13 Jan How to Identify & Help Children Struggling with Their Mental Health During the Pandemic

The past couple of years of uncertainty, loss, and change have had a profound impact on our nation’s youth. Even prior to the pandemic, rates of anxiety, depression, and suicidal ideation among adolescents had been steadily rising for a decade. 

In 2019, COVID-19’s emergence pushed the issue to a head. CDC data from early in the pandemic reveals a sharp uptick in the number of mental health-related ER visits for children younger than 18, even as emergency visits for injury and other causes declined. This trend did not subside, even once the “first wave” of COVID passed. Between January and September 2021, the Children’s Hospital Association charted a 40% uptick in children’s mental health visits to emergency departments around the country, as compared to the same time period the year prior.   

Concern for the future is so high that policymakers at all levels are sounding the alarm. Just last year, US Surgeon General, Dr. Vivek Murthy, described the state of children’s mental health as an “urgent public health crisis” and published a series of recommendations for systemic change. Three of the nation’s leading pediatric institutions jointly issued a statement, officially declaring a “National State of Emergency in Children’s Mental Health.”

To further exacerbate the issue, the U.S. faces a drastic shortage of mental health specialists. While there should be about 47 child and adolescent psychiatrists available for every 100,000 youth, the national average hovers around only 11. Even wait times in emergency departments are increasing – in 13% of cases, the wait can be longer than 12 hours. In spite of these shortages and the urgent need, there are measures that everyone can take to help fill gaps in the system and ensure that children who are struggling do not go unnoticed.

Fueling the Crisis: Heightened Stress and Profound Loss 

Even prior to the pandemic, children had a lot to contend with. Social media and technology inundate youth with unrealistic beauty standards and popular culture trends, all of which impact their self-worth and individualism.  Perhaps most notably, the Wall Street Journal reported that Instagram is toxic to one in three teenage girls and reinforces negative body image. Other recent reports indicate that social media fuels new types of bullying and exclusion, asserting that cyberbullying is on the rise. 

Even outside of the mobile screen time, distressing news cycles bear heavily on children’s everyday lives, leaching away feelings of hope or optimism about the future. These topics cause further stress, from the increasing frequency of school shootings and gun violence, to police brutality and racial injustice, quieting reports of climate change, and more. 

Then came the pandemic, which upended everything, introducing a whole new set of factors that continue to impede children’s ability to develop, process stress, and flourish. The sudden rush of illness and death introduced a near constant concern for one’s own safety of self and loved ones, a fear of dying, and a new frequency for which children had to experience and process loss. In fact, early last Fall the National Institutes of Health reported that an estimated 140,000 children lost a primary or a secondary caregiver to COVID-related causes. This early trauma and the pain of losing a loved one so young can reverberate for the rest of one’s life. Practically, losing a caregiver often introduces instability, due to lack of consistent housing, care, nutrition, or education. Even with intervention, the magnitude of this enormous loss will be felt for decades.

Outside of loss, the pandemic introduced instability and change as a new norm. Living with uncertainty and change, new financial or housing instabilities, remote and disrupted learning, newfound states of social isolation and loneliness, and increased reliance upon social media and technology all created new avenues of stress for our nation’s youth. 

Here are some things that parents and providers can recognize for those struggling and in need of intervention, and ways we can all help children cope and build resilience during this mental health crisis. 

Connection is Key: Checking in on Children 

Caretakers, families, and healthcare providers all have important roles to play in helping youth maintain healthy behaviors and support positive states of mental health. Distressing changes, heightened stress, and future insecurity are main themes important to consider. Most of all, connecting and providing a listening ear is paramount. Studies show that developing a deep connection with a trusted adult is beneficial for long-term well-being.

Boston Children’s Hospital suggests that pediatricians can open conversations with age-appropriate screeners that work to identify any potential areas of emotional distress. For children under the age of 5, asking about sickness and family members is a good way to get started. For instance: 

• Have you heard of the virus that is causing some people to become sick?
• Do you know anyone who became sick recently? 
• Do you think about other people getting sick? 

 
Asking more about emotions caused by recent changes may be helpful with children who are older:

• What was it like for you to have to stay home more often?
• Have you been able to see your friends recently?
• What has been stressing you out recently?
• What is something that you are looking forward to in the next few weeks?

 
At home, parents can make room for variations on these questions that normalize conversations around mental state, and create opportunities for sharing reassurance, love, and support:

• Right now, I’m feeling _____________. How would you describe how you’re feeling?
• What is making you happy and getting you excited? 
• How are you feeling about everything going on in the news today?
• What is the hardest thing about being you right now? 

 
If youth are showing deeper or more persistent signs of mental illness, consider making a referral. These behaviors may include: 

• Anxiety or depression lasting longer than a couple of weeks
• Sudden changes in mood
• “Putting up a wall” or new distance
• Concerning changes in eating habits 
• Difficulty sleeping or insomnia
• Signs of aggression or violence
• Prolonged difficulty concentrating

 
Helping Children Cope: Building Resilience for the Future 

Regardless of whether or not a child displays signs of mental health issues, youth today are facing unprecedented levels of stress and anxiety. Luckily, identifying when someone is struggling and providing early intervention has been shown to help. The act of compassion and caring, investing in meaningful relationships, and offering healthy alternatives to toxic habits can result in healing.

Equipping children with ways to cope early on helps to build greater resilience and healthier habits they can take with them through life. It’s interesting to note that many of these behaviors or activities are similar to wellness practices advocated for adults:

Minimize screen time: Children spending many hours glued to a screen has been associated with emotional, social and attention-span related problems. It’s best to keep the TV turned off during meal and family times, keep all screens out of the bedroom, and limit screen time to just a couple of hours per day. 

Create a nighttime routine: Everyone is different, but on a whole, children aged 5 to 12 require 9 to 12 hours of sleep per night. Sleep impacts all waking activities, from healthy eating habits, to cognition, brain development and function, emotional regulation, and more. Recurring habits and stability are helpful for kids, especially in times where everything is changing. Encourage regular nighttime routines to make bedtime exciting and build healthy sleep habits for life. 

Curate happy relationships with food: Nutrition is key to both childhood development and emotional well-being. Yet, while well-intentioned, too much emphasis on what is “healthy” can backfire. It may unintentionally craft an unhealthy narrative with desserts and other foods that can result in either stringently avoiding or overindulging. Instead, where possible with age and ability, involve children in cooking and creating meals. The joy of cooking can help build a healthy relationship with food that lasts for life: the daily ritual provides stability, while family time fosters shared experience and connection.

Encourage pursuit of hobbies & other outlets: Pursuing interests and building healthy relationships can help prevent stress, anxiety, and early signs of depression. These outlets are manifold: from helping youth find safe ways to socialize in-person; to encouraging exercise like yoga or kickboxing; supporting artistic or scientific endeavors; to offline activities like knitting or puzzling; or volunteering together. 

Although greatly exacerbated by the pandemic, loss, distance, uncertainty, fear, and stress are a set of emotions with the potential to surface at any time in life. Recognizing these emotions and working to understand them is key to healing and maintaining mental health. Encouraging discussions that help children recognize and learn from difficult emotions can help build resilience for life. Empower youth with habits that prioritize self-care, the opportunity for open connection that nurtures trusted relationships, and promote mindfulness in social media consumption and screen time. Lastly, remind adolescents that they can always reach out and ask for help. While daunting, that outreach opens the door for support, connection, and the important reminder that even if we are socially isolated, we are never alone. 

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