Keeping up kids' mental health during coronavirus

Last week in Chicago, a 14-year-old made a list of family members he thought were likely to live and those likely to die. In Cincinnati, a six-year-old worried that if he couldn’t celebrate his birthday with his friends, he wouldn’t get any older. Meanwhile, my three-year-old daughter has had more bathroom accidents in the past few days than she previously had so far this year.

The physical symptoms of the novel coronavirus are well documented. The mental health effects, less so. And though children are less likely to become ill, we’re only starting to understand what the pandemic might mean for children’s mental health and emotional well-being.

It’s a lot for a kid to process. There’s the disruption of normal activities, the sudden split from friends, and, of course, fear of the virus itself. These difficulties are compounded for children who rely on school meals, or whose family members are sickened or facing sudden unemployment.

So how can we help our children during this time of change and uncertainty? Here’s what mental health professionals and parenting experts have to say about what they’ve been seeing and how we, as parents, can help.

Different kids, different reactions

The response to the pandemic among kids spans the spectrum. Some are enjoying the novelty of time off from school, while others are experiencing what Chicago-based clinical psychologist John Duffy described as “a level of fear approaching terror.”

“What kids are telling me is that they are afraid of the unknown,” says Duffy, author of Parenting the New Teen in the Age of Anxiety.“They feel this kind of foreboding, that something awful is about to happen. And they feel they have a limited agency over it.”

Experts are also seeing some differences between younger and older kids, as well as children who might already be dealing with depression and anxiety.

Parents of younger children might notice clinginess or regressions, such as more bathroom accidents or comfort-seeking behaviors like thumb sucking. The disruption of routine can be especially difficult for young children, who take great comfort in consistency.

Parents of older children should expect mood swings and irritability. For them, social distancing might be the real hardship. “Tweens and teens steady themselves emotionally in relationship to each other,” Duffy says. The separation from peers can feel “wretched” and unnatural.

Kids are hyperaware of their own bodies, along with the safety of themselves and their family members, said Rachel Herbst, a psychologist who leads integrated behavioral health services in primary care at Cincinnati Children's hospital. And they’re picking up on stress felt by adults around them. “Anxiety is far more contagious than any virus, and kids are going to soak that up,” she said.

Parents of children who have been previously diagnosed with depression and anxiety might find this pandemic especially challenging. It doesn’t help that methods encouraged for protection—constant handwashing and sanitizing—are anxiety provoking themselves. There’s an element of obsessiveness and compulsive thinking just in being safe, Duffy said.

“No matter how measured we try to be, some kids will be super sensitive to that message and will need help recalibrating when the acute crisis has passed,” said Tara Peris, associate professor of psychiatry and biobehavioral sciences at the UCLA Semel Institute for Neuroscience and Human Behavior. Peris is also co-director of UCLA’s Childhood OCD, Anxiety and Tic Disorders Program.

Anxiety is often approached as a response that occurs in the absence of threat. But in this case, some of the threats are very real. This means some of the standard responses to anxious thinking may need tweaking, Peris says. “What I’ve found myself saying to kids who were struggling with anxiety and depression before this is, ‘You are allowed to be anxious in response to a scary and new situation. Your emotions are there for a reason, and our anxiety is natural and normal and necessary.’” The key, she said, is finding a useful way to manage it.

Fortunately, evidence-based treatments for anxiety and depression can help kids recognize and tackle worrisome thoughts, practice new coping skills during difficult situations, and soothe physical symptoms. And they're not limited to kids who are prone to anxiety—these are strategies we could all use right now, Peris said.

As we move forward in this strange new normal, here are some other suggestions from the experts on how we can help our kids’ mental health.

Model calmness, even if you have to fake it

Modeling is so important now, said Ty Hatfield, co-author of ParentShift: Ten Universal Truths That Will Change the Way You Raise Your Kids and co-founder of the parenting program Parenting From the Heart. Kids learn from us how to manage stress and solve problems when things are difficult.

Parents, this means taking care of yourself. If you can find time, exercise. Take a hot bath. Listen to music. Read a book. Whatever works for you. And manage your consumption of news and social media.

“Watching the news is not self care,” Hatfield said.

Establish a flexible routine

It doesn’t need to be color coded in 15-minute intervals with flash cards and French lessons and mind-numbing crafts. But structure makes kids feel safe, especially during times of upheaval.

“Don’t be militant with the schedule,” Peris said. “We’ve all had kids crash our calls and pop up on Zoom. This is going to be real life in all its glory. But a consistent routine is a thing parents can do to preserve everybody’s mental health in a big way.”

Be honest, but don’t tell them more than they need

For younger kids, be short and to the point. Let the child’s questions guide the conversation. But be honest, Duffy said: “Kids will become more anxious at any age if they sense you’re not forthcoming.”

Tell them what you do and don’t know. But balance that with the comfort that lots of people are working on this, and social distancing is effective at managing it. Reassure them that they’re safe and protected.

Most importantly, says Linda Hatfield, co-author of ParentShift and co-founder of Parenting From the Heart, acknowledge their feelings. For example: “It sounds like you’re worried you might get sick.” Or, “I imagine you’re sad that you don’t get to play with your friends today.”

“Children are a bundle of feelings,” she says. “When you communicate with them through feeling language, it helps them feel heard and seen and understood. It helps them feel like their world makes sense, like the other person gets them.”

Screen time has its ups and downs

This is not the time to demonize screens. Parents need to lean on them to get work done. And screens can provide a badly needed source of connection and comfort.

Michelle Icard, author of the book Middle School Makeover, runs a Facebook group with parents of middle schoolers. And in the past week, she’s noticed an interesting trend among that age group: a return to movies and television shows from earlier childhood. PBS cartoons, for example, or the movie Annie. “I think this is such an uncertain time, and there’s great comfort in going back to these things of childhood,” Icard said.

Still, too much time on screens could leave kids feeling agitated and anxious, Duffy says. He recommends no more than two hours a day, at the margins of the day. Duffy’s one exception: the family movie. “If the family is all together watching a movie, you’re going to create some in-jokes, some memories that might create some resilience over time,” he said.

Outdoor time is the antidote to screens

“The counterbalance to screen time is movement and physical activity,” Duffy said. So get outside. Walk. Run. Play tag. Build forts. Embrace imaginative outdoor play.

“I encourage adults to consider what happens when we look at screens for an extended period of time,” Duffy said. “You can sense the tension and agitation after doing that. And the relief we feel when we put them down and engage in another way is so healthy, crucial, and important.”

The good news is that, from a mental health perspective, we might experience some silver linings to what’s happening now, said Emily King, a licensed psychologist in Raleigh, North Carolina, who specializes in autism, ADHD, and anxiety.

U.S. children are overscheduled, which can lead to stress and fatigue, she said. Children with autism especially may benefit from taking a break from the public school day, which can be overwhelming and perhaps even too long.

In order to keep our families healthy, we’re all being asked to slow down and reevaluate, she said. “This may bring us all back to baseline in understanding what’s really important.”