The Kids are Not All Right

Early in the pandemic, it appeared that children might be spared the worst of COVID-19. But it’s now clear that kids are just as likely as adults to get infected with SARS‑CoV-2 (though less severely) and are suffering psychological consequences from the pandemic’s social upheaval.

“We noticed at the beginning of the pandemic that COVID-19 was having an impact on the mental health of children, but we didn’t realize how bad it would be,” says Lourival Baptista-Neto, MD, a child and adolescent psychiatrist at Columbia University’s Vagelos College of Physicians and Surgeons. “Like adults, kids quickly experienced stress and anxiety from fear of the virus, as well as from the transition to home schooling and other major life changes.”

Today, two years on, doctors are seeing distressingly high levels of anxiety disorders in children, with a variety of effects.

“Kids manifest stress, anxiety, and depression differently according to where they are developmentally,” Baptista says. Younger children, for example, tend to become more clingy, aggressive, and irritable. They might have changes in the way they play or sleep. Many show signs of depression, becoming quieter, more withdrawn, and less motivated. Others suffer academically.

Adolescents, on the other hand, tend to react to stressful situations by acting out and engaging in destructive behaviors, including substance abuse. Depression is also very common in this age group.

“There’s a national crisis in adolescent mental health,” says Baptista. “Hospitals are full of adolescents with suicidal ideation. It’s fair to say that the problem was growing before the pandemic, but no doubt it has been exacerbated.”

In addition, children of all ages are experiencing post-traumatic stress disorder, a legacy of COVID-related sudden deaths, intrafamily violence, social isolation, and fears of infection.

Baptista is also concerned that the pandemic is stunting kids’ social and emotional development. “Socialization is one of the main developmental tasks of growing up,” he says. “That’s been put on hold for almost two years.”

How can parents and pediatricians help young people? Baptista-Neto advises them to “ask and listen.”

“If kids seem to be struggling, ask questions appropriate to the child’s age,” he says. “It’s often a surprise to learn what kids are actually worrying about. It’s usually different from what adults are thinking. By creating opportunities for kids to talk, we can begin to find ways to help.”

Educators also have a role to play in supporting troubled youngsters, “but they need to be supported themselves,” Baptista says. “Very often, teachers are undertrained in how to identify early signs of stress and anxiety and in how to begin a conversation to elicit concerns and offer support. Schools in general are underserved when it comes to mental health resources.”

For its part, Columbia quickly converted all of its community childhood mental health services to telehealth at the beginning of the pandemic.

“We’ve also been expanding our services for kids, and we’re advocating for their mental health,” says Baptista. “For example, my Columbia colleague, Dr. Warren Ng, a child psychiatrist, is currently the president of the American Academy of Child Adolescent Psychiatry, giving us a voice at the national level.”

It remains to be seen how the COVID-19 generation will fare in the years ahead.

“The pandemic has lasted much longer than other disasters, with a greater impact at the personal, family, and community levels,” Baptista says. “Some kids are already getting better with the return to school and normal childhood activities, but many children have not been assessed.

“We know that childhood traumas can have serious, long-lasting effects if they are not adequately addressed,” Baptista says, but a severe shortage of mental health services for kids has created a problem, exacerbating disparities in care for communities of color and lower-income families.

“We will need to keep a close eye on all of these children.”