documented after many major disasters whether natural like hurricanes and earthquakes, environmental like oil spills and mine explosions, or manmade such as the 9/11 attacks. The coronavirus pandemic appears poised to trigger an even greater degree of mental illness in adults and children alike. Anxiety and depression, as well as substance abuse, household violence and reports of loneliness have all increased and the causes are myriad. Social distancing and quarantine have left us all isolated and without our usual support network of family and friends. Loss of the structure and routine of school, sports, and other activities has created an aimlessness to kids’ days. In some cases, parents’ job insecurity and the uncertainty of what their children’s school year is going to look like this fall leave many short on coping skills themselves.
Patterns of disaster-related mental illness vary. Both short and long-term consequences may occur. Lapsing/relapsing patterns have also been observed. Given the nature of our national and local response to the pandemic with phased reopening of some events and institutions, only to be followed by closures after significant rises in infection rates, we have to be prepared.
But how to prepare for the unknown? First, parents can help children stay connected to the extent possible. Those social media tools that may have been the bane of parents’ existence in normal times may be our kids’ lifelines to their friends today. Institutions which provided support or diversion such as houses of worship or community centers may often offer live-streamed or recorded services and classes. Keep to routines as much as possible. If fall classes remain remote, children can still be expected to rise with the family, get dressed and be ready for their day even if they may do some portion of their work on their own. And of course attention to our own self-care cannot be left to chance. Attention to healthy eating and daily fresh air and exercise cannot be underestimated. Not only are both beneficial to mental stability and overall well-being, both are important in maintaining a healthy immune system which is critical vis-à-vis Covid 19. Keep the news children are exposed to to a minimum (depending on their age and maturity level of course) and be prepared to discuss what they’ve seen in as optimistic a tone as possible.
Listen to children’s concerns, understanding that they may internalize their worries which may be voiced as somatic complaints. And when in doubt about that tummy ache or trouble going to sleep, call your pediatrician. We just might be able to help with that.
1. Neria Y et al. Post-traumatic stress disorder following disasters: a systematic review. Psychol Med. 2008;38(4):467-480.
2. Galea,S et al. The mental health consequences of covid-19 and physical distancing: the need for prevention and early intervention. JAMA Intern Med. 2020;180(6):817-818.
3. Mental Health UK. Managing your mental health during coronavirus the outbreak. http://mentalhealth-uk.org/help-and-information/covid-19-and-your-mental-health/.