How to help a child who feels COVID-19 burnout

By Dr. Diana Graham and Dr. Christopher Min, pediatric psychologists at CHOC

For many of us, the COVID-19 pandemic has created a “new normal” as efforts to curb the spread of the virus have changed what day-to-day life looks like. It can be difficult to balance maintaining our physical and mental health while also supporting one another.

Over the last several months, many parents and guardians have tried their best to think of creative ways to help children understand the dangers of COVID-19 while also trying to limit its interference with their children’s quality of life. Kids and teens alike are struggling with the challenge of increased isolation from friends, barriers to traditional academic instruction, and uncertainty about the current events of the world, all without their usual outlets of fun and stress relief. This may result in children becoming burnt out during the era of COVID-19.

As a parent you may notice signs of the following symptoms in your child who feels burnt out by the COVID-19 pandemic: increased irritability, changes in sleep and/or appetite, less motivation to engage in things that used to interest them, withdrawal from others at home and/or increases in levels of reassurance they need due to uncertainty of current events.

Here are some things you can do to help your child if they are struggling with their mental health during COVID-19.

  1. Help them engage in a consistent routine: Having structure and routine most days can help reduce your child’s reliance on screens, their anxiety related to COVID-19 uncertainty and changes, and increase their feeling of purpose during a time that typical go-to activities may be restricted.
    • Start with thinking about what a typical day looks like for your child. Do they have online schooling or a hybrid of in-person and online schooling? What types of chores do they need to get done? Do you want them to get some physical activity each day?
    • Next, decide whether it would be most helpful to schedule by the hour or in chunks of time (e.g., 9 a.m.-noon) in their routine. Be careful to not overschedule (e.g., every 30 minutes), as this may be too difficult for both you and your child to follow long-term.
    • Scheduling in sleep and meal routines can help your child remain on a schedule similar to the one they follow during a typical school year. Having consistent sleep, wake and meal schedules can also help your child regulate their mood and manage stressful situations.
    • Make these schedules visual for your child to see and follow. Put the schedule in a place that your child will most likely see, such as on the bathroom mirror, making it more likely to become their norm.
  1. Schedule flexibility into your routine: While it is important to have consistency, it is also very important to be flexible with routines because, as we all know, life can get in the way! Having this flexibility allows your child to have an element of control during a very uncertain time, which can often help with managing anxiety. Here are some small ways to build flexibility into your child’s schedule:
    • First, choose a couple of activities in your child’s schedule that allows for several choices to pick from. They can choose what food they want for lunch, or pick what to play during game time. Here’s a roundup of activity ideas for kids during COVID-19.
    • Make lists of a three to four different choices available throughout the day for the activities on your schedule. For example, your child may have lunch at the same time every day but can have a list of different food options to choose from.
  1. Keep your child moving: We are staying at home now more than ever, making it difficult to stay active and get “brain breaks.” However, we know that being more active can have a positive impact on our mood, ability to manage stress, and ability to focus. Here are some tips to include physical activity into your child’s daily schedule:
    • Schedule in time for a physical activity to ensure that your child’s brain is getting the break it needs, especially from screens. Research has shown that recess at school can help children to stay on task and increase sustained attention.
    • Keep a varied list of COVID-19-friendly physical activities that your child can choose from to help decrease sedentary behavior. Examples may include jumping jacks, YouTube yoga, a household dance party, and even taking a walk around the block while listening to music. Remember to practice physical distancing if exercising outdoors.
    • Although physical activity is beneficial throughout the entire day, studies show that exercise between 4 p.m. and 6 p.m. can help a child’s ability to fall asleep and stay asleep. If your child is having sleep difficulties, time your child’s exercise activities to help promote more restful sleep.
    • It can be challenging to motivate your child to be active when they are feeling burnt out. If your child seems uninterested in engaging in a physical activity, try to schedule it at a time when another person in the household can participate so that it can feel more fun and socially engaging rather than punishing. Or, they can take an online yoga class with a friend. As this becomes a more regular part of your child’s routine, it will likely become easier. For school-aged children and teenagers, it can also be helpful to collaborate with them on the list of choices for physical activity to increase their engagement when it becomes time to be active.
  1. Normalize not always being OK: Kids learn from those around them. Let your child know that it’s OK to feel uneasy about how things are right now.
    • You can do this by modeling good coping skills when you make a mistake or don’t have the answer to something and recognizing the uncomfortable emotions that might come along with this experience.
    • Sometimes labeling emotions is enough to help validate your child’s experiences. By showing and discussing all the different emotions you may be experiencing during a difficult situation, it will help normalize this type of emotional processing for your child too.
    • Create opportunities with your child to discuss how challenging COVID-19 is for so many people, the different ways these challenges may show up in our daily lives, and to brainstorm ideas on how to cope. This can build a pattern of communication in which your child notices warning signs of burn out sooner and can let you know when they need help.
  1. Learn how to cope together: Engaging in family activities together can be a good way to decrease the likelihood of experiencing feelings of social isolation and give you and your child shared goals. By learning these coping skills together, it models for your child that it is OK if we do not feel happy all the time and there are ways that we can help manage challenging feelings.
    • Consider regular family game nights where each person gets a turn choosing the game. Other examples may include an at-home scavenger hunt or a puzzle that the family takes time to work on each day. This provides both consistency and flexibility, in addition to social interaction.
    • One fun idea can be to set family challenges each week. You may have a week where each day involves practicing a different coping skill (e.g., deep breathing, guided imagery, stretching or journaling) or a week where each person shares something that they are grateful for. Whoever can complete the most challenges during the week gets a reward, such as choosing Saturday night dinner or the next movie for family movie night. If there is a tie, then you can always split up portions of the fun night that each person gets to choose, such as one person choosing the movie and another choosing the meal.
  1. When is this all not enough? Let’s face it, we don’t always have all the resources to implement every strategy whenever we need it. Or, you may encounter situations where you try every recommendation and still notice concerning changes in your child. Either way, it is OK to ask for help.
    • Be aware that you are only one person and many of us are forced to function without our typical support networks such as extended family and childcare centers because of COVID-19 restrictions. Consider some other avenues of support that may be helpful for you and your child to decrease burn out and help manage coping during the pandemic.
    • Reach out to your child’s teacher or school counselor for support. Are they able to check in with your child more often? Have they noticed any changes in your child’s school engagement beyond what they think is typical right now? They may be able to provide more frequent or regular support.
    • If you become concerned about your child’s mental health, contact your primary care physician. You can also call your insurance company for a list of in-network mental health professionals or do a search online for local mental health providers.

Here are additional mental health resources for your child during COVID-19

  • CHOC’s mental health toolkit has resources for parents, kids and teens, and schools.
  • CDC Parent Resources are organized by type of activity and age group, including directions for an At-Home Scavenger Hunt.
  • Helplines
    • Substance Abuse and Mental Health Services (SAMHSA) Disaster Distress Helpline
      • Toll-Free: 1-800-985-5990 (English and Español)
      • SMS: Text TalkWithUs to 66746
      • SMS (español): Text “Hablanos” al 66746
      • TTY: 1-800-846-8517
      • Website — English| Website — Español
    • National Suicide Prevention Lifeline: 1-800-273-8255
    • Crisis Text Line: Text HOME to 741-741
    • Orange County Crisis Assessment Team:
  • Helpful apps
    • MindShift: a cognitive behavior therapy-based app from Anxiety Canada that helps kids to learn about and track anxiety, as well as coach them through coping skills
    • Headspace: A mindfulness app for everyday life
    • Smiling Mind: An app that guides helpful coping skills based on age
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How to safely celebrate Thanksgiving during COVID-19

As the holiday season approaches, and the community makes plans to observe traditions in a way that may look different from years past, CHOC experts provide the following recommendations for how to celebrate Thanksgiving safely amid COVID-19.

“Family traditions during the holiday season are a treasured part of childhood, and we want all families to enjoy this special season, but it’s important to do so in a safe way,” says Melanie Patterson, CHOC’s vice president of patient care services and chief nursing officer. “After months of living through the COVID-19 pandemic, people may be inclined to make exceptions to the safety precautions we’ve all been encouraged to follow, but during this season we must remain vigilant in doing our part to curb the spread of COVID-19.”

These recommendations are meant to supplement, rather than replace, any local or statewide regulations.

Celebrate with your household

The safest way to celebrate Thanksgiving this year is to celebrate with people in your own household.

Watch Thanksgiving Day parades, sports and movies at home.

If getting a head start on holiday shopping is typically part of your Thanksgiving weekend plans, opt for online sales or use contactless pickup options.

Celebrate virtually with others

Use technology such as FaceTime, Zoom or Skype to enjoy a Thanksgiving meal with loved ones who don’t live in your household. Consider sharing recipes between family members and friends ahead of time, and cooking each of your meals together over video chat.

Children can also use video chat to do a festive craft project with cousins and friends outside their household.

Or, have a virtual, interactive watch party for your favorite holiday movie using Netflix Party or Disney+’s GroupWatch. These services allow you to synchronize your show or movie with friends and family, and chat while you’re watching.

Virtual celebrations can include gratitude activities, such as making lists of what you’re grateful for, and sharing them with friends and family.

Celebrating virtually is especially important if you are celebrating with family members over the age of 65, or those who are immunocompromised and have underlying conditions that put them at greater risk of complications from COVID-19.

Festive outdoor celebrations

As temperatures begin to dip in Southern California, be sure to dress warmly before engaging in any physically distant outdoor activities. Consider a nature scavenger hunt, apple picking, hiking or taking a drive through a neighborhood near you that may have gotten a jump-start on holiday décor.

Thanksgiving travel

Traveling can increase your chance of getting or spreading COVID-19. Staying home is the best way to protect yourself and your family.

The California Department of Public Health issued a travel advisory Nov. 13, urging visitors to California or residents returning home from non-essential travel to self-quarantine for 14 days and limit their interactions to their immediate household, in order to slow the spread of COVID-19.

If you travel this holiday, follow these guidelines:

  • Check travel restrictions for your destination before you go. Some states require visitors from certain parts of the country to quarantine upon arrival.
  • Get a flu shot before you travel. This year more than ever, it is important to get a flu shot to offer as much protection as possible from influenza.
  • Wear a face covering in public
  • Practice physical distancing
  • Wash your hands often or use hand sanitizer
  • Bring extra supplies, including masks and hand sanitizer
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I’m a pediatrician. Here’s what I want you to know about vaccines.

By Dr. Katherine Williamson, a CHOC Children’s pediatrician

dr-katherine-williamson
Dr. Katherine Williamson, a CHOC Children’s pediatrician

Proper vaccination is important for all people, but especially infants and babies. When children follow the recommended immunization schedule outlined by the American Academy of Pediatrics (AAP), they are better protected against potentially life-threatening diseases.

During the COVID-19 pandemic, your CHOC pediatrician’s office is a safe, physically distant environment to keep your child and family safe while still delivering high quality preventive care.

As a pediatrician during COVID-19, I get a lot of questions about baby vaccination and vaccines for children. Here are the most common questions I’ve gotten about vaccines during COVID-19– and why maintaining your child’s immunization schedule is more important than ever.

Can I delay my child’s vaccines during COVID19?

Getting vaccinated on time is important because even though we have the threat of COVID-19 to contend with, all the diseases that we can prevent easily with vaccines are still a threat. These diseases — such as whooping cough and measles — are ready to emerge at any time that we don’t have the majority of our kids vaccinated.

Recent data released by the World Health Organization and the Centers for Disease Control and Prevention showed that measles deaths worldwide reached the highest level in 23 years last year. Although no measles deaths were reported in the U.S., the number of measles cases nationwide were at their highest point since 1992. Public health experts have linked the increases in measles cases to insufficient vaccine coverage.

If we don’t keep our kids protected against measles and other fatal diseases, the risk for further emergence is going to be very high. While we are waiting for a COVID-19 vaccine to stop the pandemic, it is up to us to keep our kids safe and prevent any future epidemics by using the tools we already have to prevent disease.

Do I really need a flu shot every year?

It’s important that each member of your family get their flu shot every year. This is especially true this year, amid the COVID-19 pandemic. Since both influenza and COVID-19 can have overlapping symptoms, it may be difficult for doctors to determine which virus is behind your symptoms based on a clinical exam alone, according to pediatric infectious disease experts at CHOC.

These overlapping symptoms may include, but are not limited to:

  • Fever or chills
  • Cough
  • Shortness of breath
  • Fatigue
  • Sore throat
  • Runny or stuffy nose
  • Muscle pain or body aches
  • Headache

Learn more about why getting a flu shot is more important than ever this year.

Are vaccines safe?

Vaccines are one of the most important things we can do to help protect our children’s health. Vaccines and proper handwashing, more so than all other interventions, have proven to be the most safe and effective ways to prevent disease.

What is the proper vaccine schedule?

The current immunization schedule outlined by the AAP and Centers for Disease Control & Prevention has been researched and proven to be the most effective and safest way for children to be vaccinated against potentially fatal diseases. It’s important to know that no alternative schedule has been shown to be as safe and effective.

Is it better to do multiple vaccines at one time or space them out?

The safest way to keep your child safe from vaccine-preventable diseases is to get all their vaccines on time. There is no advantage to spacing them out, and instead the longer you wait, you increase the risk of them catching one of the preventable diseases before you protect them.

The amount of antigen (protein) in each vaccine is so tiny that your immune system can process multiple vaccines at one time and build an antibody “army” to protect your child for each of those potentially fatal diseases. In fact, the amount of antigen (protein) in each vaccine is 100,000 times less than if your child has a common cold, so there’s no concern about overwhelming their immune system when they get their vaccines.

What can I do to make my child more comfortable while receiving a vaccination?

Studies have shown that preparing your child for vaccinations should ideally include three components: explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Here’s more tips on how to make shots less stressful.

This article was updated on Nov. 16, 2020.

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How to help kids cope with social isolation during the COVID-19 pandemic

By Dr. Hannah Greenbaum, neuropsychology postdoctoral fellow at CHOC and Dr. Melanie Fox, pediatric psychologist at CHOC

As we have taken important steps to practice physical distancing throughout the COVID-19 pandemic, virtually all children and teens have had much less interaction with their peers than they typically would.

Peer support is a very important part of childhood and adolescence, as friendships provide support, mitigate feelings of loneliness and boredom, help build a sense of belonging, and encourage identity development. As caregivers, it is important that we promote resilience and help children cope with not being around their peers during this time. For any caregivers who are struggling with how to help children cope with social isolation, there are many things you can do to help:

Encourage creative ways to connect with others:

Help your child come up with creative methods of spending time with their friends. The safest way for your child to talk or play with people outside their household during this time is through video chats or phone calls. One way is to encourage a weekly video chat with a friend or family member. Older children and teens may prefer texting or playing online games with friends. This might require temporarily loosening rules about daily screen time. Children might also enjoy writing letters to their friends. Here’s a few more ideas:

  • Schedule “social time” each day, so your child can look forward to it.
  • Scavenger hunt walk in the neighborhood
  • Create arts and crafts together with friends. Choose a project and supplies in advance and make the same craft as friends over video chat.
  • Video chat with other family members and friends.
  • Set up calls or video chats to allow your child to spend time with extended family and other people important to him or her. You might ask a relative to read a story to your child over the phone or on a video chat. Or, invite family members or friends to a video chat party.

Seek daily purpose:

Kids and teenagers often thrive on daily purpose. Spending time doing activities they care about or value can give your child’s day meaning and help them cope with social isolation. Your child might find meaning through reading, biking, creating music, making movies, baking, dressing up, drawing, writing, planting a garden or building something.

Encourage your child’s unique creativity. To motivate them, consider organizing a family reward board, where for example, by doing something like riding their bike they can earn a sticker working toward movie night.

Older kids might enjoy researching a topic that they’re passionate about and sharing what they’ve learned with friends.

Children and teens often feel rewarded when they help others. Consider encouraging them to find ways to connect with their larger community, like making crafts for the local senior facility, picking up litter around the neighborhood, doing yard work for a neighbor, or finding a safe way to volunteer.

Talk about feelings:

Your child might feel sad about missing an important social event, such as a birthday party. Acknowledge your child’s loss, ask about his or her feelings, and validate them by showing that you understand. Allow your child to lead the discussion, rather than making assumptions about how he or she thinks and feels.

You also might consider giving your child an age-appropriate book that deals with loneliness. This can give your child words to describe his or her feelings. Or, have your child write down what they miss about certain people, places or events as a way to cope. Also, explore different ways he or she might cope with these kinds of losses, such as having a different kind of birthday celebration or planning something for when social distancing is no longer needed. Here’s more tips for talking to kids about disappointment and celebrating special events in a creative way.

Your wise mind vs. your emotion mind

Your wise mind can take in new information, be flexible considering alternatives, and be creative in thinking of solutions. Your emotion mind will urge you to give up, act impulsively or rage. Wait for your wise mind to lead, and make decisions and problem solve with your wise mind.

We cannot control the pandemic, but we can control what we do with it. Your child cannot control the current need for social distancing, but they can control how they choose to deal with the circumstances.

By encouraging your child to connect with others, share his or her feelings, and find daily purpose, you’ll help him or her cope with inevitable challenges associated with this pandemic. Working through this challenge also might contribute to your child’s personal growth and better prepare him or her to deal with future obstacles.

We know children and teenagers will continue to struggle being separated from friends as the pandemic continues. Given the importance of peer support, try to acknowledge the loss your children are experiencing, and work in your wise mind to problem-solve and find ways to continue to find peer support. After all, as the Beatles so eloquently stated, “I get by with a little help from my friends.”

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Why getting a flu shot is more important than ever this year

It’s important that each member of your family get their flu shot every year. This is especially true this year, amid the COVID-19 pandemic. Since both influenza and COVID-19 can have overlapping symptoms, it may be difficult for doctors to determine which virus is behind your symptoms based on a clinical exam alone according to Dr. Jasjit Singh, pediatric infectious disease specialist at CHOC.

dr-jasjit-singh-choc-childrens
Dr. Jasjit Singh, a pediatric infectious disease specialist at CHOC

“Access to testing for both viruses will be essential to determine the cause of the illness and help inform care decisions,” Singh says.

These overlapping symptoms may include, but are not limited to:

  • Fever or chills
  • Cough
  • Shortness of breath
  • Fatigue
  • Sore throat
  • Runny or stuffy nose
  • Muscle pain or body aches
  • Headache

Dr. Singh adds, “Influenza season and the ongoing COVID-19 pandemic present an overlapping utilization of the same resources, including personal protective equipment (PPE), hospital beds and equipment. It’s essential that we all do our part in curbing the spread of influenza this season to limit any potential strain on these resources.”

There is also growing concern among providers that people could become infected with both viruses at the same time, according to Dr. Singh.

“This year more than ever, it is important to get a flu shot to offer as much protection as possible from influenza ,” says Dr. Singh

In this Q&A, Dr. Singh answers some other common questions parents have about the influenza vaccine amid COVID-19.

When is the best time to get a flu shot? Is it possible to get the flu shot too late?

The Centers for Disease Control recommends people get vaccinated against influenza by late October, before the influenza season starts. However, it is not too late to get your flu vaccine.  Anyone who has yet to receive their annual influenza vaccine should still get vaccinated. Your annual influenza vaccine can protect you from getting infected with influenza, and importantly, can also help prevent serious outcomes, including hospitalizations or death.

What time of day should you get a flu shot? 

There is no specific time of day that makes a flu shot more or less effective. Choose a time that is convenient and available for you and your provider.

What are the side effects of getting a flu shot? 

Some patients experience low grade fever, muscle and joint aches, headaches or nausea.  You cannot get influenza infection from the flu shot, but some patients can experience mild “influenza-like symptoms” for up to two days after receiving the vaccine. Some patients also experience redness and swelling around the injection site. Here are some tips for making shots less stressful for kids.

How can I protect my family from influenza this year? How can I protect my family from COVID-19?

Besides getting an influenza vaccine, washing your hands – properly and often – is the single best way to protect yourself against influenza. Here’s advice from a pediatrician on proper hand-washing.

To further protect yourself and your family from the flu this season, remember these tips:

  • Stay home when you’re sick, and stay away from others who are ill
  • Cover your nose and mouth when you cough
  • Get enough sleep
  • Eat a well-balanced diet

With no COVID-19 vaccine currently available, the best way to prevent this illness is to avoid being exposed. It’s also important to take preventative steps:

  • The CDC recommends the use of cloth face coverings in public for those over age 2
  • Practice physical distancing
  • Avoid large gatherings, particularly indoors
  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing or sneezing.
  • The CDC recommends laundering items including washable plush toys as appropriate following the manufacturer’s instructions. When possible, use the warmest appropriate water setting for the items and let them dry completely. Laundry from an ill person can be washed with other people’s items.
  • Check out this list of how to prepare your household for a potential COVID-19 outbreak.
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Featured image c/o the American Academy of Pediatrics & SELF magazine.