By Pediatricians Beth Links Torwekar, M.D. with Randall Children’s Hospital and Deidré Burton, M.D. with Metropolitan Pediatrics

This year has been one of unprecedented stress for adults and children alike. From the health concerns brought on by a global pandemic to the movement across our country to address social injustice and an unusually fraught election, 2020 has been a year of constant challenge for us all.

As pediatricians, we are used to caring for kids with all sorts of medical problems, from broken bones to constipation and pneumonia to more serious chronic conditions like asthma, diabetes, and developmental delays. Today the needs of our patients and their families have changed. Many of the children and families we treat need mental health support and access to behavioral health resources.

The external forces in our community have escalated feelings of sadness and anxiety beyond anything we have previously experienced in our practices. It is estimated that 1 in 3 high school students have reported being unhappy or depressed in the last 10 months. With so many challenges, what can families do to help our children thrive in the midst of difficult circumstances?

Identify and address the stress that our children are facing.

Recognize that the response to stress in children looks different depending on age and temperament.

  • Young children may show developmental or social regression. It’s common for them to struggle with sleep, eating and toileting.
  •  School-aged children may withdraw, act out or demonstrate physical manifestations (stomach pain, headaches, fatigue or trouble sleeping).
  • Adolescents may be sad, withdrawn, anxious, irritable or be less interested in activities.

Actively listen. Let them know that they are not alone in experiencing uncertainty or stress.

Individualize your response to each child. Acknowledge feelings and help them name them:  “I can see you are afraid, let’s talk about it.”

Acknowledge your children’s fears and answer concerns honestly.

  • Be honest about the facts (in a developmentally appropriate way): People are sick, there is uncertainty, things aren’t fair.
  • Empower them to take actions that address their concerns: What can they do to keep themselves and others safe against COVID-19; how can they use their voice for justice.
  •  Children can play a role in the solution.

Connect to those we love and continue to find opportunities to celebrate what is good in our lives.

Cultivate gratitude.

  • Identify some of the “wins” of the pandemic.
  • Every day reflect on something good that has happened and something that your child is looking forward to.

Be intentional and creative about connections.

  • Use technology for virtual bake offs, board-game tournaments, remote movie nights.
  • Put on a mask and go outside.
  • Help your school-age children connect with other children in their classroom so they don’t miss the opportunity to make new friends.

Make a plan for holiday celebrations. We know it will look different.

  • Involve your children in creative ways to celebrate.
  • Write letters and create art for friends and family members.
  • Make IOU coupons for things your children and other family members would like to do when social-distance restrictions have lifted.

Dream about the future.

  • Plan a family vacation.
  • Itemize things that your child wants to do with friends or schoolmates or family members.
  • Don’t let go of the sport or activity that you love; get ready for when you can return to it.

Practice self-forgiveness.

  • With so many changes to daily functioning, disruption will happen. Physical and mental illness may unfold in spite of our best intentions.
  • As parents, be gracious with yourself and your children. It is okay to master “good enough” in a world that looks different than anything that we have ever known.

When to Seek Help

For concerning symptoms, seek out help from your primary care provider or behavioral health specialist. Your pediatrician is available to perform initial screenings and help develop a plan for additional assessment and treatment if needed. Our community children’s hospital is available to assist in emergency situations.

  • A child with weight loss, increase in risk taking, large mood swings, or abuse of alcohol or drugs should be seen by a provider.
  • Withdrawal from relationships, poor academic performance, neglect of personal hygiene and loss of interest in activities may reflect sadness or anxiety that needs to be addressed.
  • Any child who expresses self-harm or suicidal ideation should be evaluated.

This past year will be recorded in history as one filled with challenges. For the sake of the well-being of our children and families, we must  adjust our expectations; recognize when help is needed and take every opportunity to connect creatively and celebrate even the smallest wins and accomplishments. Gratitude and joy can be cultivated even in a forbidding landscape.

References and Resources

AAP Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families during the COVID-19 Pandemic

HealthyChildren.org – Teens & COVID-19: Challenges and Opportunities During the Outbreak

HealthyChildren.org – Mental Health During COVID-19

HealthyChildren.org – Talking to Children about Tragedies and Other News Events

Children’s book about COVID – Julie and the Evil Queen by Beth Links Torwekar

PDX Parent Staff
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