The Pandemic May Have Long-Term Effects on Our Kids' Mental Health
At the outset of the COVID-19 crisis, parents were advised to talk to their children in age-appropriate ways about what the coronavirus is and why we need to stay home for a little while to keep our loved ones safe. Parents were told to keep dialogue open and positive and to check in periodically to make sure kids were coping effectively. It's guidance similar to what a pediatric psychiatrist would advise after a child experiences a traumatic event.
But unlike most such events that parents have had the difficult duty of explaining to their little ones in the past — a terrorist attack, a natural disaster, or a car accident or death in the family — this pandemic stands to have far greater emotional consequences.
"The coronavirus is absolutely different from other traumatic or stressful experiences for a variety of reasons that, when added together, create a perfect storm for negative emotional and behavioral reactions among kids," Dr. Yamalis Diaz, a clinical assistant professor of the Hassenfeld Children's Hospital at New York University, told POPSUGAR. "Unlike other stressful events, this is ongoing and open-ended."
"The coronavirus is absolutely different from other traumatic experiences for a variety of reasons that, when added together, create a perfect storm for negative emotional and behavioral reactions among kids."
This, Diaz said, sets the stage for "accumulating stress," which is often referred to as chronic stress. "It's essentially a buildup of stress in reaction to a situation that has no end point," she said. To better explain, the child psychologist offered up a simple sink analogy. Imagine a sink with a slightly stopped-up drain. It's normally a managable inconvenience because the faucet gets turned on and off and then on and off again. This is normal stress, and the sink is able to drain between bursts. Now imagine that the faucet gets turned on at full speed indefinitely. Eventually the sink will overflow. That's chronic stress.
If kids were undergoing a fluid, ever-changing crisis with no other red flags, that'd be hard enough to manage, but Diaz explained how a few other factors have made this situation more alarming from a mental health standpoint.
"The sudden loss of all things normal is incredibly destabilizing for kids in particular," she said. "When kids have their routines disrupted in this way, you can expect increasing emotional distress and behavioral disruption. Remember, this is additive. To add this to the fact they're already in a chronically stressful situation, and you can see how quickly this can overwhelm their already-limited child-level coping skills. It's like asking them to suddenly carry and hold 100-pound weights for an hour when they're only capable of carrying 10-pound weights for a few minutes at a time."
What's worse, the "sudden increased demand on their parents" brings all of this to a head. Despite best efforts, parents no longer have the disposable time and resources to address their children's needs as effectively as if they weren't having to manage homeschooling, and work, and childcare, and housekeeping all at once.
"We absolutely have to approach this differently from other traumatic events because never before have we seen all of these significant risk factors simultaneously," Diaz said.
So, what should parents do differently? POPSUGAR consulted several mental health experts for advice on how we can help our children cope during this unprecedented time.
Put On Your Own Oxygen Mask First
The classic airplane oxygen mask rule — in which you should place an oxygen mask on yourself first before assisting others — is paramount during this time, experts say. However, because parents may not be able to fully address their own mental health issues during this time, they should simply do their best to model a sense of emotional well-being when they are around their kids, even if they too are stressed, anxious, and afraid.
"Deal with one's own anxiety before speaking with children," Denise Daniels, RN, a nurse and child development expert who created the Moodsters educational brand, told POPSUGAR, noting how kids pay more attention to people's actions and body language than their words. "Try to remain calm. Emotions are contagious, and kids will take their cues from you."
"Try to remain calm. Emotions are contagious, and kids will take their cues from you."
Diaz warned that even with the best outward-facing behavior, children will inevitably read between the lines: "Kids are like little sponges absorbing tension and anxiety from the environment around them, so even when you do your best, kids may still overhear conversations, see the news on TV, get information from friends or look it up on the internet, or simply notice that their parents seem 'stressed' and that 'something's up.'"
It's a matter of doing your best with the understanding that as this pandemic carries on for weeks and weeks, we will all falter and say something we wish our families didn't hear. In those cases, acknowledge your feelings and explain why you had them. "Use child-friendly language and be honest in a developmentally appropriate way," Diaz said.
Remind Yourself That Their Emotional Reactions Are Shifting Constantly
Just because you had a constructive conversation with your child three weeks ago, or even three days ago, doesn't mean you can assume they are still feeling the same way now. "Be prepared for their feelings and reactions to shift over time," Dr. Jennifer Dragonette, the executive director of a mental health rehabilitation facility for teens called Newport Academy, told POPSUGAR. "Initial fears about the illness may have shifted to anger or resentment at time away from friends, or sadness if someone has passed away, or confusion about why adults are acting differently now."
The best way parents can be supportive is by continuing to express curiosity about their child's experience on an ongoing basis — even if it seems that the conversation has already happened.
"Children process information over time and may be better able to understand the current situation differently than they did one or two weeks ago."
Follow Your Child's Lead With Coronavirus Conversations
Some parents prefer not to talk about coronavirus whatsoever while others can think of nothing else to discuss. The most important point here is that neither matters compared to how your child wishes to connect on the subject matter.
"It's perfectly OK for parents to say, 'I don't have the answer to your question, but I will keep you updated as I learn more," Daniels said, noting that what's not OK is avoidance. "Not talking about this crisis can actually make kids worry more."
Diaz added that leaving too many things unsaid can allow fears to grow. "Kids have very active imaginations," she said. "So if you won't fill in then blanks, their potentially worried imagination will do it for them and they may end up more versus less anxious about it."
To that end, Dragonette said it's smart to ask follow-up questions about their thoughts and feelings to be sure everyone is on the same page. "Children's concept of, say, death and dying, can be different than adults, and they may simply be asking questions to better understand the very basics."
When in Doubt, Offer Blanketed Reassurance
Even if you don't have full confidence that your family is going to be safe — perhaps you are an essential worker and must leave the house every day or maybe you have a grandparent or someone with a compromised immune system living with you — experts agree that in this climate, reinforcing to our kids that they are safe is crucial to their emotional stability.
"When kids ask about death, we need to reinforce that they are going to be OK, that our jobs as parents are to protect them," Dragonette said.
The only caveat, Diaz cautioned, is that offering only reassurance may close a conversation instead of opening it up. "It may feel temporarily nice, but it kind of leaves kids feeling like the emotion they're feeling is getting overstepped," she said. She advises parents to try to validate concerns and offer honest feedback first before concluding with reassurances and positive coping solutions.
Daniels — who has worked with children in refugee camps and with communities following 9/11, Hurricane Katrina, and the 2004 tsunami in southeast Asia — said she ends every crisis conversation with children by reassuring them that doctors and scientists will figure out how to keep everyone safe and healthy. "I'd also say, 'Our family loves you very much, and we care about you. We'll always do our best to keep you safe and healthy.'"
Address Any Extreme or Obsessive Behaviors
One side effect to the ongoing nature of this potentially traumatic event is that children could be developing unhealthy coping mechanisms, like as some experts predict, compulsive handwashing or germaphobic tendencies.
"It's important to frequently wash our hands during this time, but to prevent obsessive behaviors, remember that kids are taking their cues from parents," Dragonette said. "If a child sees that you are frantically handwashing or panicking about the virus and germs, they will likely replicate that."
In that instance, the child has likely developed a "coping response" to the external stressor, and parents should minimize the intensity of their message when having kids follow hygiene guidelines.
"Parents should be very mindful of their tone, frequency, and negative reactions if not done 'perfectly,'" Diaz said. "Give corrective feedback when needed in a neutral tone. Say, 'I don't think you washed long enough — remember to count to 20 like I showed you' versus 'You have to wash your hands really well or you could get us all sick!'"
"Children often work through challenging feelings through play."
Some parents, however, may observe their kids exhibiting this behavior despite not modeling it themselves. "It is important to note that parents do not 'create' extreme behaviors in children," Erin McClintock, a mental health counselor with a specialty in trauma who is the senior director at education company EverFi, told POPSUGAR. "Overwhelming fears or compulsions are often rooted in anxiety, and some children's natural temperament may make them more prone to it than others."
If teaching healthy stress responses — internal techniques children can use to take care of themselves — isn't working, it might be worth consulting your child's doctor for next steps.
Another seemingly extreme emotional side effect to the pandemic? Strange play centered around death, viruses, or physical distancing.
"Children often work through challenging feelings through play," Dragonette said. "Don't be alarmed if children reenact the same fears through play over and over. Research has consistently shown that this is one way children process traumatic events. It could be helpful to encourage imaginative play around any aspect of the current crisis that parents are concerned about. Pay attention to the nature of their play over time to see if different themes emerge, or ask your child to talk to you about what the play means."
Take Note of When Your Child's Anxiety Crosses Over to Something Worse
For most families, children may actually exhibit no changes in anxiety levels during this time or they may display a slight uptick that will likely dissipate once the shelter-in-place orders are lifted and their lives return to normal.
Nonetheless, there is no guarantee that that's the case for every kid. It's more important than ever to pay attention to signs of severe anxiety or depression in your children, not only because of the ongoing traumatic experience they are enduring but also because there are likely no other adult figures in their current daily life who can advocate for them.
Dragonette recommended parents pay particular attention to feelings of sadness, hopelessness, or irritability for the "majority of the time" they are awake. She also urged them to notice even subtle changes in their behavior. "Some symptoms might include showing changes in eating patterns or loss of appetite, showing changes in sleep patterns, showing changes in energy – being tired and sluggish or tense and restless a lot of the time," she said. "Acting out aggressively, not wanting to do anything for long periods of time, or having a hard time paying attention can also be a sign of severe anxiety or depression in our kids."
McClintock noted that children, particularly young ones, don't always have the language skills to verbalize their emotions the way that adults and older kids do.
"So these feelings can often manifest in tantrums, being very attached to a parent, being defiant, or acting out," she said. "When these behaviors occur, rather than jumping immediately into 'punishment' mode, consider what may be causing the behavior and respond in a comforting way."
McClintock added: "With any child, if behaviors last for longer than is typical for them, or if your parental instinct is simply telling you that something more serious might be going on, reaching out for professional help is seldom a bad idea. Trained counselors can provide insight, coping strategies, and are often as great of a resource for parents as they are for the kids that they work with."
Be Prepared to See Long-Term Emotional Side Effects
Even well after society returns to normal — which, according to experts, may still take several months — children may still carry emotional scars of the pandemic with them.
"We know that the incidence of mental health increases when there are traumatic events in childhood. And it is still unclear how traumatic these current events will prove to be."
"A child's environment can stabilize his or her life," Daniels said. But an environment filled with uncertainty and drastic departures from routine can leave them reeling. Even when kids do return to school, if there are still strict public health protocols in place, those can have an adverse affect on their mental health. "Stressors carried into the classroom can impair learning and developmental growth, making it impossible for a child to concentrate and learn during the school day."
Not only that, she said, "toxic stress can remap a child's brain."
Again, the coronavirus — and the global response to it — is unlike anything we've ever experienced, and most behavioral experts are only certain of the fact that there's no way of knowing what the long-term emotional effects of this crisis will be on citizens.
Thousands of parents have shared a meme on social media — a fictional story of a child asking his grandparent, who was a child during the 2020 coronavirus, what that scary time must have been like. The grandparent remarks that he doesn't recall the fear or anxiety, but only remembers that it was a wonderful time at home with his loving family. It's a sweet sentiment, but it's the absolute best-case scenario, and, sadly, many children across the nation are not immune to the realities of this pandemic. From a "loss of employment to increasing marital stress," to widening educational gaps, to a relative's death without a proper funeral to provide closure, Diaz said the list of damaging stressors goes on.
"We know that the incidence of both mental health and physical health problems increase when there are traumatic events in childhood," Dragonette said. "And it is still unclear how traumatic these current events will prove to be. As with any trauma, it is critical that caring adults are willing to meet their children where they are, listen and validate their concerns, and provide a stable, loving foundation so our children can begin to heal."
And that is clearly easier said than done.