The stress and isolation of the pandemic may have a lasting toll on some children, but Duke experts say most will recover fully — and some might even emerge with new strengths.
Everyone has suffered during the global pandemic — physically, economically, psychologically, or all of the above. Aside from those directly affected by COVID-19 infection, families with children at home have suffered perhaps more than most.
Parents had to figure out how to work from home or safely work outside the home, scrambling to find childcare and helping children with online school while under significant stress themselves. Children had to adapt to new ways of learning while absorbing parental stress and experiencing isolation. Families of color have endured even higher burdens of disease, death, and economic worries.
“The isolation from quarantine has led to increases in depression, anxiety, and PTSD, and greater substance use and greater suicidal ideation and attempts,” says Ernestine Briggs-King, PhD, associate professor in psychiatry and behavioral science, and the director of research at Duke’s Center for Child and Family Health. “This is true of children and adolescents in general, and then we are seeing some alarming trends for children of color and other marginalized children and adolescents.”
Briggs-King suggests parents talk with their children, foster social connection with peers, and, if necessary, seek out mental health professionals. “When in doubt, reach out,” she says. (See Sidebar below)
IN THE LONG RUN
While the mental health of children and adolescents trended downward during the pandemic, it’s not all doom and gloom. “Each individual had a different experience,” says Andrea Diaz Stransky, MD, assistant professor of psychiatry and behavioral sciences. Some children, including bullied children and some with social anxiety or learning differences, preferred online school. Many children benefited from increased attention from parents during lockdown. And now that schools are open again, many young people are starting to feel more like themselves.
“Children and adolescents are very flexible in many ways, so long as their developmental needs are met,” Diaz Stransky says.
It’s too soon to say what the long-term effects of the pandemic might be, but Duke experts expect outcomes will vary. Most children and adolescents will likely recover quickly. For some, the pandemic’s challenges may even spur new skills and strategies that will help them down the road.
“Much is being written about post-traumatic growth, where kids learn resilience by coping with challenges, finding meaning and important connections, and learning important self-care strategies,” says Christian Mauro, PhD, associate professor in psychiatry and behavioral sciences.
At the other end of the scale, some children and teens are at higher risk for lasting consequences, including those whose pandemic experiences involved significant loss and trauma, those previously coping with mental health issues, and those impacted by systemic racism and health inequities.
“If history is a guide, most kids will bounce back,” says Briggs-King. “But there will also be a critical subset that are headed for long-term suffering and illness if we can’t provide the basics that families need, including access to mental health and health care services, as well as stable and suitable housing, food security, and other resources.”
INFANTS AND NEW PARENTS
Babies learn about emotional connection and communication from their parents. That kind of learning happens best when the parents are mentally healthy. The pandemic put unprecedented stresses on pregnant and new mothers, who have had to manage a life-changing transition without some of the support typically provided by family and community members.
“It’s been much more challenging for pregnant and postpartum mothers during the pandemic,” says Marla Wald, MD, associate professor of psychiatry and behavioral sciences, who treats pregnant patients and new parents.
“Postpartum depression in the general population is very common, and made more common during the pandemic, where access to services was suddenly limited. The pandemic isolation made women feel even more alone.” New mothers can shore up their mental health by prioritizing sleep, self-care time, and seeing friends. “One of the things women tend to forget when they are pregnant or postpartum is that they have to engage in self-care in order to be the best mom possible,” Wald says. If that’s not enough, Wald suggests reaching out to a trusted healthcare provider for guidance.
For children in daycare or preschool, the pandemic disrupted the structure of their day. “Young kids thrive on routines,” says Naomi Davis, PhD, assistant professor in psychiatry and behavioral sciences.
For many children, when daycares and preschools closed, screen time replaced in-person interactions and explorations.
“Young kids learn by interacting with people to learn about the world and emotions,” Davis says. “There is a pretty big impact on young kids if they get cut off from those kinds of opportunities in everyday life.” Children with developmental delays also lost many kinds of in-person support services.
Daycares and schools are open now, but outbreaks can still send kids home for a week or 10 days to quarantine.
Davis says parents can help their children by maintaining routines for mealtimes and bedtimes. Keeping those things stable makes it easier for kids to manage unexpected changes in other parts of their day.
A SENSE OF CONTROL
Structure is also important for kids in elementary school. “The big struggle for school-aged kids was the loss of structure and routines that give kids a sense of predictability and control,” Mauro says. “When you take that away, it can be unnerving and unsettling.”
When schools closed, kids also missed out on social interactions with peers, and in some cases, free meals and social services.
Mauro has seen higher rates of anxiety and depression in his young patients. In general, children who had mental health issues before the pandemic were more affected. He says parents can help their children by validating that uncertainty is hard, and by reassuring them that some things are certain — such as the love and support of their family.
For most of his patients, going back to school is helping. But some are struggling with the adjustment to interacting in person. Mauro worries that the increase in screen time is contributing to the rise in sleep disturbance among children and may contribute to other problems down the line, such as obesity.
For most adolescents, the pandemic put the brakes on the developmental task of seeking independence from parents and spending more time with peers. Diaz Stransky says some of her teenaged patients distanced themselves from their families virtually, in some cases even reversing their sleep schedules so they could interact with friends online at night and sleep during the day when their families were up and about.
Diaz Stransky says using social media to connect has pluses and minuses. Chatting with a friend online can be helpful, but doom-scrolling or fishing for “likes” can make things worse. “Ideally, finding ways for teens to safely interact even with one or two other peers is a more meaningful connection,” she says.
The good news? “The majority of teens are coping and are quite resilient,” Diaz Stransky says. “There are things we can do to build that resilience. Find ways to help them stay connected and find the support they need so they can thrive.”
She advises parents to talk regularly with their teens, even though, as she says, “It is part of their developmental task to think more independently, and this might mean they don’t always share everything with you.”
Her other tips for teens apply to everyone in the family: Maintain a routine. Get enough sleep. Exercise.
“Go for a run or go for a bike ride,” she says. “Be physically active on a regular basis. Staring at a screen all day is not healthy for anyone.”
WHEN — AND WHERE — TO GET HELP
How do you know if your child needs professional help? Talk to your child, but also look for unspoken clues. Changes in behavior, such as a marked change of mood, loss of motivation, extreme sadness, and changes in eating or sleeping patterns, can signal that it’s time to reach out for professional help: a pediatrician, a guidance counselor at school, a minister or rabbi, or a mental health hotline.
North Carolina Psychiatry Access Line (NC PAL), a collaboration between the Duke Department of Psychiatry and Behavioral Sciences and the North Carolina Department of Health and Human Services, is a free telephone consultation and education program for professionals who provide health care to children, adolescents, young adults up to age 21, pregnant people, and those who have recently given birth. Health care providers can call 919-681-2909, Monday through Friday, 8 a.m.-5 p.m.
Pause-Reset-Nourish handout to promote wellbeing
Supporting Kids’ Mental Health During COVID-19, National Institute of Mental Health
For parents and families
The National Alliance on Mental Illness NAMI HelpLine at 800-950-NAMI (6264), Monday through Friday, 10 a.m.-10 p.m. Eastern
In a crisis, text NAMI to 741741 for 24/7 for free confidential counseling.
Alliance Health (Durham, Wake, Cumberland, Johnston counties) 24-hour Access and Information line: 800-510-9132
800-SUICIDE or 800-784-2433 or 800-273-Talk or 800-273-8255
Taking Care of Yourself & Your Loved Ones, a Duke Psychiatry Webinar Series
Story originally published in DukeMed Alumni News, Winter 2021