In for a routine visit, the 16-year-old had no history of significant mental health concerns. But he appeared dejected. When Evelyn Berger-Jenkins, M.D., M.P.H., FAAP, probed deeper, the teen admitted to feeling depressed.
He had lost interest in school and his grades were suffering. There were family stresses from food insecurity and a constant worry that if he returned to in-person learning, the older relatives at home could catch COVID-19. He began having frequent headaches.
The teen is one of many young patients seen every day by Dr. Berger-Jenkins, a member of the AAP Committee on Psychosocial Aspects of Child and Family Health. In this case, she counseled him on how to decrease stress and provided resources for his family members.
Feelings of isolation and chaos from virtual schooling and other restrictions are taking their toll. Therefore, developmental-behavioral pediatricians and school health experts are emphasizing the need for mental health screening at all patient encounters.
“I actually think this is incredibly hard on all children but for different reasons,” said Sara M. Bode, M.D., FAAP, a member of the AAP Council on School Health Executive Committee.
Elementary school children don’t do well with being on Zoom all day. They learn best when they can connect with their teachers and peers and have hands-on experiences, Dr. Bode said.
Older kids may have other challenges like caring for family members.
“Many of our teens are feeling isolated right now, and that’s leading to a lot of mental health concerns in that age group,” she said.
Robert D. Keder, M.D., FAAP, a developmental-behavioral pediatrician, agreed. “We still want to encourage them to develop continued and real relationships with friends … even to just have real conversations on the phone.”
Parents, too, are suffering along with their children.
“I think the pandemic is such a pervasive challenge for families that we have to take into account not just the child and their emotional health but the parents’ emotional health, especially parents of kids with very complex special needs,” Dr. Keder said.
Removal of special services, their own job and health concerns, and loss of child care are hurting families. Some parents feel like they’re doing a terrible job at everything right now, he said.
Another challenge is inadequate access to laptops and unreliable internet connections. When parents are working or unavailable, kids must navigate these issues on their own.
“Think about a child learning remotely who has ADHD (attention-deficit/hyperactivity disorder) and learning disabilities and imagine that student who also has an IEP (individualized education pprogram) … trying to manage online school by themselves,” said Adiaha Spinks-Franklin, M.D., M.P.H., FAAP, a developmental-behavioral pediatrician.
She has found that her patients’ conditions have worsened during the pandemic, requiring more treatment. The problems are compounded for families living in poverty or traditionally under-resourced communities.
Importance of screening, listening
The issues are drawing attention to the critical role of screening. For general pediatricians who don’t feel comfortable in all counseling situations, simply lending your ear helps, Dr. Berger-Jenkins said.
Often, it may involve only a few extra visits where pediatricians can use motivational interviewing or troubleshooting with the family to find ways to support the child — or provide temporary help before the family can see a mental health provider.
“Just the power of sitting and listening and giving time — and making sure that the family feels that their concern is heard is really helpful,” Dr. Keder said.
Querying parents about their own support systems also is key, according to Dr. Spinks-Franklin. If the parents are struggling, she said, “it’s going to be hard for them to rally the cognitive and emotional resources necessary to help their child who is struggling.”
Dr. Berger-Jenkins emphasizes maternal depression screening. In addition, many of her families experience food insecurity, and she offers resource links through the patient portal.
Every child is dealing with the pandemic in his or her own way, said Dr. Keder, as is every family and teacher. For kids with complex needs, he advocates talking with teachers about their IEP goals and perhaps dialing back on excessive homework if they become overwhelmed.
Such concerns can prompt a call to the special education provider, Dr. Bode suggested.
“You really want to have a better understanding of where that child is at with their education and what interventions they are currently getting, and then being that intermediary between the parent and the school,” she said.
Partnering with counselors and social workers is an approach that Dr. Keder is finding more helpful than ever.
“We don’t know what reading scores are going to look like in a year for the districts. But what we can do is figure out how we first and foremost emotionally support our children,” said Dr. Keder.
He encourages the basics, including adequate sleep and physical activity, as well as creative activities at home like virtual trips or games. When families can’t go outdoors for exercise safely, he suggests dancing indoors with younger children. For older kids who are overdoing screen time, substitute a dance video game.
School advocacy opportunities
Upset about how teachers must educate students who are online and those in the classroom, Dr. Spinks-Franklin would like to see pediatricians advocate for school funding to pay for a separate set of teachers for online education.
Advocacy will be even more important when the pandemic is over, Dr. Bode said.
“We have so many kids that are going to have an almost two-year gap in their academics; and they’re going to have suffered new health challenges, new economic challenges, new social determinants of health because of it,” she said. The Council on School Health “is going to work incredibly hard to keep the spotlight on those inequities so we can make a difference.”