By Dr. Mary Margaret Gleason, a child and adolescent psychiatrist who is vice chief of the mental health program at CHKD

COVID-19 has affected everyone. While most children haven’t experienced the infection, they’ve all been exposed to life changes and stresses. Past community crises, such as Hurricanes Katrina and Sandy, the 9/11 terrorist attacks, and mass shootings, have shown us the long-lasting impact of such events on some children’s mental health, along with their emotional and behavioral development.

Mental health problems affect one in six children, and rates go up during community crises. Specifically, a higher number of children develop:

• anxiety
• depression
• disruptive behavior problems
• sleep disorders
• substance use disorders
• suicidal symptoms

It’s important to note that most children do not. For most, the memory of COVID-19 will shape their world view in the same way that the Great Depression shaped how many of our grandparents and great-grandparents lived.

They will remember it, they might overstock on toilet paper, or be overly cautious about spreading germs, but it won’t interfere with their development or their long-term relationships.

Minimizing the exposures

What happens to a child during the crisis or “dose” is one of the factors that determines how the child’s development is affected. Some aspects are out of a parent’s control, such as school closings, loss of family income, and children not being able to play with friends in person.

But, parents can minimize the “dose” of COVID stress in these ways:

• Make sure their child is getting fact-based information about what we know and don’t about the virus.
• Limit exposure to graphic media or frightening stories on TV, social media, and online.
• Caregivers should talk with other adults about these issues to process their own fears or worries.

Some children are known to be at higher risk

Some groups of children are at higher risk of being negatively affected by the COVID crisis and need extra protection, just like children with immune problems need protection from infectious exposures. They include children who have mental health problems and those who have had traumatic events like abuse, a major car accident, violence in their household, frightening medical procedures, and bullying.

There are also some common life events called adverse childhood experiences (ACES) that contribute to a child’s risk of mental health problems: long separations from a parent, having a parent with mental health or substance use problems, and exposure to injustices such as racism.

Fortunately, there are things parents can do now and in the coming months to lessen the mental health impact of this pandemic on children.

Safe, supportive, and consistent relationships offer the most powerful protection

One of strongest factors in protecting a child from the negative outcomes related to crisis is a healthy relationship with at least one supportive, caring adult. Knowing that they have someone they can count on for protection and comfort, and who will help keep life predictable, offers a powerful protection against the pandemic’s harmful effects.

Healthy emotional development is built on a network of relationships

Social connectedness beyond parents offers protection. With physical interactions limited, creative online video chats and text messaging circles with relatives and friends can help, even for young children. Staying connected with teams, bands, or other extracurricular groups through email, texting, or video can also be helpful.

Give your child a chance to talk about feelings and help them with the big ones. Check in with your child about how they are feeling. If they aren’t able to talk about feelings easily, parents can label the big feelings they see. Saying things like “It can be really scary not to know what’s going to happen next” or “I know you’re angry you can’t be with your friends” can help them connect to their feelings. Encourage them to use tools to organize emotions, like deep breathing, mindfulness, or meditation activities. If they don’t know how, there are lots of free apps for preschoolers through adolescence.

A healthy body is good for the mind. All humans, and especially children, need to move around. Your child can keep their body moving through indoor or outdoor exercise, taking walks, and playing active games. Limiting time on screens also gives children a chance to be more active.

Take care of yourself because children do better when their parents are better. You and your child will benefit if you take care of your own stress reactions: staying connected to your social supports, exercising, reading, meditating, or praying. Adults with stress that isn’t controllable or with mental health symptoms should stay connected with their mental health provider or reach out for help.

Seek professional help if children have emotions or behaviors that are intense, persistent, or don’t respond to the usual interventions.

Seek help from your child’s health provider if they have any self-harm behaviors or if they show an ongoing pattern of emotional or behavioral concerns, such as nightmares, excessive focus on anxieties, increased aggression or disruptive behaviors, and regressive behaviors that do not resolve with support.

We know that most children with mental health problems get no treatment at all. Parents are the best advocates to be sure their child’s symptoms are evaluated and addressed.

Additional Resources:

Sesame Street’s Belly Breathe video with Elmo

American Academy of Child & Adolescent Psychiatry 
Resources for Helping Kids and Parents Cope Amidst COVID-19

Zero to Three
COVID-19 information for families with young children

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About Mary Margaret Gleason, MD

Dr. Mary Margaret Gleason is a pediatrician and child psychiatrist at CHKD. She is interested in mental health promotion and creating collaborative systems of care that support early intervention and timely access to quality mental health care. A recent transplant from New Orleans, she is thrilled to join the mental health team at CHKD as the vice chief of its growing mental health program. She is also the division director of child and adolescent psychiatry at Eastern Virginia Medical School. Dr. Gleason looks forward to sharing her background in leading residency training programs, early childhood mental health, and developing clinical and research programs to enhance CHKD’s new mental health initiatives.