Monitoring your child’s news and social media intake during COVID-19

By Dr. Chris Min, pediatric psychologist at CHOC Children’s and Luiza Mali, predoctoral intern at CHOC Children’s

Throughout the COVID-19 pandemic, many of us have experienced a thirst for answers and information — especially to help guide our behavior and try to put our worries at ease. Due to social isolation, many of us have looked online and to social media to fulfill those needs. From receiving breaking news on our smartphones regarding updated guidelines to scrolling through our social media feeds to learn about  numbers of infections, we are constantly bombarded with information. As parents, many of us have wondered whether our children’s increased exposure to repetitive and gloomy news is harmful, and whether the information our children consume may come at a cost.

What happens to our minds when we are overexposed to the news

Research shows that continual media coverage of community or health crises — such as COVID-19 — overexposes us to negative information, and this information becomes overrepresented in our minds. This overexposure increases the perception of threat and makes worry more difficult to control.

These psychological risks are particularly true for children, who tend to be more emotionally reactive or have difficulty dealing with uncertainty. For younger children, intaking a huge amount of information may be confusing, overwhelming and raise more questions than answers. For older children and adolescents, particularly those who are worriers, the likelihood of something bad happening may seem like a certainty to them, and that can lead to catastrophic thoughts about the present and future.

Should I isolate my child from the news during COVID-19?

Isolating your child from any information regarding COVID-19 can create a variety of problems. Many times, parents assume that their children are either too young or oblivious to changes in their environment to wonder about why their daily routine looks different. However, children tend to notice these changes, although they may not verbalize their concerns to their parents.

With many changes to their routine and lifestyle — distance learning and social distancing to name a few — that profoundly affect a child’s day-to-day schedule, even young children may notice and wonder why these changes are happening. If parents shield their children from any and all information about why they aren’t going to school or can’t go to their friend’s house, children can feel confused and disappointed.

For older children and teenagers who have unsupervised access to social media and television, parents leave what and how much information is given to their children up to chance. This age group may catch a glimpse of what’s on the news or what friends share on social media, leading to more potential confusion — especially if parents hold back from giving their own accurate take on things.

For these reasons, it is important to ensure that your family is consuming media responsibly and is striking a good balance between absorbing relevant information and protecting your mental health.

Here are some developmentally appropriate ideas to ensure that your family is interacting with media in a careful and helpful way during COVID-19:

Younger children and media

  • Filter the kind of information young children are exposed to.
  • For toddlers and preschoolers, parents will be the ones providing age-appropriate explanations on things like social distancing and hand hygiene on a need-to-know basis.
  • Younger children will benefit from the use of social stories; The National Child Traumatic Stress Network has examples. Children also benefit from informational shows such as the CNN/Sesame Street COVID-19 town hall.
  • Avoid having the TV constantly on to avoid unintended exposure to scary media and inappropriate content.
  • If children ask you questions and you don’t know the answer, look up the answer using trusted sources such as the Centers for Disease Control and Prevention.

Older children/teenagers and media

  • Have a conversation with them about COVID-19.
  • Asking open-ended questions to get their understanding of what the virus is, their opinion on how dangerous it is, and their take on the necessity of social distancing can be a great place to start.
  • Getting an idea of what their friends are saying on social media can be helpful, as adolescents tend to shift their thinking toward opinions from their peer group.
  • Once you have an idea of your teenager’s knowledge base and opinions on COVID-19, confirm the right facts. If you aren’t sure, that’s OK! Look up information on reputable sources like the CDC or World Health Organization.
  • Gently challenge any false notions and provide information from trusted sources as evidence.

Media tips for all children

  • Set boundaries. Excessive use of media is associated with negative psychological and physical consequences including depression and obesity.
  • Set limits for daily use. Encourage active interpersonal exchanges such as video chats with same-age peers, and steer children away from using electronics solely for passive activities such as watching videos.
  • Be sure that your child is also spending time away from electronic devices, engaging in physical activity, and other social and educational activities.
  • Model appropriate consumption of media and reactions to news reports. Obtain critical updates from reliable sources once or twice a day.
  • Avoid sensationalism or repeated coverage of the same information.
  • Check in with yourself – am I distressed or agitated? If so, turn it off and pursue other activities. Although some level of worry, confusion, or sadness is to be expected, if your child senses you are feeling overwhelmed and hopeless, they will be more likely become emotionally dysregulated as well. React calmly and provide reassurance so that your child will follow suit.

If your child is expressing excessive worry, anxiety or hopelessness about COVID-19, it may be a good idea to limit his/her exposure to news and social media. With the flood of potential misinformation from social media as well as repeated exposure to distressing  content on the news, your child may start to think that the future is hopeless and that his/her own health is at serious risk. Combat this impression by focusing on the measures that your family is currently taking to limit risk of infection as well as steps that your child or teenager can take to ensure continued health and safety. Take time to have a discussion about interesting and fun activities that your child can participate in that follow the public health recommendations.

Get more information on Coronavirus (COVID-19)

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Tips for making the most of your first mental health telehealth appointment

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

Mental health services don’t always need to be carried out in person. Services can be delivered via a smartphone, tablet or computer. You and your child can engage in mental health services for telehealth from any private location with internet access.

If you are new to mental health telehealth services, here’s a guide for how you can prepare for your visit virtual appointment and what to expect, plus benefits of telehealth for mental health and answers to some commonly asked questions.

What happens before my first visit?

  • CHOC’s psychology team will email you a secure link for your virtual appointment. It is recommended that you practice signing onto the teleconference link prior to your visit.
  • We will also email a link to consent to mental health evaluation and treatment, for you to review and sign prior to your appointment.
  • We recommend that you find a place with stable internet service and good lighting in which you and/or your child can speak openly and freely with privacy.
  • Please ensure that a parent or adult caregiver will be physically present in the same location as the child at all times during telehealth mental health visits in case of emergency.

Who needs to be at the first telehealth mental health session?

Both a legal guardian and the child should be present at the beginning of the first session to go through the consenting process. It is recommended that the primary caregiver and the child be in the same physical location for the first appointment.

What will we talk about?

Your clinician will introduce themselves and confirm that a legal caregiver and child are present. They will review and confirm your contact information in the event of technology disruption or an emergency. Then, your clinician will review the consent process and answer any questions about using the teleconferencing software.

After the family consents to services, the clinician may wish to speak to the parent(s) and child separately. Your provider will review your concerns and your child’s history, and will offer feedback and recommendations/resources at the end of your visit. They will also answer any questions or concerns you may have about your child’s symptoms.

Is telehealth therapy as effective as in-person therapy?

Yes! Telehealth-delivered therapy techniques have been studied for over a decade. Many evidence-based therapies have research to prove that they are just as, if not more effective when delivered via telehealth. Cognitive behavior therapy (CBT), trauma-focused interventions, and parent-coaching models all have research to support their effectiveness when delivered online by a trained, licensed provider. Some minor adaptations can be made to ensure appropriate delivery of most evidence-based outpatient therapeutic interventions online.

What are the benefits of receiving mental health therapy via telehealth?

Telehealththerapy is a great way to access mental health services from the safety, comfort and convenience of your own home. Here are some of the other benefits of telehealth delivered therapy that families and clinicians have shared:

  • Families find it easier to attend sessions.
  • Families have flexibility in their schedule when cutting out commute time.
  • There are reduced childcare costs for untreated siblings.
  • Families save time, especially during high-traffic appointment times or when living far away.
  • Therapy is still accessible when on vacation within the state of California.
  • Children who might be nervous to do therapy feel more at ease using telehealth for a first session. Then, they are more likely to follow-up with telehealth mental health sessions afterwards.
  • Family members in separate locations can both attend a therapy session without having to be in the same location.
  • Parents at work can call in on their breaks to participate in family sessions.
  • Children and families are better able to remember and use coping skills when they have learned and practiced them in their own home environment.
  • Clinicians can see and live-coach families through difficult home-based situations like picky eating at mealtimes, setting behavioral limits such as a time out, or supporting a child in accepting a medical intervention such as  injections, pill-swallowing or nebulizers.
  • Clinicians have a richer and more nuanced understanding of families when they can see them in their home environment.
  • Clinicians can make more personalized and immediate recommendations. For example, “That looks like a great spot to put a reminder to check your blood sugar! Let’s create a reminder together and put it up during our session today.”

My child has trouble keeping their attention on the screen. What can you do for them?

The mental health community has created inventive and engaging ways to keep a child engaged over telehealth! Your clinician will talk with you and observe your child to assess their capacities for sustained attention, and can adapt interventions to fit their needs. For some children, we may ask parents to print out or set up certain activities before the therapy session to help facilitate. Other engagement strategies include share-screen therapeutic drawing and games such as Pictionary or Heads Up, gratitude scavenger hunts, “show and tell” topics, and parent-assisted relaxation exercises. If a child is unable to interact over telehealth, parent training models in which the therapist helps coach the parent to interact therapeutically with their child, are available.

How can I ensure my privacy?

 CHOC clinicians hold your confidentiality and privacy rights during telehealth sessions as seriously as they do when you come to the office. During a mental health telehealth appointment, your clinician will be in a private space where no one can see or hear them, and will be using secure, encrypted video conferencing software. We recommend that you access any mental health telehalthe services through your own password protected device on a password protected internet network to maximize your privacy. You may also wish to use headphones in order to have a more private conversation when sharing a home with others. For some very sensitive conversations, some families have chosen to step out to their cars or another more private location.

I have to work, but my child is home with another adult. Can we do a mental health visit via telehealth?

 For the first session, it is best if a legal guardian and their child can be together in the same location. Please contact your clinician for questions about special circumstances. For follow-up sessions, it will be up to you and your clinician to determine whether it is appropriate for the parent to call in from work while the child is at home with another trusted adult caregiver. Please talk to your clinician in advance of any adjustments that might need to be made for the supervision of your child during scheduled therapy sessions.

What if my child has very serious mental health symptoms?

If your clinician feels that your child’s mental health symptoms are too severe to manage over telehealth, they will review their recommendations and alternative options with you.

If you are concerned your child may be having a mental health emergency, do not wait for a telehealth mental health appointment. Instead, contact one of the crisis lines below, go to your nearest emergency department, or call 911.

  • National Suicide Prevention Lifeline: 1-800-273-8255
  • Crisis Text Line: Text HOME to 741-741
  • Orange County Crisis Assessment Team: 866-830-6011

If it becomes clear to a mental health clinician during the course of a telehealth session that your child is having a mental health emergency, the clinician will advise you to go to the nearest emergency room or call 911.

Learn more about mental health services at CHOC

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Tips for parenting a child who is depressed

We understand that in these very difficult times, children and teens can struggle with feelings of depression.

If you are a parent who is concerned about your child or one of their friends, here are tips for starting the conversation. This guide on common sayings to avoid, and what to say instead, can help as well.

Below are parenting tips for a child or teen who is depressed, from the mental health experts at CHOC Children’s:

  • Show your love. Children need love, empathy and respect. Let them know you care and that this is important. Just be present, sit with them and reassure them that you understand how they feel.
  • Make a date. Schedule time to spend with your child, even if they won’t talk during this time. Schedule pleasant activities, preferably out of the house and active such as walking or going to the park. Before and after the COVID-19 pandemic, these dates might look like going to a movie or getting ice cream. Your child may not want to engage in activities. Encourage them to do it anyway.
  • Stick to a routine. Schedules and routines create a sense of structure and security. Make things seem normal – even though they may not be. Learn more about creating structure and routine for kids during COVID-19.
  • Focus on the positives. Track your ratio of negative to positive comments to your child. Your goal should be one negative to five positives.
  • Stay calm. Kids who are depressed are very sensitive. Small things set them off, so communicate calmness through your voice and body language.
  • Develop a positive environment and atmosphere to help your child relax. Make a list of fun things to do and follow through with them.
  • Take care of yourself. Find a support group, exercise, or ask another adult in the home to stay with the kids so you can relax. You have to take care of yourself before you can take care of your child. Learn more about how parents can deal with stress during COVID-19.
  • Find treatment for your child. Your child may benefit from some treatment to help them feel Options include therapy/counseling and medications. Speak with your doctor to determine what will work best for your family.
  • Get help. If your child expresses thoughts about wanting to kill themselves or is saying scary things, call 911 or bring your child to your local emergency department.

Helpful books for parents of children who are depressed:

  • “Depressed Child: A Parent’s Guide for Rescuing Kids” by Douglas A. Riley
  • “Help me, I’m sad: Recognizing, Treating and Preventing Childhood Depression and Adolescent Depression” by David G. Fassler and Lynne S Dumas
  • “Lonely, Sad and Angry: How to Help Your Unhappy Child” by Barbara D. Ingersoll
  • “Raising Depression-Free Children: A Parent’s Guide to Prevention and Early Intervention” by Kathleen Panula Hockey
  • “The Childhood Depression Sourcebook” by Jeffrey A. Miller

If you or your child are thinking about suicide or hurting yourself, please use one of these resources:

If you or your child is in immediate crisis and/or danger, you can call the Orange County Behavioral Health Crisis Assessment Team (CAT) at 1-866-830-6011. They will come to where the child is to do a safety evaluation. You can also call 911 or proceed to the nearest emergency department.

If you or your child is struggling, you can access these resources 24 hours a day:

  • California Youth Crisis Hotline 1-800-843-5200
  • Suicide Prevention Center 1-800-784-2433
  • Suicide Prevention Lifeline 1-800-273-8255 (TALK)
  • Crisis Text Line 741741
Learn more about mental health services at CHOC

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Depression: Say this, not that

Talking to someone with depression can seem like you are walking on eggshells. Although you may have the best of intentions, the words you use may not express exactly what you mean. Here are some common statements to avoid and some tips on what to say instead. You can also learn how to start a conversation around mental health.

Say this: “Whenever you feel like talking about what’s going on, I am here to listen.”

Not that: “What do you have to be depressed about?”

Clinical depression is a serious medical condition; it is not a choice.

Say this: “No one is rushing you to feel better; take as long as you need.”

Not that: “Hurry up and get over it!”

A person with depression can’t just get over it. They have to learn the skills to effectively manage their depression.

Say this: “You are not alone in struggling with depression.”

Not that: “There’s someone worse off than you!”

When you compare other problems with depression, you run the risk of minimizing the person’s struggle with depression.

Say this: “I can help you get whatever help you may need.”

Not that: “Stay away from therapy and drugs.”

Many people are scared to ask for help because of the stigma of mental illness. They may come from a culture that shames them for talking about personal problems with a stranger.  The use of medications can also feel scary to them because of stories of addiction and dangerous side effects.

Say this: “I may not know exactly how you feel, but I know it must be hard.”

Not that: “It can’t be that bad.”

Depression is a complex condition.

Learn more about mental health services at CHOC

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Depression coping tips for kids and teens

We understand that in these very difficult times, children and teens can struggle with feelings of depression.

If you are a parent who is concerned about your child or one of their friends, here are tips for starting the conversation and tips for parenting a child who is depressed.

If you are a teen struggling with depression, here are tips for coping.:

Try not to bottle up your feelings

Seek out a trusted friend or adult, such as your parent, to talk to about your feelings and what is on your mind.

Understand that there is a name for what you are going through, and that you are not alone

At least half of your classmates will experience symptoms of depression at some point in their lives. There are other people who have felt the same way you do.

Keep up with friends and activities

Even if you do not want to do things, you should still try to do them. Push yourself to try to do fun things, even if you have to go through the motions. During the COVID-19 pandemic, some of the activities you used to enjoy may not be safe in their typical form. Talk to your parent or guardian about activities you can have fun doing while still being safe.

Do something that makes you feel proud.

Do your homework, finish a chore (such as cleaning your room), and notice what a good job you did. Feel proud of your hard work.

Talk about your sadness

Sometimes when people feel sad, the things they think about are sad, too. If your best friend told you they were feeling really sad or had a problem, what would you say to them?

Talk about scary thoughts and feelings

Sometimes when kids feel upset, they think a lot about death or dying. If you notice yourself having scary thoughts such as, “I want to die,” tell a trusted adult, such as your parent or guardian.

Focus on getting enough sleep

We are more likely to get upset or feel down if we don’t get enough rest. Try to make the hour before you go to bed peaceful and relaxing. Try to stay away from your phone and the TV, since the light tricks your brain into thinking it is daytime.

If you are thinking about suicide or hurting yourself, please use one of these resources:

If you are in immediate crisis and/or danger, you can call the Orange County Behavioral Health Crisis Assessment Team (CAT) at 1-866-830-6011. They will come to where you are to do a safety evaluation. You can also call 911 or proceed to the nearest emergency department.

If you or your child is struggling, you can access these resources 24 hours a day:

  • California Youth Crisis Hotline 1-800-843-5200
  • Suicide Prevention Center 1-800-784-2433
  • Suicide Prevention Lifeline 1-800-273-8255 (TALK)
  • Crisis Text Line 741741
Learn more about mental health services at CHOC

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