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Re-emerging After Flattening the Curve :

June 17, 2020

The COVID-19 pandemic has ushered in change for people all over the world and disrupting daily life.

The COVID-19 pandemic has ushered in change for people all over the world and disrupting daily life. As if writing this, hundreds of thousands of people have been hospitalized or had a loved one hospitalized. In addition, attempts to flatten the curve to allow medical facilities provide care for the sick without becoming overwhelmed has created unintended consequences, especially for children. When the number of acutely ill people decreases and social distancing measures ease, pediatric providers will play a continuing critical role in disaster response for our patients.

During disasters and times of stress, domestic violence against women and children increases. One resource states that couples feeling financial strain (regardless of income) have up to 3 times an increased risk of violence. Unemployment, decreased income for those who remain employed, and medical debt for people who were hospitalized or ill will create more financial strain in families. For some families, this financial strain will be new, while for those already living in poverty, their food insecurity, lack of shelter, and lack of medical care for their children will worsen.

Specific to the COVID-19 pandemic, discussion with parents and children about how they feel regarding preparation for the coming school year is critical. Most children have been distance learning, with varying parental involvement, and physicians should assist parents how to advocate for additional help over this summer or at the beginning of this coming school year. In addition, schools often have guidance counselors parents can reach out to for additional support, including accessing school resources and coping with loss of a family member, as well as handling stressful hospitalizations while facing decreased support/visitor restrictions for themselves or family members.

The mental health of our patients and their families will no doubt be influenced by these uncertain times. These anxiety-provoking days worsened by loss of routines and schedules will test parents’ and children’s mental well-being. During times of extreme stress, children can respond with developmental regression, including accidents, tantrums, sleep disturbances, and loss of milestones like speech. Teenagers may experience appetite changes, sleep disturbance, mood disturbance, and the loss of enjoyment in activities typically seen in anxiety and depression. There could be an increased risk of suicide for children and their parents. During the pandemic it is important to help families anticipate these behavioral problems, provide reassurance such behaviors can be normal, and provide resources as able. These actions will continue to be important as we lead families through the process of recovery in the coming months.  

As pediatricians, part of our role is to advocate for our naturally vulnerable population. Unique and creative changes are needed at the local and national level. You can become involved with your community and local resources, advocating for changes in legislature to help protect children, and assisting in development of your area’s disaster preparedness plan, in addition to modifying your typical anticipatory guidance during visits to address these timely topics. I suggest reading the policy statement from the American Academy of Pediatrics, Ensuring the Health of Children in Disasters for more ideas.

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