Ask a pediatrician: How can parents best support their children during the pandemic?

Q: My children are having a rough time as the pandemic drags on. What are the signs that they may need more support, and how can I help?

A: The ongoing stress, fear, grief and uncertainty from COVID-19 have weighed on all of us. Many children and teens have also had a tough time coping.

Over 120,000 children in the United States have lost a primary caregiver to a COVID-19-associated death. Many have lost jobs, and many are having financial trouble due to the pandemic. There have also been unequal effects of the pandemic on Black and Brown people, and increased racism and xenophobia toward Asian families.

The usual supports for children, such as school, health care and community, were also interrupted, in many cases. Check in with your children often and watch and listen for signs they are struggling. Invite your children to talk about how they are feeling. Feeling depressed, hopeless, anxious and angry could be normal reactions to stress. However, if these feelings are constant and overwhelming, or if they affect your child's ability to keep doing what they usually do (such as go to school, complete their work or have fun), these may be signs they need more support. Keep in mind that younger children may not know how to talk about these feelings but may show changes in their behavior or development. Teens and young adults may try to hide their feelings because of shame or because they don't want to bother others.

Signs of stress and mental health challenges are not the same for every child or teen, but there are some common symptoms. Young children may start acting like they did when they were younger. They may also have increased problems with:

• Fussiness and irritability, crying more easily and being more difficult to calm down
• Falling asleep and waking up more during the night
• Feeding issues, such as more nausea/vomiting, constipation or loose stools, or new complaints of stomach pain
• Being anxious when they have to separate from their family, clinginess, not wanting to socialize and fear of going outside
• Hitting, being frustrated, biting and more tantrums
• Bedwetting after they're potty trained
• Aggressive behavior

Older children and teens may show signs of distress with symptoms such as:

Changes in mood that are not usual, such as ongoing irritability, feelings of hopelessness or rage, and frequent fights with friends and family

Changes in behavior, such as stepping back from personal relationships. For example, your outgoing teen stops spending time or texting with friends or video chatting

• A loss of interest in activities they used to enjoy. Did your music-loving child suddenly stop listening to music?
• A hard time falling or staying asleep, or sleeping a lot
• Changes in appetite, weight or eating patterns, such as never being hungry or eating all the time
• Problems with memory, thinking or concentration
• Less interest in schoolwork and a drop in grades
• Changes in appearance, or they stop taking care of their hygiene
• An increase in risky or reckless behaviors, such as using drugs or alcohol
• Thoughts about death or suicide, or talking about it

Your pediatrician can give you advice on ways to best support your child and help them build resilience, which is "the ability to deal with and recover from stress." Always check in with your child, ask them how they are feeling, and remind them you are there to talk if they want, and/or when they are ready.

Some children or teens may need more time and space to express their feelings. Some may do better with gradual conversations and other activities besides talking, such as painting, drawing or physical activity to manage stress. Others might be more comfortable with direct conversations or activities.

Parents set the tone in the household. Expressing extreme doom or fear can affect your children. It can be challenging to stay positive, especially if you're struggling with your own stress. But try to stay positive and give consistent and hopeful messages. It helps to set aside time to take care of yourself for a few minutes every day. This will help you, your child and your entire family in the long run.

If you have any concerns, ask your pediatrician's office about checking on your child's social and emotional health.