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Melanie Cole (Host):  This is the Children’s Hospital of Alabama podcast on COVID-19 dated April 14, 2020.

Welcome to Inside Pediatrics, a podcast brought to you by Children’s Hospital of Alabama in Birmingham. I’m Melanie Cole. And today, we’re discussing coping with COVID-19 at home. Joining me is Dr. Nina Reynolds. She’s a Pediatric Psychologist with Children’s of Alabama and an Adjunct Assistant Professor at UAB. Dr. Reynolds, it’s a pleasure to have you join us at these unprecedented times. Tell us a little bit about what we’re experiencing right now as far as acute stress and is this normal?

Nina Reynolds, PhD (Guest):  Thank you so much for having me. Yes, absolutely, I think what we’re all experiencing is acute stress. There’s the distinction here. Acute stress tends to be a novel, new stress related to a particular circumstance as compared to for example, chronic stress which tends to be stress related to a repeated event. We are experiencing something as you mentioned, absolutely unprecedented in most of our lifetime. And so, with that in mind, we’re all stressed, and I think it is important to understand that being a little anxious right now and feeling stressed is normal. Most of us are feeling it. 

Host:  So, since we’re talking about COVID-19 and how we can help our children. Let’s start with how should we talk to them and answer questions and how do we compartmentalize our children’s fears and help them to separate reality from what’s actually occurring? It’s all about the communication. How do we start?

Dr. Reynolds:  That’s a wonderful question. I think first and foremost, it is important to be open and honest with our children. Children’s imaginations sometimes are far worse than the actual information. So, it is important to be direct with them. Having said that, you very much have to think about their level of development. Younger children in particular, do not need extra explanation or a lot of different details. It’s important to keep things simple and direct with them. Our older children, our adolescents particularly those that have access to or more access for example, to media, may need more details but there again, keeping it simple and not overwhelming them with emotionality about it can be very helpful.

Host:  Well it certainly can. So, the stress that we’re feeling, and it’s a pervasive worldwide stress right now Dr. Reynolds. Can you put this into perspective for us and help manage our expectations for quarantine and so thereby helping our children deal with the stress of this quarantine? They are not used to that. They are crazy not being in school. They want to hang out with their friends. They are not understanding the need for social distancing. Help us with this stress we’re feeling so that we can help out kids.

Dr. Reynolds:  Both as a psychologist and a mom, I understand this well. Again, these are just unprecedented, unusual times and certainly there are some very good guidelines out there with respect to how to manage stress during this time related to for example, doing our very best to keep ourselves and our children on some semblance of a routine or a daily schedule. But I think it’s very important to also say that because these are unprecedented and unusual times; we need very much to be flexible and patient with ourselves as caregivers and also very patient with our children. So, guidelines for example may recommend having this beautiful daily routine and include virtual schooling and physical activity, all things I certainly would recommend but I think it’s important to also say to caregivers during this time show yourself leniency. Every day doe not need to follow a perfectly structured daily schedule. And every day may look a little different, but I think you do the very best you can given the information you have and the set of circumstances.

Host:  Well I’d like to expand on that for a minute because our kids are tending to want to sit there on Tik Tok and Instagram all day long. And I know the American Academy of Pediatrics has a limit on screen time but is that something that for now, we can set aside for just a little bit and give as you said a little more leeway in some of those things because we want to keep our kids from fighting with each other or fighting with us or vice versa. I mean it can all kind of build up in this feeling of anxiety.

Dr. Reynolds:  In my humble opinion, I think that we should show again ourselves and our children some leniency with respect to screen time guidelines. I think there are ways to allow more time than perhaps some parents or families are used to. For example, in order to – for many of us who are working from home, in order to do some of that work, we may need our children to have more screen time than they are used to. Or quite frankly, just due to virtual school, that, in and of itself is some screen time. But again, I think that there are still ways to set parental controls, set timers to maybe break up screen time even if it is some total more than it typically is. But to answer your question, in my opinion, I think it is important to show ourselves and our children some leniency with respect to screen time during this time because I think it’s also important to remember that this will not be forever and we will reset and get back some of the control that we not feel like we have currently in terms of some of the household rules and screen time being an example. But for now, I think again, we do the very best we can under these circumstances.

Host:  Well then along those lines, and thank you for that answer, I’m sure parents really appreciate hearing from you that it’s okay sometimes to just be a little more lenient. Now one of the things that I’m noticing with my own children is because the schedule is so thrown, because school is online, their sleep patterns have changed and while sleep and lack of sleep can contribute to stress and our reactions to stress; our stress can also contribute to lack of sleep. How can we manage that because I think the kids think they are on permanent vacation right now.

Dr. Reynolds:  Yeah, absolutely. Circling back to what we discussed earlier in terms of trying to stick to some daily schedule, what happens in between may vary day to day. But I do recommend that parents try to keep their children on a consistent wake and sleep time. Again, it is challenging during this time when we don’t have the physical presence of going to and from school, but I do think that children and parents alike really benefit from having that as set in stone as possible. Because we also know that disrupted sleep tends to occur when we get off of our sleep schedules. It may be that parents need to build in some relaxation for their children prior to bedtime, knowing that some of our children may be dealing with a little bit of underlying anxiety that they are not used to in light of these current circumstances.

Or quite frankly, feeding off of a little bit of anxiety that we all feel right now during this time. So, building in some different strategies, relaxation prior to bedtime can also help promote better sleep during this time.

Host:  So, important and what a great point Dr. Reynolds. So, if our children are starting to have an attack, if they are really scared, and they’re really concerned; can you, as a psychologist, tell us how to halt if they are having a panic attack or if we are and what are some home and self-care things that we can do to help manage our anxiety and stave off any kinds of those attacks that might be starting to creep up?

Dr. Reynolds:  Again, I do want to normalize that having some anxiety or stress during this time, is not abnormal. So, you’ve got individuals who don’t have any underlying anxiety or any preexisting mood concerns for example who feel anxious or feel perhaps depressed. And I do want to normalize that or validate that that’s not uncommon right now. Having said that, you also have families who certainly may have children with underlying anxiety disorders or mood disorders or even developmental disabilities for example that are really struggling during this time to understand and so it is very important to monitor our children’s behavior. A lot of times, particularly for younger kids, it’s behavior that we’re going to notice first rather than them articulating to us mom, dad, whomever, I am stressed.

So, I do think it’s important for parents to be mindful that you may see some behavior that you aren’t used to seeing but you want to be paying attention to just how much it’s interfering and when it really begins to interfere in your day to day or their day to day; that’s when I think it absolutely is time to be thinking about different strategies and potentially even reaching out for mental health support.

With respect to strategies, I think it would be helpful for all of us to build into our day, if at all possible, a few moments of quiet time. Turning off the news, to the extent that you are able, unplugging from time to time and allowing for some quiet mindfulness or relaxation. Our children will benefit from that as well. I think if you as a caregiver notice that your stress is very high and it’s interfering with your ability to parent, please remember as hard as it can be and it’s certainly easier said than done; you can take a time out yourself. You can step into a different room and take a quiet time. It is okay momentarily to press the pause button. And I think monitoring ourselves for that will be very important.

I also think yes, we have been asked to physically distance ourselves from one another but that really doesn’t mean social distancing in terms of our access to technology. Calling people, texting people, when you feel that you need some extra support is important and it’s the right thing to do. It’s not a sign of weakness. We’re all in it together. And very much could benefit from each other’s support during this and the same is true for our children, understanding that our teenagers for example may need some feedback from their friends more than they need it from us at the time. So, I do think using some of those kind of strategies if you are a family that exercises and are able to continue to do that; I think that that too helps break up the day and helps reset the mind a little bit in a way that can be very helpful in terms of stress management. But again, if it does ever get to a point where it really feels like it’s interfering, your child’s acting out or withdrawn, having difficulty completing work, seems to be struggling; then I would make the recommendation that you reach out to a mental health professional.

Host:  Well I couldn’t agree more and as an exercise physiologist; I think the exercise advice is just really spot on. Before we wrap up, Dr. Reynolds, you mentioned reaching out to a mental health professional. Is Telehealth an option as a way to reach out to a mental health professional at children’s of Alabama?

Dr. Reynolds:  Yes, absolutely. I assume at this podcast we can provide some resources linked to the podcast. But Children’s Behavioral Health is practice group part of Children’s of Alabama. We are currently providing Telehealth. Most pediatricians are familiar with local mental health providers as well and for the most part, it’s my understanding that many practice groups have moved to Telemedicine as well.

Host:  It’s so important. Do you have any final thoughts for us about parents who are quarantined with their kids and the stress that we’re all feeling and since so much is unknown, how can we deal with what we don’t know and help our children as well so that we can all really manage this anxiety very well. Give us your best advice Doctor.

Dr. Reynolds:  My best advice is the advice I have been giving myself, which is one moment at a time, it’s all new, we’re doing the very best we can given the circumstances. Follow the guidelines where you can but please, do not add to your stress when the day does not go as you had planned, or you notice that you have felt more anxious. Anxiety right now is typical up to a point. And I think we need to be – show ourselves and our children grace and patience during this time and so again, my main message would be we’re in this together, hang in there and continue to be as flexible as you can.

Host:  What a great sentiment Doctor, thank you so much for joining us and sharing your expertise at this time that so many people need to hear your message. Thank you again. And thanks for listening to Inside Pediatrics brought to you by Children’s Hospital of Alabama in Birmingham. For information about COVID-19 including symptoms and prevention please visit www.childrensal.org/coronavirus and of course more podcasts like this one can be found at www.childrensal.org/podcast. I’m Melanie Cole.

Thanks for listening to Inside Pediatrics. More podcasts like this one can be found at www.childrensal.org/insidepediatrics.