How living through a pandemic like COVID-19 can affect children’s mental health

By Dr. Heather Huszti, chief psychologist at CHOC Children’s, and
Dr. Sheila Modir, pediatric psychologist at CHOC Children’s

Taking care of your mental health, and your children’s mental health, is particularly important during a crisis such as the COVID-19 pandemic we’re currently living through.

There are many possible risk factors affecting children during this time that can lead to mental health distress:

  • Shelter in place orders and disruption in former routines
  • Loss of family from COVID-19
  • Loss of family income
  • Virtual schooling
  • Lack of access to peers
  • Possible violence in the home

These risk factors can compound existing mental health conditions or bring on new mental health challenges.

A study published by the Society for Disaster Medicine and Public Health polled families who faced isolation due to SARS or H1N1 and found that 30% of children met criteria for post-traumatic stress disorder (PTSD) per parent report. This rate was higher among children who received no mental health services and those whose parents had been isolated because of these diseases. If parents had anxiety or PTSD, their children were more likely to be impacted on a mental health level as well.

Research is emerging that suggests adults are struggling with increased mental health problems during the current COVID-19 pandemic. It also shows that many parents are worried about how to help their children’s mental health. These resources can help:

What happens when we are isolated

Research conducted by Australian psychologist and researcher Kimberley Norris found that when people are isolated due to a pandemic, they tend to cycle through different phases of emotion. How we feel and act can vary in these phases based on our age and other factors, but generally the cycle follows this pattern:

  • Confusion – panic-buying, seeking clarity over regulations, or kids feeling unsure why they can’t see their friends at school anymore
  • Honeymoon – finding a routine, adapting to work from home changes, feeling a sense of community
  • Resentment – feeling cooped up or sick of wearing masks
  • Reunion – the phase where we start to step out of isolation and may feel a rollercoaster of emotions. This could be, “I’m scared to get sick but I’m happy to go to the beach.”
  • Reintegration – back to functioning normally in society

Through self-isolating and sheltering in place, we as clinicians worry that people in our community may not feel comfortable seeking the mental healthcare they need. However, telehealth is available and mental health sessions can be conducted from the safety of your home. Here’s advice on deciding where to go for physical healthcare during COVID-19.

The impact of trauma on children during COVID-19

The COVID-19 pandemic is a new mass trauma that can impact children’s mental health both now and later in life. This trauma will likely exacerbate existing mental health conditions and contribute to new stress-related illnesses.

If the signs and symptoms of trauma are left untreated, they can have a lasting impact on the child’s emotional, behavioral and physical well-being.

Signs and symptoms of trauma in children can include:

  • Depression and/or anxiety
  • Regression behaviors such as loss of toileting skills
  • Increase in separation anxiety
  • Changes in sleep, eating and school performance
  • Engagement in risky behaviors
  • Loss of interest in friends and/or activities
  • Isolation
  • Defiance

Tips for building resilience to mitigate the impact of trauma

There are a number of things parents can do to help children build resilience needed to thrive during this chaotic time, as well as help mitigate the impact of trauma. Resilient children tend to be happier, more motivated and engaged, more confident, and adopt a more positive attitude as they encounter more challenging situations. Here are some ideas to try in your own home:

  • Making a schedule — Whether times are uncertain or not, all children benefit from having a routine in place. Following a schedule provides consistency, structure and predictability. When we don’t know what the world is going to throw at us next, building in some routine and predictability serves as a buffer from the outside chaos.
  • Emotion identification — Today is a great day for a family movie night, and what movie does a better job of describing the internal world of a child than Pixar’s “Inside Out”? Consider making a family fort and gathering your favorite movie snacks. After the movie, grab some markers and paper and have your child draw what recent feelings they have experienced. What does that feeling look like? What would it say if it could talk? What does that feeling need to feel better or safe?
  • Coping skills — There are different ways to manage big emotions that children feel.
    • Deep breathing – This will help the child calm and self-soothe. Breathe in for 3 seconds, hold it for 3 seconds, and release it for 3 seconds.
    • Progressive muscle relaxation – Tense your muscles as you breathe in, and then relax them as you breathe out. This will help you identify in the future times of stress when you feel tense, and you can use deep breathing skills to help relax your body.
    • Grounding – Bring your attention to the present moment using your five senses. For example, name five things you see in the room, four things you feel, three things you hear, etc.
  • Family coping box — A coping box can include tools that different family members can utilize when feeling stressed. The family box should be located somewhere that everyone can access it easily. Consider items such as a soft stuffed animal, word searches, a book of yoga poses, fidget toys or stress balls.
  • Conflict resolution — Stay at home orders can mean tight quarters, which can naturally lead to disagreements. Establish communication rules for your family, like using “I” statement to express how you feel, not interrupting each other, and taking a timeout when things get heated.
  • Mindfulness – Science has shown that the power of thought can change how we feel and lead to changes in those around us. One example of practicing mindfulness is a loving-kindness meditation. Since we can’t be with many of our loved ones right now, we can send them kindness and well wishes instead. Close your eyes, imagine the person or pet you care about and say aloud or silently, “May you be safe. May you be healthy and strong. May you be happy. May you be peaceful and at ease.”
  • Gratitude — Research has found that teaching gratitude to children increases their happiness, optimism and generosity. Encourage your children to keep a gratitude journal and to write three things every day they are grateful for. At the end of the week, everyone can share their reflections.
Get more information on Coronavirus (COVID-19)

Related posts:

Talk Openly To Your Kids About Bullying

Bullying continues to make headlines around the country.  In particular, cyberbullying has become an increasingly common and serious issue largely due to the easy access, and in some cases the anonymity, of digital devices.

CHOC Children’s offers the following tips to help you start a conversation with your child around bullying, and guidelines to help you and your child combat bullying.

Dr. Heather Huszti, chief psychologist at CHOC, says one of the best ways to protect your children from bullying is to talk openly about it. “Have a discussion about why some kids might be bullies,” she says. “You can explain that most bullies have low self-esteem and that they bully other people to try to feel better about themselves.”

Dr. Heather Huszti
Dr. Heather Huszti, chief psychologist at CHOC Children’s

Dr. Huszti suggests asking your child open-ended questions such as, “Is there anything going on?” or “Is there anything I can help you with?” This approach usually works better than firing off a list of specific questions.

If you learn your child is being bullied, here are some additional steps you can take:

  • Inform your child’s school about the bullying.
  • Talk with the bully’s parents about the behavior.
  • Help your child build up his or her self-esteem. The better your child feels about herself, the less effect a bully will have on her overall well-being.
  • Be mindful of your child’s online activity.
  • Have a plan. Talk about what your child might do if he or she is bullied, including who to tell.
  • Pay close attention to signs from your child that may show something is wrong, such as acting withdrawn, sad or irritable, or changes in their sleep or appetite. Keep in mind however, that sometimes kids will not display any signs at all so it’s important to keep an open dialogue with your child.
Learn more about CHOC’s commitment to mental health

Related posts:

  • Cyberbullying and COVID-19
    Cyberbullying has become an increasingly common and serious issue in recent years largely due to the easy access, and in some cases the anonymity, of digital devices. As children and ...
  • How teens can deal with bullying: Teen advisers weigh in
    One in five students age 12-18 in the U.S. have experienced bullying, according to the National Center for Education Statistics and Bureau of Justice. More than 70% of young people ...
  • Weight-Related Bullying – Tips Parents Should Know
    Bullying continues to be an unsettling epidemic that’s most apparent in our children’s schools. There are many forms of this negative behavior, but weight is one of the top reasons ...

How teens can deal with bullying: Teen advisers weigh in

One in five students age 12-18 in the U.S. have experienced bullying, according to the National Center for Education Statistics and Bureau of Justice. More than 70% of young people say they have seen bullying in their schools. Kids and teens who are bullied can experience physical and mental health issues, and problems at school.

CHOC Children’s teen advisers share their own experiences observing and dealing with bullying, and what they do to cope. CHOC experts also weigh in on what parents can do to support a child who is being bullied.

Talk openly about bullying

One of the best ways to protect your child from bullying is to talk openly about it, says Dr. Heather Huszti, CHOC’s chief psychologist.

Dr. Heather Huszti
Dr. Heather Huszti, chief psychologist at CHOC Children’s

“Have a discussion about why some kids might be bullies. You can explain that most bullies have low self-esteem and that they bully other people to try to feel better about themselves,” she says.

CHOC teen adviser Heather Bisset, age 14, has seen this play out firsthand.

“When someone bullies another person, it is often because they are insecure and do not know how to emotionally handle it,” she says. “A bully does and says things to make others feel hurt or down, and if you do not show a response, they will most likely leave you alone.”

choc-childrens-teen-advisor-heather
Heather Bisset, a CHOC Children’s teen adviser

Dr. Huszti also recommends parents ask open-ended questions of their children such as, “Is there anything going on at school?” or “Is there anything I can help you with?”

She adds that this approach usually works better than firing off a list of specific questions and can facilitate a bond between parent and child that will encourage them to open up to you when something is affecting them.

Find a trusted adult to talk to

CHOC teen adviser Zoe Borchard, age 15, knows the benefits of having someone to talk to when you have been bullied.

“At a high school football game, a girl that I don’t even know called me stupid along with a bunch of other nasty words behind my back. When I heard what she had said, I thought it wouldn’t affect me at first, but it started to eat away at me. I walked away to a quieter area during halftime and called my mom. I told her what happened, and it made things a million times easier to process and even let go,” she recalls. “To this day, I’ll call my mom every time I need help. If you can find someone you trust to share your problems with, it lightens your emotional load and gives you room to breathe and feel better.”

choc-childrens-teen-advisor-zoe
Zoe Borchard, a CHOC Children’s teen adviser

Teens can look beyond their parents in finding someone to talk to.

“The best advice I could give someone who is being bullied is to talk to an adult you trust and know is willing to help you,” says CHOC teen adviser Carina Alvaro, age 16. “This could be a teacher who has openly expressed willingness to help, or another trusted adult who can help you resolve these problems.”

choc-childrens-teen-adviser-carina
Carina, a CHOC Children’s teen adviser

Teens and cyberbullying

Nearly 15% of high school students have experienced cyberbullying, according to the Centers for Disease Control. Cyberbullying can include text messages, instant messaging and other apps, social media or gaming.

CHOC teen advisers see a clear link between social media and bullying.

“Social media plays a part in bullying because it’s a lot easier to target someone and attack them online,” says Sanam Sediqi, age 16, a CHOC teen adviser. “On social media, everyone is hiding behind a phone or computer screen, so they more freely throw out hurtful comments towards the victim, often without actual consequences.”

choc-childrens-teen-adviser-sanam
Sanam, a CHOC Children’s teen adviser

CHOC teen adviser Layla Valenzuela, age 14, agrees.

“Having the power of technology comes with responsibility. When you send a message, people can’t see your face or hear your voice, so there is no way of conveying sarcasm or playfulness,” she says. “A simple joke could be interpreted in an unintentional, harmful way. Being responsible for everything you do online is a huge part of being considerate and staying away from bullying.”

choc-childrens-teen-advisor-layla
Layla, a CHOC Children’s teen adviser

Social media and technology use contributes to a rising number of mental health concerns in young people, says Dr. Christopher Min, a CHOC Children’s psychologist.

“Technology is great, but it has consequences, especially on our younger population,” he says. “it’s made teenage culture very unstable.”

Tips for staying safe online

Dr. Min offers the following tips for parents on how to keep kids safe online:

  1. Monitor teens’ social media use
  2. Encourage teens to get together in person
  3. Remember that parents control access to social media

For teens, his advice includes pausing before posting.

“When you’re ready to post something, pause for five to 10 seconds to consider your actions, the post’s meaning and the possible consequences,” he says. “This will help you avoid posting things you don’t want cemented on the internet forever.”

psychologist-tips-back-to-school-anxiety
Dr. Christopher Min, a pediatric psychologist at CHOC Children’s

What to do if your child is being bullied

There are several things parents can do if they learn their child is being bullied, Huszti says, including:

  1. Inform your child’s school about bullying
  2. Talk to the bully’s parents about the behavior
  3. Help your child build up their self-esteem. The more solid their self-esteem, the less impact a bully’s behavior will have on their overall well-being.
  4. Monitor your child’s online activity.
  5. Remind your child of the trusted adults in their lives in whom they can confide.
  6. Pay attention to signs in your child that show something is wrong, such as acting withdrawn, irritable or sad; or changes in appetite or sleep. Some children will show none of these signs, so an open dialogue with your child is key.
  7. If your child needs additional support, ask your pediatrician for a referral to a pediatric psychologist.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative and to receive tips and education from mental health experts..



Related posts:

  • Cyberbullying and COVID-19
    Cyberbullying has become an increasingly common and serious issue in recent years largely due to the easy access, and in some cases the anonymity, of digital devices. As children and ...
  • Talk Openly To Your Kids About Bullying
    Bullying continues to make headlines around the country.  In particular, cyberbullying has become an increasingly common and serious issue largely due to the easy access, and in some cases the ...
  • Weight-Related Bullying – Tips Parents Should Know
    Bullying continues to be an unsettling epidemic that’s most apparent in our children’s schools. There are many forms of this negative behavior, but weight is one of the top reasons ...

Depression and Suicide Prevention: Know the Warning Signs

All children experience days or periods of sadness or other deep emotion. It’s when those feelings are persistent and last longer than a several weeks that it may be time to seek professional help, according to mental health experts at CHOC Children’s.

Suicide is the second leading cause of death for individuals ages 10-24 in the United States. Suicidal children and adolescents may have depression, or a combination of other mental illnesses such as anxiety disorder, attention deficit disorder, bipolar disorder, or child-onset schizophrenia, says Dr. Heather Huszti, chief psychologist at CHOC Children’s.

Dr. Heather Huszti

Other signs that children may be depressed include:

  • Changes in behavior, including appetite
  • No longer enjoying activities they used to like
  • Changes in sleeping pattern
  • Always feeling tired,
  • Isolating themselves socially
  • These changes may be especially concerning if connected to a significant loss or change

“It’s difficult to imagine that children as young as 10 could attempt to end their lives, but unfortunately it can happen,” says Huszti. “The first thing parents can do to help their children is talking openly about mental health issues and any concerns they might have, including talking about the potential warning signs.”

Download your copy of CHOC’s “Let’s Talk About It” guide and learn how you can help start a conversation about mental health.

Warning signs that a child may be considering suicide include:

  • Giving away possessions or making a will
  • Threatening, planning, or joking about suicide
  • Sending despairing texts or online messages
  • Expressing feelings of failure or shame
  • Avoiding friends and social situations
  • Engaging in risky behavior

Always take warning signs seriously, advises Huszti. If your child, or anyone else, is in immediate danger of self-harm, call 911. Other local and nationwide resources are available, such as 24/7 suicide prevention lines and 24/7 crisis response services.

Learn more about CHOC’s commitment to mental health

Related posts:

Overscheduled Kids

TIME OUTpost_kidschess

“There are a number of studies that suggest kids actually do need some unstructured time,” says Dr. Huszti. Kids need moments when they can use their imagination, daydream and even goof off a little bit, she says. And no, this doesn’t mean parents should allow kids to play video games all day.  Instead, try other unstructured-time activities:

  • Going outside to play
  • Playing a board game

FAMILY BONDING

“Kids need some family time,” says Dr. Huszti. “If we find ourselves being overscheduled, we really don’t have that time to bond as a family and develop a strong foundation. Look at what’s important to your family, such as dinners or bedtime reading and carve out time for that,” she says. Make room for family activities at least once per week. Here are some family-fun ideas:

  • Start a family book club
  • Replace organized team sports with family sports

WRITE IT DOWN
To get a handle on how to balance your child’s social and academic calendars, sit down as a family and  create a schedule. “If you look at the schedule and realize we’re really cutting into homework time, or there’s no unstructured or family time, you may be doing too much,” says Dr. Huszti. To keep a good pace, have your child pick two activities per week that they really want to do, and you pick two. If something else comes up, take one away.

What Else Can You Do To Trim Your Child’s Schedule?
Approach the schedule with a “moderation” mentality. If you notice a decline in your child’s grades, or an increase in irritability or sickness, try taking them out of some activities and see what happens, says Dr. Huszti.

FAST FACTS

  • The percent of kids who wish they had more free time: 61%
  • Number of hours of unstructured time recommended per week: 2
  • The percentage of kids who said they felt too busy all the time: 24%

View the full feature on Kids and Overscheduling

Dr. Heather Huszti Psychology
Dr. Heather Huszti
Psychology

PHYSICIAN FOCUS:
DR. HEATHER HUSZTI

Dr. Huszti is a licensed psychologist and has been with CHOC since 2002. She is a member of the American Psychological Association and the Society of Pediatric Psychology. Dr. Huszti served her internship and post-doctorate fellowship at the University of Oklahoma Health Sciences Center.

Dr. Huszti’s philosophy of care: “I want to help kids and families function as optimally as possible. I believe that involves working with the whole family.”

EDUCATION:
University of California, Irvine (B.A., Psychology)
Texas Tech University (Ph.D., Clinical Psychology)
University of Oklahoma Health Sciences Center (internship and fellowship)

More about Dr. Huszti

This article was featured in the Orange County Register on September 23, 2013 and was written by Shaleek Wilson.