From the beginning of the COVID-19 pandemic, we have grappled with the impact of this crisis on children. Many of us think children are uniquely resilient, able to bounce back from anything.
But like all pediatricians, we know that children are not simply small adults. Children and adolescents are experiencing acute mental trauma right now — especially as the pandemic continues alongside mounting protests and civic unrest. We must urgently pay attention.
Research shows that traumatic events in childhood can lead to deleterious health effects over the life course.
In the 1990s, a landmark study found that children who had adverse childhood experiences were far more likely to have serious physical and mental health issues like heart disease, depression, and substance misuse. Most of the subjects of that study were white and middle-class; subsequent studies found that children in urban communities of color experienced even more adverse childhood experiences because of structural racism’s consequences — poverty, discrimination, and exposure to community violence.
If anything, children are the least equipped to process unrelenting anguish resulting from something as catastrophic and world-shifting as a public health emergency. We have learned this lesson before. For example, in the aftermath of Hurricane Maria 2 years ago, the federal government’s anemic emergency response contributed to a spike in pediatric depression, anxiety, and suicide in Puerto Rico.
So if our pandemic response addresses infectious disease transmission alone, the health of our most promising generation will deteriorate — a devastating byproduct of distress and trauma.
Only a response that braids public health, healthcare delivery, and education can offer adults the resources to effectively support the children in their lives.
There are ways to take immediate action.
First, healthy, loving adults and supportive environments can mitigate trauma’s toxic and long-lasting effects.
In New York City, to ease the stress of parenting at this challenging time, nurses and community health workers continue to check on families with infants, including every baby born to a family living in a homeless shelter, using telehealth.
We’re re-imagining virtual services, including mindfulness and telehealth services for LGBTQ youth. We’re even facilitating remote group discussions with youth about racial disparities and structural racism and training thousands of New Yorkers who work for grassroots organizations in communities of color how to practice Mental Health First Aid.
It’s never too early to understand what creates health and shapes the world.
Second, parents should speak openly about COVID-19 at a level appropriate for their child, while acknowledging their own anxiety and how they are managing it. This empowers children to label and validate their own feelings and to feel protected.
Young children may be unable to verbalize distress and discomfort and need special protection during this time. Parents of young children should watch for signs and symptoms of anxiety or traumatic stress — from increased moodiness, clinginess, and irritability, to nightmares, inattention, and behavioral regressions — for example, children previously potty trained starting to wet the bed again.
For older children, traumatic events can aggravate signs and symptoms of depression and suicidal thoughts and behavior, as well as general anxiety. Though it can often be difficult to distinguish between sadness and clinical depression, parents should always communicate openly. And if a parent is concerned that their child might be having thoughts about suicide, the best way to find out is to ask. Explicitly asking, research and experts prove, can literally save your child’s life.
Finally, for parents and caregivers seeking COVID-19 pandemic coping strategies for youth with a history of complex trauma, we recommend the Foundation Trust’s new guide. The Health Department also offers resources via Early Childhood Mental Health Training and Technical Assistance Center and provides free teletherapy for young children experiencing developmental delays through our Early Intervention Program.
As we continue to grapple with the acute stressors of the COVID-19 pandemic, children are absorbing stressors of parental distress, fluctuations in school-based supports, and family illness and loss. The extent of our efforts cannot be determined simply by current hospitalization and death statistics.
If our attention should ever waver, we will be dealing with the consequences long after the pandemic subsides.
Oxiris Barbot, MD, is the Health Commissioner of New York City.
Daniel Stephens, MD, is the New York City Health Department’s Deputy Commissioner for Family and Child Health
Last Updated June 29, 2020