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We need to pay attention to children’s mental health


The coronavirus pandemic has created a variety of hardships that have left families and children in distress. Social isolation. A mounting death toll. An estimated 8 million Americans falling into poverty. We have entered uncharted territory, and uncertainty continues as cases continue to rise across the U.S.

Grief is a normal reaction — grieving not just the loss of life, but also the loss of normalcy and freedom when a disaster occurs. So what happens when we add even more stress to families and their children, particularly when schools close?

The trickle-down effect of all this misfortune can dramatically weigh on kids, especially if they don’t have access to mental health resources at home. Typically, mental health symptoms are identified at school, by their teachers and peers, social workers and guidance counselors.

Children need a routine and consistency. Remote learning and social isolation will continue to uproot them. Children with autism also face challenges with irritability, anxiety and behavioral disturbances. And the erratic nature of schools’ opening and closing (albeit temporarily) can have a lasting effect.

A recent study in JAMA Pediatrics showed that more than 22 percent of students in the Hubei province of China reported symptoms of depression, and more than 18 percent had anxiety symptoms, when schools closed for over a month. A second study, in the Journal of Pediatrics, determined that younger children (ages 3 to 6) were more inclined to show fear or clinginess, where older kids (6 to 18) were more likely to show inattention and persistent inquiry. Clinging, inattention and irritability were the severe psychological conditions demonstrated by children in all age groups.

School closures — short or long — are unfortunately bound to happen until a safe and effective vaccine is available. Prepare to take care of your child now.

First, children need outlets. In early childhood, play is important for development in the physical, verbal and emotional domains. Build that imaginary fort, encourage storytelling, toast s’mores in your backyard. For adolescents, it’s important that they develop their own sense of identity but also explore peer relationships. Encourage this — in a socially distanced, safe way.

Second, seek normalcy. The goal is to foster continued development, even if your children can’t attend school in person. They want to feel safe — an important tool for parents to use during the crisis. Make sure you provide protection and consistency in an otherwise uncertain time. Talk to them about their feelings. Ensure their safety by creating an atmosphere of stability.

Third, adapt to the environment. Summer may be gone, but you can still enjoy the outdoors safely during the fall, and even on some nice winter days. When the extreme cold sets in, continue building on the elements of safety and fun you have already introduced. Have family game nights. Schedule a movie night. Cook and bake together as a family. Designate a reading hour. Although it may be colder, it’s important to get exercise, so go for a walk or a hike or a brisk bike ride. There are also online exercises for kids, like yoga and others.

Fourth — and most important — pay attention. Younger children can’t always express their distress, anxiety or fear. Their behavior may regress. Look for the signs, which include an increase in crying or neediness, more temper tantrums or somatic symptoms (headaches, stomach aches) than normal. Older children may also show increased anger and irritability.

If you think your children or adolescents may need a mental health professional, don’t hesitate. They are acting that way because they need help. So watch out for them to verbalize any suicidal thoughts, ongoing sleep disturbances, a decline in overall functioning (hygiene, grooming), aggression or worsening substance use. If you see these signs, seek treatment.

Following these steps may help keep children mentally fit during one of our harshest times. Nothing can replace life as we knew it pre-Covid, but you can manage this new normal and keep your kids safe, too.

Sharon Skariah, M.D., is the director of child and adolescent psychiatry for Zucker Hillside Hospital. She is also an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.