Supporting Your Child’s Mental and Emotional Health During COVID-19

According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), nearly 1.6 billion youth, 90% of whom are school-aged children, have been affected by the school closures related to the COVID-19 pandemic.

Changes to the learning environment aren’t the only adjustments children have had to make as a result of the crisis. Adjusting to modified schedules and routines, adhering to shifting CDC recommendations and guidelines, such as masking and social distancing, and witnessing how parents and other family members have been affected by the virus are all examples of changes children may struggle with.

So, how can you help your child navigate their current situation while encouraging their independence and helping them maintain mental and emotional health amid the unwelcome changes and adjustments they have experienced due to COVID-19? Roshni Koli, MD, board-certified child and adolescent psychiatrist, and Jeffrey Shahidullah, PhD, licensed pediatric psychologist, both practicing in UT Health Austin Pediatric Psychiatry at Dell Children’s, a clinical partnership between UT Health Austin and Dell Children’s Medical Center, weighed in on how parents and children can make the best of this ongoing situation.

How are children affected by change?

Coping with change can be difficult at any age. For children, who crave stability and routine, changes that affect various elements of their life can be especially difficult to handle, often causing changes in their behavior or mood.

“We think about kids as being resilient, and they are, but at the end of the day, kids really thrive on structure and predictability. I tell parents in our clinic that the more unpredictable the environment around your child is, the more unpredictable their behavior is going to be,” explains Dr. Shahidullah.

Changes, such as switching between at-home and in-school learning environments, eating meals at varying times, not being able to participate in extracurricular activities, going to bed or waking up at different times, as well as seeing family members and parents struggle with illness, relationship issues, financial issues, and other strains can all contribute to a child’s stress levels.

“Children are typically used to specific routines and schedules, so when those are altered, as they likely have been due to COVID-19, that can affect them negatively, and they may feel like their world is out of control,” says Dr. Koli. “Children with developmental delays, intellectual disability, and those with a history of trauma, anxiety, depression, or other mental health concerns may also be at higher risk of experiencing significant stress due to sudden life changes.”

What behaviors indicate a child is not adjusting well to change?

For children and adolescents, stress often manifests itself through changes in behavior. Younger children tend to find it difficult to identify and verbalize the stress they are experiencing. But there are things you can look for and ways you can help your child better express their feelings.

“Behavioral changes typically depend on the developmental age of the child. Younger children tend to be more behaviorally expressive. So, you may notice an increase in irritability, or they may be exhibiting behaviors that are needy or clingy,” explains Dr. Shahidullah. “Older children and adolescents tend to internalize symptoms a bit more, so you may also notice an increase in social withdrawal as well as irritability, frustration, and anger, even over small matters,

Symptoms to look for that may suggest your child is not coping well:

• Withdrawal from activities that typically give them pleasure
• Irritability or moodiness
• Routinely expressing worries
• Complaining more than usual
• Crying
• Displaying surprising fearful reactions
• Clinging to a parent or teacher
• A change in sleep patterns, such as sleeping too much or too little
• A change in eating habits, such as eating too much or too little

“Parents know their kids best. We may be experts in child development and psychiatry, but as a parent, you may be able to better pick up on cues that your child just doesn’t seem like themself. It’s important to pay attention to those instincts and seek out help.” says Dr. Koli.

What can parents do to help their child cope or manage stress better as it relates to COVID-19?

If your child is struggling to express how they are feeling, it’s never too early to help them recognize certain emotions to better explain their feelings. Identifying a character’s feelings in picture books, stories, tv shows, and movies are a great starting point for teaching children how to express what they’re feeling. As a parent, it’s important to be open and honest about your own emotions. If you are feeling frustrated, take the time to explain to your child what that means, how it feels, and in which ways you choose to express this emotion. Being able to identify how your child is feeling can help you better address their specific needs.

Ways to help children adjust to change and reduce stress:

• Develop a daily routine and structure (it doesn’t have to be overly rigid)
• Have a separate and dedicated schooling environment for at-home learning
• Break the day into chunks, such as morning, afternoon, evening, with predetermined goals for each part of the day
• Keep lines of communication open, checking in and asking how your child is doing
• Have one-on-one time with your child, free of distraction
• Incorporate mindfulness activities into your child’s daily routine
• Incorporate daily physical activity into your child’s daily routine
• Be a role model for healthy coping mechanisms
• Create a reward system; children are often motivated by positive rewards, try small rewards, like time spent together, or get creative with a reward system they can have fun with
• Encourage social interaction through video calls with loved ones, writing letters to friends and family, or small pod-like playdates where you can safely interact with friends who are also limiting their exposure to others

Parents, remember to take care of your mental health needs, too.

“It’s also important to give kids grace and parents, give yourself grace, too, especially right now when everyone is under more pressure than normal,” says Dr. Koli. “Kids respond in different ways and have good days and bad days. Recognizing this can help ease stress for everyone.”

When should parents seek professional help for their child?

“If you notice mood or anxiety changes accompanied by changes in appetite, sleep, or energy level for a period of two or more weeks, something a bit more serious may be going on and reaching out to your child’s pediatrician or a mental health professional could be very beneficial. Certainly, if you have any safety concerns for your child or if they have expressed thoughts of not wanting to be here (or wanting to end their life), seek emergency health care as quickly as possible,” explains Dr. Koli.

“My advice to parents is, don’t wait. Even if you and your child are struggling with something small, just one appointment with an expert can be extremely helpful,” says Dr. Shahidullah. “We provide a lot of support to kids individually, but we also do a lot of work with parents, too. We help parents find a balance and reassure them that they don’t have to be the perfect parent. There are many sustainable things that you can incorporate into your day-to-day life that can help make things easier for everyone.”

Resources for parents and children:

• Healthychildren.org – includes various resources sources by pediatricians for children of all ages, including COVID-19 related content
• GoNoodle – both an app and website that provides free resources for kids and families, encouraging them to be active, stay mindful, and have fun
• Cosmic Kids – both an app and website that offers yoga and mindfulness classes and resources for kids
• Headspace – meditation and mindfulness activities for kids, including breathing and visualization exercises

To learn more about UT Health Austin Pediatric Psychiatry at Dell Children’s, visit here. For more information about inpatient programs for children and adolescents or to schedule an assessment to determine the level of care that is right for your child and your family, please call 1-512-324-0029 or email childrensmentalhealth@ascension.org.

If you think your child is in mental health crisis and might harm themselves or others, please call 9-1-1 or visit the nearest emergency room.

If your child is showing symptoms of distress or mental illness, please call our 24/7 assessment line at 1-512-324-0029 to speak with a licensed social worker, who is qualified to understand your current situation and direct you to the appropriate services.