The link between COVID-19 and suicide: What parents should know

By Dr. Meredith Dennis, post-doctoral fellow at CHOC Children’s; and Alva Alvarez and Christopher Reeves, mental health social workers

It is an understatement to say that living through the COVID-19 has been tough. For kids and teens already struggling with mental health issues like depression, their symptoms may have worsened with the added stress of COVID-19. No parent wants to imagine that their child would think about ending their life or hurting themselves in any way, but the reality is that kids and teens are not immune to severe symptoms of depression like suicidal thoughts. Unfortunately, we have seen a negative impact of everything that comes with the COVID-19 pandemic on child and teen mental health, including increased suicidal thoughts. This can raise many questions and concerns for parents. Why is this happening? What can I do about it? How can I make sure my child is safe?

A good place to start as a parent is to be aware of the risk factors for suicide. Among others, here are things that could increase risk for thoughts of suicide:

  • Feeling like a burden. If your child believes they are a burden to people in their life, this increases risk for suicide. Keep in mind that it doesn’t matter whether or not this is actually true. It’s about what your child may mistakenly believe.
  • Being disconnected or isolated from others. No matter how much support you try and give, your child may feel lonely or think no one cares about them. This may be especially true if your child feels they do not have any friends.
  • Repeated engagement in self-harm behaviors or suicide The more your child harms themselves or makes attempts at dying, the “better” they get at it. They are also better able to tolerate pain — studies show they experience less pain with more self-harm —, and become less scared of dying.
  • If your child believes that things will stay this way and not get better, there is greater risk. Again, this is not about what is actually happening, but what your child believes to be true.

The COVID contribution

Our lives are nearly unrecognizable these days amid the COVID-19 pandemic. So many elements have changed as we work together to follow various safety guidelines. From the way we go to school and work to the way we interact with our social groups, this new way of life has vastly transformed our routines. Furthermore, these changes occurred suddenly and without warning. It is no wonder that we are seeing increases in symptoms of depression and anxiety, as well as in suicidal and self-harming behaviors. Here are some specific ways COVID-19 may be affecting mental health:

  • Sudden disconnect from peers and support groups outside of the home may increase feelings of isolation while also deterring one’s motivation to seek support, knowing they are unable to interact face to face.
  • Most opportunities we used to enjoy for fun and relaxation have been closed, canceled or restricted. There are limited replacement options. Daily life is now filled with more stress and less fun, making it harder to ignore feelings of loneliness, sadness, worry and hopelessness.
  • Separation from stressful situations within the home may not be possible due to safety precautions. While confined to your home, your child may begin to focus more on their current stressors with little or no distraction from them.
  • A major challenge many families face in these times is financial insecurity or loss of income. Though young, kids and teens are often acutely aware of their parents’ stress. Knowing that parents are worried about finances can increase a youth’s perception of being a burden, and thus increase risk for suicide.
  • Increased exposure to social media and news coverage could lead to increased thoughts and risk of suicide for your teen. Since youth’s activities are severely restricted now, many are spending more time on their screens. This means increased exposure to “doom and gloom” news coverage as well as increased exposure to negative online peer interactions. These things increase hopelessness that the pandemic will ever be resolved and decrease the sense of social connectedness. Increasing suicidal thoughts and behaviors means kids and teens are more frequently exposed to this content online. We know this is a dangerous risk factor for youth suicide.
  • Decreased physical activity along with an increase in screen time may diminish one’s ability to focus throughout the day and negatively affect sleep. Poor sleep and diminished concentration may lead to impaired judgment. This is a recipe for misinterpreting the environment — for example, believing no one cares about them, or feeling like they are a burden.

Accidental adult errors

More often than not, caregivers are doing a great job of reaching out for support and guidance when it comes to a child’s mental health. There are times, however, when adults inadvertently engage in verbal and non-verbal behaviors that can increase or exacerbate risk factors for suicide in children. While these behaviors can be perceived as harmless by adults, to a young person who is already struggling with suicidal thoughts, they can make the difference between ideation and intent. Examples of these behaviors can include:

  • Avoiding conversations about the current state of events, including COVID-19, may accidentally increase distress in youth. This may include avoiding discussing your own thoughts and feelings regarding the impact of COVID-19. Attempting to protect children from the current state of life creates the impression that COVID-19 is too scary to talk about, potentially increasing anxiety or hopelessness about the situation.
  • However, oversharing information — such as financial burdens, parental stress, workload and constant news updates — can also increase suicidal ideation in adolescents by creating what feels like a flood of negative messages that they feel they can’t escape from.
  • Adults sometimes try to help youth feel better by telling them they are overreacting, that things aren’t that bad, or by saying things could be worse. This accidentally increases the intensity of those emotions, leading to escalations of experiences like depression, anxiety and self-harming behaviors.
  • Expecting children and teens to continue functioning at the same pre-COVID-19 levels can place unrealistic pressure on them. Many adults continue to struggle with symptoms of grief related to COVID-19 losses that may be financial, emotional or social.As a result, adults have had to make adjustments to their own expectations for “normal” functioning. Youth also need to know that they are allowed to make adjustments and that not everything needs to be perfect.

Action steps to support children and teens suffering during COVID-19

There are things you can do as a parent, guardian or caregiver to help children and teens who are suffering during this time. Kids are resilient, meaning they have the ability to “bounce back” when difficult things happen. There are also several protective factors to be aware of that are helpful in lowering the chance your child will experience more serious risk. Here are a few ways you can help:

  • Stay connected. With social distancing guidelines in place, it may be difficult to find safe and appropriate ways to keep your child socially engaged that meet your needs. Set up virtual hang-outs with friends, or meet at an outdoor space like a park where social distancing can be maintained if everyone agrees to wear a face covering.
  • Stick to a routine. Maintaining predictability in the day can help your child build structure and have a sense of security. Daily routines also help increase engagement in activities, which can increase feelings of accomplishment and self-confidence, directly reducing things like hopelessness and feeling like a burden.
  • Have a conversation. Setting aside time to talk to your child about how they are feeling is important. Give them a safe space to share their thoughts and feelings. Show them you are there to help by validating them and being supportive. Let them know it’s OK to feel the way they feel and that you will get through it together.
  • Find time for self-care. Keep your child engaged in things they like that are fun and/or relaxing. It works best if you do this with them! Do fun things or a favorite activity, do things you are good at, learn a new skill, and keep them involved in extracurricular activities like sports or clubs if possible.
  • Take care of basic physical needs. A healthy body helps us be as prepared for the daily stresses as possible. Get enough sleep, move your body and eat balanced foods.
  • Limit screen time. Even though our lives revolve almost exclusively around screens, make time to disconnect and seek social connection, fun, relaxation and joy using “old school” ways.
  • Self soothe. We could all use some extra comforting these days. Teach your children to use their physical senses to comfort themselves by listening to relaxing music, finding a soft comfort object such as a blanket or T-shirt, or using a favorite scented candle or lotion.
  • Seek mental health support when needed. If your child seems to be having a pretty hard time and does not already have mental health services like therapy or counseling in place, this would be a great time to start. Medication may also be an option. Talk to your doctor, insurance, or school about where to get connected.
  • Get immediate help if needed. If your child continues to express thoughts about harming themselves or dying, go to the nearest emergency room or call 911.
  • Help your child identify reasons to live. What is important to your child? What are their values and goals? Helping them get connected to these things can be a very powerful way to recognize that they have things in their lives that are important and matter – and that this situation is not going to last forever.
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Back to virtual school: 10 tips to help kids transition after summer break

By Dr. Sabrina Stutz, a pediatric psychologist at CHOC Children’s

As summer break comes to an end, kids and parents alike are faced with an uncertain transition back to school. While many children are starting the school year in a distance learning model, no one knows for sure what kinds of changes might take place in the future. We know that children and families alike can feel frustrated or scared about the transition and the uncertainty of this time. Here are 10 tips to help kids transition back to virtual school and prepare for the uncertainty of the future.

  1. Create a routine. In times of uncertainty, kids have a sense of safety and predictability in structure and routines.
    • Start by making clear bedtimes and wake times that will allow your child to get enough sleep – 9 to 12 hours, depending on their age.
    • Build a morning routine that is similar to the one they were used to with in-person Have your child wake up, eat breakfast, brush their teeth, put on clothes, and do any morning chores needed, such as feeding a pet. This will make sure your child is awake and alert in the mornings and ready for the school day. It also gives you valuable quality time with your child in the morning in which everyone is likely to be in a better mood. By following a morning routine, you are not only setting your child up for school success, but you are also modelling how to build and follow structure in a day.
    • Using your child’s school learning schedule as a guide, schedule out your child’s learning time, brain breaks, lunch, recess and homework time.
    • Schedule home and family time, dinner, active time, relaxation time and a bedtime routine. Be flexible with finding a routine that works for your family in these new circumstances.
    • If following routines is difficult for your child, consider adding in incentives to help them get used to them. For younger kids, a sticker chart and praise for following each step of the routine can be helpful. For older kids, points to earn screen time or allowance for following a new routine can also help motivate them.
    • If your child is distracted by other screens or devices, consider restricting device access until after the school day and homework are complete. In addition, for kids who will already have several hours of screen time during the day for school, support them in finding activities without a screen for their free time, such as playing outside, reading a book or cooking.
    • Build in fun activities into the routine as well, such as family walks or new weekend traditions. These traditions could be getting take-out from your favorite restaurant, playing outdoor games, cooking a new recipe together, or building something like a birdhouse.

2. Designate a learning space: When home and school occur in the same place, it can be easy for kids to get distracted by their favorite toys and activities, wanting to take a nap in their bed, seeing the TV screen, or wanting a snack from the kitchen. By finding and preparing a dedicated learning space for your child, it will help them stay focused on their school work and allow them to experience the separation between learning with play and relaxation time that they had when they were going to school in-person.

    • Locate a quiet space in your home with minimal distractions, good lighting, and sturdy seating. For kids who have a shorter attention span, scope out multiple potential appropriate spaces so that your child has different workstations to associate with different subjects. For example,  a seated location for writing, a comfortable space for reading or a higher countertop for standing while working.
    • Partner with your child to find comfortable positions that support their bodies. Put boxes under a tall chair to provide a footrest for a child whose feet do not hit the ground. If your child has a Zoom call, you can stack books under the laptop to bring the screen to eye level, avoiding neck strain. Just like at work, consider what will make a child’s body the most comfortable, without any strain.
    • If space is a concern in your home, be creative with different workspace solutions. For example, consider a foldable lap desk for couch sitting, or allow your child to kneel on the floor using an ottoman as a desk. Consider using low shelves or folding tables as workstations.
    • It is recommended to avoid bedrooms or lounge areas as learning spaces. Especially avoid having your child work on their bed, as this can disrupt a child’s association with their bed as a place for sleep and rest.

 3. Pre-plan organizational support: At school, teachers can monitor notebooks, desks, backpacks, planners and other things kids use to stay organized. In distance learning, parents can support children by ensuring they stay well-organized throughout the week.

    • If your teacher has recommended an organizational structure, help your child get whatever materials they need such as folders, school supplies or pencil cases. Low-cost alternatives to some popular organizational supplies could include plastic food storage  containers or reusing and decorating cardboard boxes.
    • If your teacher has not recommended an organizational structure, build one together with your child. Help them have a separate space to put their work for each subject, divided into completed work versus work that still needs to be done. For typed work, you can also help model for a child how to have different folders on their laptop for each subject.
    • Become familiar with your child’s virtual learning platform and support them in understanding how to integrate that platform with the physical organizational structure they have at home.
    • At the end of each school day, review with your child what they completed and what they still have left to do. Help them set up their workspace for the following day so that they can start the next day with success.

4. Test-drive the technology and review online safety: With more education occurring online, kids are using the internet more often to find resources for assignments, or to pass the time if distracted during the school day. Now is a great time to ensure you are familiar with the technology they are using and review internet safety.

    • Test out your child’s technology and see if they can maintain a good connection on their platforms in a variety of likely scenarios — another child in the home also has a Zoom call, or a parent needs to give a work presentation while the kids are engaged in distance learning.
    • Review your house rules on internet use and consequences for breaking those rules. Revisit your parental controls for screen time use and content.
    • Have a conversation with your child about common pitfalls of internet use including clicking on spam links, downloading content, cyberbullying and predators, and social media sharing.
    • Keep computers and laptops in common areas of the house so adults can monitor internet use.

5. Partner with your child’s teachers: While this transition to distance learning is an adjustment for families, it is also a major change for teachers! By collaborating and partnering with your child’s teacher, you can find creative ways to engage your child in learning and communicate successes and areas for problem solving.

    • Become familiar with the teacher’s expectations for your child’s progress and learning. Since children learn at different paces, it can be helpful to consult your teacher regarding options for additional enrichment or modifications that can support children with learning disabilities.
    • If you are concerned your child is spending all their free time on homework, having difficulty tolerating extended screen time, or struggling to understand the concepts provided, contact your teacher to see what suggestions they have.
    • If your child has a 504 plan or Individualized Education Program (IEP), stay connected to their special education teacher or case manager to help problem-solve how to make material more accessible for your child’s ability level in a distance learning format.

6. Make flexible back-up plans: Be prepared for something to go wrong in your distance learning plans, and stay flexible with changing the plan if it is not working for your family.

  • Create a plan with your family about what to do if technology fails, such as a power outage or device running out of battery . Will the child try to log back in on a different device? Or call in, instead? Who will communicate with the teacher to find the information the child needs to catch up?
  • Talk about plans for a child missing a live class.  Decide how the child will find out the necessary information for the class they missed, by contacting a friend for notes, emailing the teacher, asking for extra credit, or another way. Consider consequences for older children who miss live classes and help them problem-solve how to ensure attendance in the future.
  • Consider alternative childcare arrangements if a parent is unexpectedly called in to work on-site or needs to tend to another family member.

7. Find ways to enrich learning: Kids learn best through using a variety of learning approaches. Look for opportunities to enrich their learning at home and in your community.

  • Some kids benefit from hands-on learning. Get creative and partner with your teacher to find ways to use common household objects to help support your kid’s learning. This could look like breaking up crackers to teach fractions, using ice cube trays for sorting or teaching measurement through baking.
  • Find documentaries or educational programming that elaborate on what your child is learning about in school, or what they are interested in learning about.
  • Consider what kinds of physically distanced field trips you can incorporate into a child’s curriculum to help make their education come alive. Some ideas are: bringing art supplies to a local park and painting the clouds, collecting leaves or going to a local farm to pick fruit. You can also take virtual field trips to places like aquariums, zoos and planetariums.

8. Be creative about maintaining social connection: One of the aspects of in-person school that parents can supplement in distance learning is social connection and skills development.

  • Encourage regular virtual contact with other youth that the child knows from school or the neighborhood. Some children, even middle schoolers, are not yet experts in starting social relationships and may need their parents’ help with organizing virtual playdates or online communications.
  • Consider building social encounters that would normally happen in person into your child’s virtual schedule. Some teens might enjoy doing homework after school while on a video call with a friend.
  • Look for online groups or clubs put on by the school or community centers to capitalize on your child’s passions.
  • Although physical activities are still important, limit in-person time with other children and connect virtually if possible. Before engaging in any physically distant activities, ensure your child is up-to-date on well-child visits and immunizations. Parents should follow guidance from the Centers for Disease Control and Prevention regarding potential in-person playdates.
  1. Teach kids to cope with uncertainty: Many families do not know how long distance learning will be in place. Parents can support their children in developing resiliency to be able to tolerate unknowns about the future by focusing on the here and now.
    • Praise your child for all the bravery they are showing by trying a new way of schooling, for communicating their concerns to you, for problem-solving in a less-than-ideal situation, and for trying hard to adjust to distance learning. The more parents let kids know they are proud of them, the more the child will persevere and keep trying different solutions to find balance in theirs and their family’s lives.
    • Periodically, check in on your child’s mental health by asking how they feel and monitoring their sleep, appetite, motivation, and school performance. If you have concerns about your child’s mental wellbeing, contact your pediatrician or some of the resources listed below.
    • Here are additional tips from CHOC pediatric psychologists on:

 10. Ask for help: No one was given a manual on how to help their children cope with a global pandemic, all while coping with it themselves, managing their own work or finances, and supporting their kids’ education at home! It takes a village, and it is OK to ask for help or tap other resources to support you and your family through this time.

    • Reach out to your child’s teacher or school counselor if they are not adjusting well to distance learning or are struggling to keep up. To your comfort level, share with them any additional factors that might be contributing to your child’s needs – these could be family separations or disruptions in custody agreements, financial problems, an ill family member, lack of school supplies, a sibling who is distracting in the home. They may be able to help find creative solutions.
    • Be realistic about what kind of support you can or cannot provide during work hours. If you are concerned about engaging your child in distance-learning, consult your child’s teacher about schedules and other support. In pre-COVID times, grandparents or nannies were often a source of support to children while spending periods of time at home. The nature of the COVID-19 pandemic has made mixing households risky, and families may want to re-consider their typical avenues of 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 search online. You can also contact any of the resources below.

Resources

  • CHOC’s mental health toolkit has resources for parents, kids and teens, and schools.
  • 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): “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: 866-830-6011
  • Helpful apps
    • Woebot: a cognitive behavior therapy-based artificial intelligence self-care app designed by psychologists at Stanford University.
    • Headspace: A mindfulness app for everyday life
    • Calm: A sleep, meditation and relaxation app
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Helping children adjust to life after COVID-19 stay at home orders

By Dr. Sheila Modir, pediatric psychologist at CHOC Children’s

As communities navigate through re-opening efforts after shelter-in-place orders, it’s natural for adults and children alike to have mixed emotions about what is to come. Children tend to echo the feelings of their parents or caregivers. They will look to the adults in their lives for support and guidance on how to react to this new transition of going outside again, and whether they will continue to remain safe once they are away from the safety of their home. Although parents may not know all the answers to these questions, there are some things you can do to boost your child’s sense of emotional safety in order to help them navigate life as things slowly re-open.

Communicate

Have an age-appropriate, open conversation with your child about what is going on with COVID-19 and why things are beginning to re-open.

  • Clarify any misinformation and provide them with the correct facts in a developmentally appropriate manner.
  • Limit information to the questions that they ask you, so that you avoid overwhelming them with information that they may not need to be privy to right now.
  • For teens, ask them what information they have read online or what their friends have told them about things re-opening
  • Ensure that your children understand ways to keep themselves safe in public, as well as the symptoms of COVID-19, so that they can feel a sense of agency in their world as they re-enter

Reassure safety

For children who are prone to higher levels of anxiety, transitions and change are difficult for them. It can be scary to go from staying at home all day — which had been associated with staying safe — to slowly reintegrating back into the world — which had been associated with people getting sick.

Remind your child about ways that everyone is working hard to keep them safe as things slowly re-open. For instance, your family helps keep each other safe by doing things like washing your hands and sneezing into your elbow rather than your hand. Doctors and nurses are working hard to save lives in the hospitals, people wear face masks when they go outside to protect each other, and schools are planning how to handle hygiene and social distancing once they re-open.

If your child is worried about you going back to work, tell them about all the ways that your work is keeping you safe. If your child is worried about getting sick if they go outside, remind them of all the ways you have taken care of them in the past when they have gotten sick. You can let them know that most sick people are recovering, and many children are not getting sick.

Establish routines

If you child’s daycare or school is opening, it is important to remind them of what their daily schedule used to be when they were going to school. If you are going back to work, collaborate with them to create a new schedule of what their days will look like while you are at work. Reviewing their schedule can help them anticipate what to expect and will also provide them with structure and predictability during a period of transition and change.

If your child’s routine at school or daycare will change, review this new change with them often, so that they can mentally prepare for it.

Explain and model emotion regulation

Explain to your child that feelings are normal, and it is OK to feel scared, anxious, worried or excited about things re-opening and people going back to work. Avoid dismissing their fears by saying things like, “Don’t stress about all of this.” Instead, you can model for your child how to express these emotions in a healthy manner. For example, you can tell your child, “I am also worried about going back to work, but whenever I get worried I talk to your aunt because she’s a good listener, then I take three deep breaths, and I think of all the people that are working hard to keep me safe.”

Limit media exposure

Repeated exposure to the news has been found to increase distress and intensify already heightened emotions. It’s also important to be mindful of conversations you have with other adults about COVID-19, as children may listen and misinterpret things said. Here’s more advice on monitoring news and social media intake during COVID-19v.

Be aware of emotional cues

The experience of a pandemic has been traumatic for many children. Being aware of your child’s emotional cues can be helpful in knowing when they are experiencing distress.

Some signs and symptoms of distress are a normal part of adjusting to a transition — such as changes in your child’s sleep or appetite — and will subside as your child adapts. However, when these signs and symptoms begin to interfere with a child’s ability to function, consider contacting a mental health professional.

Here are signs and symptoms of pediatric traumatic stress: 

Preschool and young child

  • Increase in crying and/or screaming
  • Difficulty falling asleep on their own and/or increase in nightmares
  • Increase in separation anxiety from caregivers
  • Engaging in regressive behaviors such as losing their speech, toileting skills, or eating poorly

School-age children

  • Feelings of anxiety, sadness and fearfulness
  • Constant worries about their safety and safety of others
  • Acting clingy
  • Somatic complaints such as stomachaches or headaches
  • Impaired concentration
  • Difficulty sleeping

Adolescents

  • Feelings of anxiety, depression and loneliness
  • Engagement in risky behaviors such as self-harming, using substances or restrictive eating
  • Increase in argumentative behaviors
  • Isolation
  • Difficulty sleeping or sleeping too much
  • On edge much of the time or easily irritable

Resources for parents

Children’s books that can be helpful when discussing worries and emotions around transitions and changes.

  • “The Kid’s Guide to Staying Awesome and In Control” by Lauren Brukner
  • “The Invisible String” by Patrice Karst
  • “Wilma Jean the Worry Machine” by Julia Cook
  • “What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety” by Dawn Huebner
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7 ways to help kids cope with coronavirus (COVID-19) anxiety

If the ongoing spread of coronavirus (COVID-19) is causing anxiety, stress and uncertainty for grownups, consider how troubling it may be for children.

Depending on their age and media exposure, children may know more about the virus than grownups think. And even if unaware, children still might sense tension and anxiety from adults around them.

Here, CHOC Children’s pediatric psychologist Dr. Sabrina Stutz offers seven things parents can do to help reduce their children’s anxiety about COVID-19.

Meet children’s concerns with validation, compassion

  • Listen carefully to their concerns and learn where they heard their information. Validate their fears by saying something like, “It can be frightening when a new illness comes around, and we don’t know how long it will last.”
  • Gently correct any misconceptions they may have heard and encourage them to continue to ask questions.
  • Maintaining a routine can provide children a sense of security. Keeping a usual schedule – including schoolwork, activities and chores – will protect mental and physical health.

Stick to developmentally appropriate facts

  • ​Avoid having adult-level conversations about COVID-19 around children. Similarly, carefully monitor children’s exposure to media reports about the virus.
  • Answer questions with brief, developmentally appropriate explanations. For example, you might tell a young child, “Coronavirus is a new type of germ that can make some people very sick, and so it is important for us to wear masks around people other than our family, keep 6 feet away from people outside our family, wash our hands more, avoid touching our face, and spend time outside rather than in buildings to keep ourselves and others healthy.”
  • Remind children that doctors and other experts around the world are working hard to stop the virus and will let us know when it is safe to return to certain activities. This can help kids understand that smart, capable people are taking action.

Reassure kids by empowering them

  • Telling kids how they can help provides a sense of agency and can turn anxiety into an actionable goal.
  • Reassure children that they can protect themselves and others by wearing a mask, staying 6 feet away from others, practicing proper hand-washing and cough etiquette and taking other healthy steps.
  • Kids can also be included in other family-wide For example, if you are expecting to be staying at home for a while, ask the child what they might want to snack on or what activities they might enjoy. Be creative with helping your child choose activities that appeal to their passions or curiosities.

Look for kid-friendly methods

  • Make learning about hand-washing and other preventative measures fun. Help kids learn about germs by giving them some lotion and then sprinkling glitter on their hands. Tell them the glitter is like germs, and then ask the child to try to wipe it off with a paper towel or just water. They won’t get far! Then you can explain how soap and warm water removes the glitter – and germs – best.
  • Teach kids how long to wash hands for by singing a 20- to 30-second song together. “Happy Birthday” or the “ABCs” are classics. You can also be creative and estimate 20-to-30 seconds of any song the child likes.

Emphasize kindness

  • As always, it is helpful to teach kids to continue to be kind to all people, regardless of their country of origin or their appearance. Kindness is always possible – even when they feel afraid.
  • Educate children that most people who visit the doctor or wear a mask probably don’t have the virus.
  • It is important to remind children that we are all trying our best to stay healthy and it’s not anyone’s fault if they do get sick.

Remember to model positive behavior

  • Parents who show good coping skills can help reassure kids that they are safe. After all, kids learn from their parents how to react in new situations.
  • Remember that kids make mistakes. If your child accidentally does not wash their hands, gently remind them. Scaring children with the potential consequences of their mistakes is not helpful.
  • Adults should model self-care behaviors: Maintain activities and sleep schedules. Eat healthfully and practice hand hygiene and cough etiquette.
  • It’s also helpful for grownups to limit their own media consumption around coronavirus (COVID-19) and stick to a few trusted resources such as the Centers for Disease Control to prevent information overload and anxiety.

Watch for behavior changes

  • Changes in a child’s sleep, appetite, interest in being with friends or leaving the house, or levels of reassurance seeking, as well as excessive hand-washing can be signs that more help is needed.
  • If basic stress reduction techniques like deep breathing, distraction or guided imagery don’t help, reach out to your primary care provider for additional support.

This article was updated on August 18, 2020.

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Understanding the role of cultural stigma on seeking mental health services

By Dr. Sheila Modir, pediatric psychologist; Baleska Alfaro, licensed marriage and family therapist; and Dr. Ava Casados and Dr. Sarah Ruiz, post-doctoral fellows at CHOC Children’s

For some people, making an appointment with a mental health provider may be a personal and independent decision. For others, the decision to seek therapy services may be influenced by their culture or community, as each culture has its own understanding, interpretation and beliefs around mental health symptoms.

Our own culture also teaches us ways to cope with distress and whom to rely on for support during difficult times. This may impact whether a person seeks mental health services and treatment, or their decision not to seek care at all.

In many cultures, negative stigma about mental health symptoms or therapy services is a major obstacle to getting professional help. Research shows that people in racial and ethnic minority groups in the U.S. are less likely than White people to seek outpatient therapy services. Many ethnic minority groups are more comfortable going to their primary care physicians or family members for assistance with mental health symptoms as opposed to speaking with a mental health provider. We all want to be accepted by our communities, and sometimes fear of shame or embarrassment prevents people from seeking mental health treatment.

For instance, Black families may be understandably reluctant to seek mental health therapy due to the longstanding history of discrimination, racism and mistreatment the Black community has experienced at the hands of providers in the U.S. Instead, they tend to take an active approach in handling adversities independently and directly. They also tend to rely more on spiritual resources for emotional support. While these beliefs and approaches are valid, overly negative views of therapy can keep children who do need a higher level of care from getting that help.

Studies show that Latinx (a gender neutral reference to a person of Latin American cultural or ethnic identity in the U.S.) families are also less likely to trust mental health providers compared to White families and are more likely to rely on social support from extended family and other community members. When Latinx individuals do tell others about their experiences with stress or emotional difficulties, they often focus on physical symptoms such as trouble sleeping or loss of appetite and are less likely to discuss the thoughts or feelings that are bothering them.

For Asian American and Middle Eastern American communities, cultural beliefs that seeking mental health treatment will bring shame and dishonor to the family leads some people to internalize their symptoms instead of seeking therapy. Many Asian American children have described feeling pressured to appear perfect and successful, and therefore keep their symptoms secret. For Middle Eastern American adolescents, research has found that they tend to seek support from other family and religious community members.

While these beliefs and approaches are valid, overly negative views of therapy can keep children who do need a higher level of care from getting that help.

These examples are broad, but they illustrate just a few of the reasons why ethnic minority children are much less likely to receive therapy when they need it. Ultimately, it is the responsibility of the mental and medical health system to make services more accessible to under-served families, and to spark change to counteract myths about the stigma of mental health symptoms and mental health treatment. Parents can also play an important role in examining their family’s own cultural beliefs about treatment and identifying ways to advocate for their children to get expert help whenever they need it.

How our community can end mental health stigma

So, how do we, as parents, healthcare professionals and the community begin to work on eliminating the stigma surrounding mental health disorders and accessing mental health services? After all, one in five children experiences a mental health disorder.

Here are some tips that can help our children and families feel more comfortable with identifying, discussing, managing and accessing services for mental health.

  1. Seek reliable information — A first step that we can take to end mental health stigma is to seek out reliable and accurate information about mental health disorders, treatment options and resources in our community. Trusted sources can include, but are not limited to:

When speaking to children about mental health, use resources that are age-appropriate and engaging. A young child may find books helpful, while an older child may prefer to get information online. Look over resources with your child to help them find reputable sources of information and avoid popular social media platforms as your only source of information. Not sure how to start? Here are a few resources for kids:

  1. Use appropriate language — The resources listed above can help you understand how to talk to your children about mental health issues, as well as how to dispel mental health myths they might have heard about conditions and treatment. Using correct language can reduce any shame or guilt you or your family and friends may have about mental health and can create a space that makes it easier for children and teens to speak openly about their own struggles and seek help.

 

  1. Celebrities normalizing mental health conditions — Because so many people live with and manage symptoms related to a mental health condition, it isn’t hard to find a celebrity or well-known public figure your child admires who has a mental health condition. We can use celebrity or public figure examples to help normalize mental health conditions and access to mental health treatment. Our children will be more open to discussing their mental health condition and to trying out mental health services if they know that their favorite singer, actor or athlete also lives with a mental health condition.

 

  1. Learn to explain your child’s mental health condition to your support system and community — Once we have accurate information about our child’s mental health condition and treatment plan, it could help to share this information. If we share information about mental health with our families, schools or places of worship, as well as other members of our support system, they can each better understand the child’s mental health and how they manage symptoms. Sharing information can also help increase empathy and support for the child’s well-being.

 

  1. Seek support in your community — Children and teens with mental health conditions may not know anyone else with a similar diagnosis, which can impact their self-esteem. For teens especially, finding support from an online community may be a helpful way to openly speak about their mental health condition. Parents may also benefit from knowing other parents with children who have mental health conditions, as this can allow families to find a sense of community or support. Your local National Alliance on Mental Illness chapter offers peer support groups for parents and individuals with mental health conditions.

 

  1. Advocacy — Engaging in advocacy is another way that parents and community members can help break down mental health stigma. Organizations like National Alliance on Mental Illness engage in advocacy and policy change using individual’s stories. Advocacy can help raise awareness about important mental health issues and help dispel myths and break down stigma. It could also have positive impacts for those who are engaging in advocacy, helping to develop a sense of solidarity and common purpose.
Learn more about mental health services at CHOC

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