As COVID cases decrease and the U.S. opens up after months of lockdown, the impact of missed school and social isolation on kids’ mental health needs.
Children kept out of school due to the COVID-19 pandemic during lockdown might have fared well — if they had parents at home who were attentive and able to help with home schooling, if they had reliable technology available for zoom classes, if they had siblings for playmates, and if they had nutritious meals, too.
Unfortunately, that’s not the picture perfect world for many youngsters.
Robert (who asked his real name not be used), a middle school teacher in an economically disadvantaged school district in Atlanta, says 10- and 11-year-old students asked him for food when they no longer attended class in person because of the lockdown.
Some had their tablet computers, supplied by the school system for remote lessons, taken by relatives and never returned — so, they had no way to participate in class. And, when in-person classes resumed, many of the children appeared lost and anxious about catching up on schoolwork.
Robert reported suspected abuse and lack of food during the lockdown to the school administration and social service agencies. He’s not sure, however, how much it helped. Bottom line: The children’s remote learning set-up was a far cry from what they were used to during classes in school, which sometimes included the only good meal they had all day and normal social reactions with friends.
“I love these kids. Most of them try so hard despite some of them having difficult home lives,” Robert says.
Although the children are mostly back in school, things have not automatically returned to the pre-lockdown classroom experience, and it’s not only because many are behind on their lessons.
“Although my students seem happy to be back and with their friends, anxiety is a big problem for many of them, and some seem depressed,” Robert notes. “I’m sending many of them to the school counselor and meeting with parents, when possible, to try to find ways to help them.”
Economically disadvantaged youngsters in urban areas aren’t the only ones who have experienced mental health problems brought on or heightened by the COVID-19 lockdown.
According to the Centers for Disease Control and Prevention (CDC), trips to emergency departments (EDs) for mental health crises among children and teens increased dramatically in communities across the nation as the lockdown continued after several months in 2020.
The consequences may have long reaching impacts on the youngsters.
Facts about COVID-19 risk for kids’ physical and mental health
From the get-go, the coronavirus pandemic was fraught with conflicting ideas about how big the risk of the infection was to children and whether they could be carriers, putting adults at risk.
Some reports and politicians erroneously claimed kids are immune from COVID-19. While that’s not true, the impact on children’s health for most youngsters who contract the virus appears to be fairly mild.
The American Academy of Pediatrics (AAP), working with the Children’s Hospital Association in an ongoing collaborative effort, is collecting and sharing all publicly available data in the U.S. about COVID-19 cases in children. So far, almost four million American children have tested positive for the virus since the pandemic was first reported in this country, but the number of new cases reported weekly plummeted by spring of 2021.
While a few states have reported hospitalizations and deaths of children due to the coronavirus, the AAP notes those dire outcomes are uncommon and “it still appears that severe illness due to COVID-19 is rare among children.”
In all, according to statistics from states reporting COVID-19 data on children, the mortality rate for children infected with the coronavirus ranges between zero and .03 percent.
While it turns out children are at little risk from serious illness from COVID-19, the lockdown was meant to protect everyone. So, it’s important to note that before American adults were becoming widely vaccinated, they could have been at risk for catching COVID-19 from infected, asymptomatic kids — part of the rationale for having kids wear masks.
The AAP notes it’s still not known if infection with the virus might harm the physical health of infected children in the months and years to come. What’s more, the AAP warns the pandemic lockdown may have resulted in serious, long-term emotional and mental health effects on kids.
Research has shown negative mental and emotional impacts on some children is already occurring.
Mental health problems in children linked to the COVID-19 lockdown
When widespread lockdowns first began across much of the U.S., and many schools turned to remote classes, ED visits for Americans of all ages first decreased. News reports showed packed hospitals and cases of COVID-19 patients on respirators and dying from the virus. As cases of the coronavirus soared, the public, fearing catching the coronavirus, stayed away from visiting emergency departments, often when they had physical injuries and non-COVID-19 related illnesses.
By mid-March of 2020, however, CDC research shows a change occurred. The proportion of mental health related ED visits soared, continuing into October. Compared with the same period in 2019, when there was no lockdown, increases of mental health emergencies bringing youngsters to the ED increased 24 percent among children between the ages of five and 11 years old and 31 percent among adolescents between 12 and 17 years old.
The CDC explains EDs are often the first point of care (especially when other services are unavailable) for children experiencing mental health crises, which can include panic attacks, extreme depression, threats of suicide, and self-harm.
Published reports point to the increase in mental health problems in young children and teens being directly related to the COVID-19 crisis, according to the CDC. Studies so far suggest numerous factors related to the lockdown are involved, including social isolation from friends due to school’s closing.
How and why COVID-19 lockdowns impacted kids’ mental health
While more research and long-term follow-up is needed, multiple studies suggest the COVID-19 pandemic has had a negative effect on children’s mental health due to a variety of reasons — and may depend, in part, on the age of a child, as well as socioeconomic factors.
The American Psychological Association explains parents who may be out of work and struggling financially due to the pandemic — and possibly abusing drugs or alcohol to cope with stress — were more likely to be physically and emotionally abusive to children during the lockdown and more likely to be involved in partner violence. Children who are abused or witness abuse at home have an increased risk for both physical and psychological trauma, related anxiety, and other emotional and mental health problems.
A team of Oxford University psychiatrists, writing in The Lancet Child & Adolescent Health about the mental health impact of COVID-19 on kids between the ages of four and seven, explained very young children have difficulty understanding the causality of “bad things” happening and are influenced by a type of “magical thinking.”
What that means, the psychiatrists explained, is that children often believe their thoughts, wishes, or unrelated actions almost magically cause some external event like an illness, or a big change in their life — such as a shelter-in-place situation due to COVID. The little ones can mistakenly think they are somehow responsible because of their behavior, feel guilty, and become anxious and depressed.
Adults need to be aware of this, the mental health experts write, and be vigilant that youngsters “are not inappropriately blaming themselves or feeling that the illness is a punishment for previous bad behavior.” They advise listening carefully to what children believe about COVID-19, including how it is transmitted, and providing kids with a calm, simple, non-frightening but accurate explanation they will understand about the infection.
When it comes to tweens and adolescents, the mental health and emotional problems associated with the pandemic and lockdown may be more pronounced and potentially more dangerous.
A report in the BMJ journal Injury Prevention by CDC adolescent health researchers Marci Hertz and Lisa Barrios, points out how studies found a disturbing trend in U.S, teens — significant increases in adolescents feeling sad, hopeless, and resorting to suicide-related behaviors — before the COVID-19 pandemic and subsequent lockdown. The lack of in-person classes and separation from friends and classmates has likely increased mental health problems in teens.
The duration of feelings of loneliness have long been shown to be strongly associated with depression and other mental health problems in youth, and the repercussions of COVID-19 (with school closings and social and sports activities eliminated or reduced) has contributed to loneliness over many months for adolescents. Hertz and Barrios point out studies evaluating the effect of the pandemic on youth mental health have found numerous negative impacts, including eating and sleeping changes, irritability, acting out, compulsive behavior, depression, and even the development of post-traumatic stress disorder.
How many of these symptoms a young person may have, and how severe the symptoms are and how long they last, are influenced by age, history of trauma, psychological status before the pandemic, whether they have social and economic support, and other factors.
Pre-pandemic, almost 3.5 million American teens received mental health services in their educational settings, primarily youngsters with public insurance, from low-income homes and from minority groups, the CDC researchers pointout. Unfortunately, the nationwide closure of schools limited access to mental health services for many adolescents most vulnerable to mental health and emotional problems. Even when telemedicine mental health options have been available, families of financially disadvantaged teens often have not had technology to access those services.
How to help children and adolescents with COVID-19 mental health fallout
As the country opens up and schools reopen, it’s important to not assume your child will automatically snap back into a regular routine school and homework routine — or quickly catch up on any missed lessons. Be patient and talk openly and gently with your kids about their concerns and feelings.
Schedule conferences with teachers, if needed, and work with your school to learn about, and take advantage of, counseling and other programs to help your children with anxiety and other mental health problems which may have been fueled by the lock-down. Ask if any tutoring services are available through the school, if needed, to help your child catch up on classwork.
The American Psychological Association offers these additional tips for finding help for children and teens whose mental or emotional health has been impacted by the pandemic:
- Talk to your family physician or pediatrician about concerns you have about your child’s mental health. If you have health insurance, ask your carrier for a list of covered mental health providers in your area.
- If you don’t have health insurance, or your policy doesn’t cover mental health, contact your local department of health to see if help is available through your county or state.
- Your state psychological association may also offer assistance in finding mental healthcare in your area for your child.
Other organizations that can assist you in locating mental health professionals and resources nearby include:
- Substance Abuse and Mental Health Services Administration. SAMHSA is a branch of the U.S. Department of Health and Human Services and offers a 24-hour helpline for people dealing with mental health issues. Hotline: (800) 662-HELP (4357).
- National Alliance on Mental Illness. NAMI is a national mental health organization with a free hotline staffed with trained specialists who provide information, resources, and referrals to those who need mental health assistance. Hotline: (800) 950-NAMI (6264).
- American Academy of Child and Adolescent Psychiatry. Visit AACAP’s website for resources to help you provide support for your children during the pandemic and the aftermath of lockdown and missed school. It also provides a tool to help find mental health providers in your area who work with children.
- United Way. The United Way supports 211, a free and confidential hotline service that helps people across North America find the local resources 24 hours a day they may need, including locating mental health support. Just dial 2.1.1. on your telephone or smartphone.
June 17, 2021
Janet O’Dell, RN