Raising Resilient Children in the Age of COVID

When the American Academy of Pediatrics, in cooperation with the American Academy of Child and Adolescent Psychiatry and the Children's Hospital Association, identified a national emergency in children's mental health in late 2021, ¹ many were quick to blame the pandemic for the precipitous decline in pediatric psychological well-being. In truth, the crisis began long before COVID-19 significantly altered the global landscape. As President Biden noted in his 2022 State of the Union Address, children were struggling with “bullying, violence, trauma and the harms of social media” ² long before the pandemic. Nonetheless, the pandemic has certainly exacerbated these issues, highlighting the crucial need for swift action.

According to the World Health Organization, globally, 10% of children and adolescents struggle with their mental health. ³ In addition, one in four youth worldwide are experiencing clinically elevated depression symptoms, and one in five are experiencing anxiety. These estimates are double those recorded prepandemic. ⁴ Unfortunately, whether due to stigmatization of mental health issues, obstacles to accessibility, or lack of knowledge, the majority of these children do not receive care. The rates of childhood mental health concerns and suicide rose steadily in the decade between 2010 and 2020. Since then, the pandemic, along with exposure to footage of violent conflict worldwide, has no doubt intensified this crisis. In the United States alone, the Centers for Disease Control and Prevention found that between March and October 2020, emergency department visits for mental health issues rose by 24% in children aged 5–11. ⁵

There are many attributes of the pandemic—its extended length, rapidly changing and conflicting messages, need for quarantine and physical isolation, and uncertainty about the future—that have increased its effects on people of all ages. ⁶ However, infants and young children in particular are suffering. ⁶ Though an individual child's response to crisis depends upon many factors (prior exposure to emergency situations, physical and mental health, socioeconomic circumstances of the family, and cultural background), children may be particularly vulnerable to situations such as the pandemic because of their limited understanding of events, inability to communicate their feelings effectively, and lack of coping strategies. ⁷

As Biden mentions in his address, children's “lives and education have been turned upside down” by the pandemic. The pandemic has interrupted access to vital pediatric mental health resources, both at school and in the community, and parents are noticing that the worldwide crisis has affected their children's psychological states. A recent poll ⁸ found that 71% of parents believe the pandemic has taken a toll on their child's mental health, 69% say the pandemic is the worst thing to happen to their child, and 67% wish they had been more vigilant about their child's mental health from the start.

Throughout the pandemic, most parents have had their hands full managing their own emotions surrounding the global crisis, and it turns out that how they handle the strain is a key factor in how their child will respond to the situation. What may be interpreted as misbehavior in young children can actually be a reaction to sensing their parents' stress. ⁷ A recent study ⁹ identified clinginess, distraction, irritability, and fear as the most common behavioral problems associated with pandemic stress in children. Parents may also notice their children showing regressive behaviors such as fussing and whining, difficulty focusing or engaging in play, and aggression. ⁷ Like adults, emotional stress in children can result in disruptions of physiologic functions such as sleeping and eating as well, and anxiety may cause children to become more irritable or socially withdrawn. ⁶ As such, it is essential to give people across all age groups access to effective tools to help manage their mental and physical reactions to stress.

Understanding children's emotions and stress responses is vital to addressing their mental health care needs. According to the U.S. Preventive Services Task Force, ¹⁰ untreated anxiety can have both short- and long-term effects on children. These include headaches and stomachaches, poor academic performance, and developmental delays. Childhood anxiety disorders have also been tied to increased risk for depression, anxiety, behavior problems, and substance use disorders later in life. To address this issue, in April 2022, the Task Force issued a recommendation that all children be screened for anxiety starting at the age of 8 years old. It is hoped that this intervention would allow for earlier identification and treatment of anxiety, thus alleviating negative impacts on the child and improving treatment outcomes.

Unfortunately, with a scarcity of mental health professionals and countless barriers to accessing care, recommendations such as these may be difficult to meet. While it is true that the state of pediatric mental health was already poor before the pandemic, the global response to COVID-19 is almost certainly to blame for much of the recent increase in youth psychological issues. In part, the isolation and lack of social interaction associated with home confinement and remote schooling has increased feelings of loneliness and stunted social development in young people. ¹¹ In addition, frequent changes in school and public health rules have significantly increased children's anxious feelings. ¹² These children's lives, including their essential support structures, were uprooted in 2020. It is not surprising, then, that there would be a great deal of emotional fallout.

As of now, in some ways, many children's lives are returning to “normal.” Most schools are open for in-person instruction, and many extracurricular activities and even mental health supports have returned. However, the pandemic is not over, and children who have experienced its upheaval will not emerge unscathed. As some early pandemic restrictions such as quarantine and social isolation are removed, for children, new challenges are emerging. Returning to “normal” is complex, and navigating the world's new rules can be difficult. Now that the immediate danger to physical health is reduced, there will be a whole new range of issues to address, and it is likely that the impacts of interruption to learning and socialization will not be fully quantified for quite some time.

For children today, the world can be frightening. Not only were their lives suddenly disrupted by a global pandemic, but due to technology, they are now often exposed to more information about the world than ever before. Experts have been quick to blame access to technology, and the wealth of information—and misinformation—that it provides, for the steep increase in mental health issues among young people.

This idea is not without merit. Children are in fact spending more time on screens and online than ever before. ¹³ There, they may be exposed to information about concerning world issues, such as climate change and footage of violent global conflicts, and this makes their future seem uncertain, aggravating their mental distress. Add to that the complex social calculations required to engage successfully with social media, and it becomes plausible that access to technology would negatively impact children's mental health. However, solid statistics to support this assertion are still limited, and study findings are understandably nuanced. ¹⁴

While it may be convenient to use screen time as a scapegoat for the mounting pediatric mental health crisis, when used appropriately, technology has many attributes that can actually improve mental health in people of all ages, especially during the pandemic. During shelter at home orders, adults and children alike used technology to remain connected to friends and loved ones. By communicating via video calls and messaging apps, or even playing collaborative online games, children were able not only to alleviate feelings of loneliness and isolation, but also to practice the social interactions that they were not able to experience in the physical world.

Technology also enabled students to continue their education via remote classrooms, not only providing some stability and structure, but also mitigating the learning loss caused by pandemic circumstances. The physical distance required to stop the spread of COVID-19 led to an environment where children and their guardians had to become comfortable with technology use out of necessity. This experience has put young people in a position where they can navigate technology fluently, enabling them to use it in innovative and creative ways, both now and in the future.

The widespread use of technology during the pandemic also encouraged those who were hesitant or resistant to allowing their children to use screens to take the leap and allow it. In the end, observing the benefits that come with technology use during the pandemic may have helped ease the stigma of increased screen time overall.

Because each child is unique, and some are more vulnerable to the negative effects of screen time than others, there is no “right” amount of technology use that will ensure only benefits and eliminate drawbacks for children. Researchers have also noted that what children do on screens is just as important as how much time they spend using them. ¹⁵ While certain more passive activities such as watching preposted videos may not be the best for engaging the user, other more collaborative activities such as playing a game with friends or video chatting may, on the other hand, help boost the participant's mental state.

One way to address this growing crisis and to improve pediatric mental health is to foster resilience and give children tools to help encourage this trait throughout their lives. Parents and other trusted adults can best do this by modeling resilient behavior themselves, demonstrating ways that they care for their own mental health (e.g., mindfulness, relaxation, and other coping skills) and maintaining a positive mental outlook during challenging times. ¹⁶

Yet, the responsibility should not fall solely to family members and loved ones. Mental health professionals, schools, and other organizations can help alleviate this crisis too. There is evidence that young people are six times more likely to participate successfully in and complete mental health treatment if the services are integrated into their school. ¹⁷ Building networks of social support for children and encouraging young people to explore their passions or engage in a community recovery effort can help make children feel less vulnerable in a situation that is out of their control. ¹⁶

In the end, it is only a multipronged solution that will be successful in addressing such a complex crisis. Parents, professionals, and organizations will need to cooperate to provide indispensable resources to children as they face a dauntingly uncertain future.