US – According to a policy brief published by the United Nations Sustainable Development Group (2020) in April 2020: “Children are not the face of this pandemic. But they risk being among its biggest victims. While they have thankfully been largely spared from the direct health effects of COVID-19 – at least to date – the crisis is having a profound effect on their wellbeing” (para 1). The physical health effects of the pandemic on children have only recently become news. Still, the United Nations makes clear, children have been experiencing their share of pandemic stress: feeling unsettled with changes in daily routines resulting from the lockdown and school closures; loneliness due to separation from friends, and in some cases, not seeing relatives, such as grandparents, as often as usual; and further, more significant distress when economic stresses, job losses, or illness or deaths due to COVID, have impacted their families (United Nations Sustainable Development Group, 2020).
Two recent studies demonstrate the impact of COVIDrelated stresses on both parents and children. Using survey methodology both before and after the outbreak of COVID19, Gassman-Pines and colleagues (2020) examined the impact of the pandemic on families of hourly service workers with children ages 2 to 7 years. They found that parent psychological well-being worsened under COVID restrictions, and both parental and child mental health worsened in relation to the number of COVID-related hardships a family faced (i.e., household job loss, income loss, caregiving burden, household illness). In June 2020, Patrick and colleagues (2020) conducted a survey of a national sampling of parents with children under age 18 years exploring “changes in health status, insurance status, food security, utilization of public food assistance resources, childcare and use of health care services since the pandemic began” (Abstract). Among their findings were the following: “Worsening mental health for parents occurred alongside worsening behavioral health for children in nearly 1 in 10 families, among whom 48% reported loss of regular childcare, 16% reported change in insurance status, and 11% reported worsening food security” (Abstract). These two recent studies paint a concerning picture. In addition, some children – such as those who have a history of abuse, family violence, bullying, a long separation from parents, or those who face parental mental illness, or other adverse childhood experiences – may be at an increased risk of developing mental health conditions as a result of COVID-19 outcomes (Gleason, 2020). For these children and the one-in-six children who already experience mental health conditions (Gleason, 2020), the impact of the pandemic on mental health may be particularly significant.
Some children with mental health concerns have private therapists who may have been offering telehealth appointments as support. However, school-based counseling is the only source of care for some children and teens, an option not available to many in the spring nor again in the fall of 2020, given widespread school closures. Golberstein and colleagues (2020) indicated as many as 35% of adolescents receiving mental health services typically received those services exclusively in school settings, and an additional 23% typically received at least some of their mental health care in schools.
Children’s hospitals have recognized the challenge the pandemic is posing for pediatric mental health. For example, Children’s Hospital of Philadelphia, Philadelphia, PA; Nationwide Children’s Hospital, Columbus, OH; and several other pediatric institutions made a fairly quick transition to telehealth in order to provide mental health care to children and adolescents (Wanneh, 2020). Not only did these institutions quickly implement telehealth, but they also provided guidance for patients and families about accessing services in this new way. Professional associations and governmental agencies have developed resources to help families deal with these emerging issues. Individual pediatric hospitals have also posted excellent resources on their websites. As an example, the Behavioral Health Program at Children’s Minnesota, Minneapolis, MI, offers a variety of important services, from virtual and in-clinic visits to distance learning support (see https://www.childrensmn.org/behavioral-supporthub/). Another section of the website specifically addresses “tips for mental health while schools are closed” (see https://www.childrensmn.org/2020/03/18/five-tips-men tal-health-schools-closed/). In a series of webinars and online conversations funded by the Lucile Packard Foundation for Children’s Health, Palo Alto, CA, the Institute for Patient- and Family
As COVID-19 continues in the United States and throughout the world, the impact on children and their families will also continue. Whether or not the health of individual children is impacted by the virus, their behavioral and mental health is affected by uncertainty, changes in “normal” life, most notably, school attendance and stresses within their families.