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Caitlyn White (Host):  You’re listening to Children’s Health Checkup. Welcome. I’m Your host, Caitlyn White. Many children are facing changes in their day to day lives because of Coronavirus. With all the unknowns that come with a new virus, it’s normal to feel stressed, or anxious about the what ifs and the future. Today, we’re going to discuss how parents can help support their child’s overall mental health during Covid-19 with Nicholas Westers, a Clinical Psychologist at Children’s Health ad Associate Professor at UT Southwestern. Dr. Westers, what are different ways children and their mental health may be affected by this COVID-19 pandemic?

Nicholas Westers, Psy.D., ABPP (Guest):  We still don’t know the long term impact the pandemic will have on the mental health of our children. At least not yet. But we do know that they’re experiencing more symptoms of anxiety and depression and that older children particularly high school age are actually experiencing greater distress than our younger children. So, the concern has been that those with pre-existing anxiety and depression prior to the pandemic are the ones that have tended to experience even greater distress throughout the pandemic. However, we also have some concern about sub-threshold levels of anxiety and depression that is sub-threshold meaning symptoms of anxiety, depression that may not rise to the level of a diagnosable mental health disorder but are problematic nevertheless and could worsen. So, we want to keep our eyes on those.

And I also want to highlight grief. Grief is another common reaction that we’re seeing during the pandemic. First mourning the loss of certain developmental milestones like graduations, birthdays but even more so among those who have lost a loved one whether just throughout the pandemic, unrelated to COVID or because of having contracted COVID and experienced complications. There may be bereavement so many youth may know someone that has died or that has contracted COVID-19 and oftentimes we forget to consider the role of grief and bereavement in children who have lost loved ones.

Host:  So, what are some signs that we an look for in children facing stress, anxiety or depression?

Dr. Westers:  Typically, the best indicator is looking for change in behavior that’s a significant difference in how the child has behaved in the past. So, we may look at regressive behavior, defiant behavior, and disruptive behavior. For example, with regressive behavior, particularly among younger children, there may be a return to bedwetting, or whining, thumb sucking, more baby talk than usual. So that can be a symptom of anxiety for them. Or defiant behavior in the form of tantrums, increased aggression, and I think a lot of parents may misinterpret defiant behavior as a behavioral problem as opposed to an emotional problem. And also disruptive behavior. So, this is where we’ll commonly see difficulties with sleep. So, anxiety and depression, one of the symptoms of each is disruptions in sleep so having a greater difficulty falling asleep than usual. Or sleeping excessive amounts, more so than usual. And then changes in appetite. Suddenly your child is not hungry or is eating less because that can really suppress appetite with elevated levels of stress or maybe they are overeating now and stress eating. And then a diminished interest in previously enjoyed activities where maybe you child really enjoyed certain toy or playing a certain video games and suddenly, they are not even interested in that or they are withdrawing socially. Maybe they have been a very social individual before the pandemic but now they’re just increasingly isolating themselves and not even reaching out to friends or responding to messages from friends.

And so, parents are going to know their child better than anyone to know if these are changes in their own child. But these are common symptoms that we look for.

Host:  So, even if we do know those symptoms, how can parents tell the difference between a normal emotion or reaction versus signs of a more serious, deeper issue?

Dr. Westers:  Normal emotions typically come and go. So, we have a disappointing day, maybe got some bad news that maybe a birthday is cancelled, or certain plans are cancelled and so there’s going to be clear disappointment especially if your child has been looking forward to participating in an activity, even if it’s a family activity of going camping or something. And so, there’s disappointment, sadness and maybe some increased defiance there briefly. However, that typically goes away after a short period of time where signs of a more serious issue would be if that persists, these tantrums or behavioral difficulties persist for days at a time or difficulty sleeping and sad mood, isolated behavior continues for a couple of weeks or more, that’s more indicative of greater problem or significant distress than a typical normal emotion would be.

Host:  So, how can parents help a child who is facing these worries and fears about Coronavirus?

Dr. Westers:  So, a lot of parents have already talked to their children about Coronavirus at this point. Kids are hearing about it a lot. So, there is still a lot we don’t know, and I think kids can also pick up on that. So, I recommend that parents first validate the fear or worry that their child may be experiencing related to the Coronavirus rather than saying that you have nothing to worry about. That may not be so helpful as much as asking what are you worried about. And then you can ask them what they are most worried about. And we know from recent research that knowledge about prevention and control measures that this increased knowledge about COVID and preventing and controlling it are protective against symptoms of depression and anxiety in children and adolescents.

So, having that greater knowledge of how we can prevent spread whether that’s through handwashing, wearing masks, physical distancing and then optimism, a fun focus on the future that actually research has shown that children who are optimistic about the pandemic are less likely to experience symptoms of depression. So, highlighting that this will end someday and exploring with your child what enjoyable things, what fun things they can do now and what they can focus on at this point can help stave away depression or significant worry and focus might be on seeing friends as the school year begins and progresses.  Or seeing certain family members or doing certain family activities. And I also think it’s important for parents to establish routine. I highlight this a lot when talking to families at Children’s Health, that in this world right now, we can’t predict when Coronavirus is going to end but we can predict playtime for younger children, mealtime, study time, school time, bedtime, family time if we have this routine, tis established routine. That can create a sense of safety and consistency for children and ourselves where it’s a lot easier to tolerate uncertainties that are surrounding us particularly related to the Coronavirus.

Host:  And while social distancing is of course important; children may find it difficult to adapt to not seeing classmates, friends, family, you know parts of their old routines like you were saying. So, what are some tips for parents on how to keep kids socially connected while of course staying six feet or more apart?

Dr. Westers:  Yeah, this social connectiveness is super important. I remember earlier on in the pandemic, the two concerns I heard about most were one, boredom and how that’s probably going to be less so as school begins but two, this lack of being able to see friends and worrying that when the school year starts, am I still going to have the same friends I had at the end of last school year? When I see them is it going to be awkward? Is anyone going to like me at this point? And so staying connected is one of the most important things I think parents can help their children to do and using technology is one great and creative way. I know when I’m talking to families and children and adolescents here at Children’s Health, I’m exploring with them how they can stay connected especially as the school year begins and they are at home for those that are doing distance learning. And we talk about creative ways such as establishing times during the day like at lunch having – you might not be able to see your friends at the lunch table, but you’re Facetiming with them or you’re using an app and communicating during your lunch hour at school and then planning times after school when you can touch base with your friend whether it’s playing video games with them online, Facetiming them, sending them messages or if it’s possible, and if it’s okay, doing visits from a physically distant location using masks of course, so they can still see their friends.

So, establishing regular times to connect with friends whether that’s again, lunchtime or forming a study group virtually with friends and checking in daily or having parents help plan a physically safe, physically distanced mask wearing time where they can just really see their friend and say hi. But I do want to highlight that parents should be checking in with their kid about their social life and not even that, but their connectiveness. Because they don’t necessarily need to have all their friends like 100 friends but if they have one or two friends that they can connect with consistently, that can really prevent this sense of disconnectedness, loneliness that is a risk factor for depression.

Host:  And that leads me into my next question of course, all kinds of events and celebrations, even school is cancelled. So, how can parents help their children cope with this disappointment of missing these events, sometimes annual things to look forward to? How do we just deal with all of this stuff getting cancelled?

Dr. Westers:  We definitely can empathize and validate how disappointing and difficult that is having to celebrate a big birthday like you’re turning 13, the first years of being a teenager and you can’t even have a birthday party with your friends or see them. I know a lot of families have gotten creative as far as doing drive by’s, scheduling surprise parties with friends and families driving by and waving and honking. Some parents may have not even just for birthdays, but also like these developmental milestones, graduations, decorating the house at night inside and outside so when their child wakes up the next day, they can see and be surprised to be able to get creative with these celebrations and I think those are important to get creative. And so, maybe they have a certain meal that they’ve been wanting to prepare, that they would normally do for their birthday, but they can’t now because their favorite restaurant is closed, maybe they can figure out a new recipe and make it on their own. Or do some planned family activity. Getting creative to be able to celebrate rather than just simply saying oh I’m sorry this year is just a disappointing event and birthday we can’t celebrate. Rather than lie down and accept that, we can actually get creative and make it memorable and fun and enjoyable and meaningful.

Host:  Looking at the upcoming school year, it’s of course going to be so different in different places. I mean what advise do you have for parents who are just dealing with all of these changes and how can they help their kids get back to school in this weird way this year?

Dr. Westers:  That’s one of the most challenging concerns I think a lot of families are experiencing right now. So, first, we can be honest with them with our children that there’s a lot we may not know when it comes to going back to school if you’re going back to school in person. There’s a possibility that your school may need to temporarily close again before it can reopen depending on the pandemic. And so maintaining that flexibility and being honest as we just don’t know a lot.

Second, we can highlight that this is okay. We don’t have to know everything. We do know that there are going to be lots of enjoyable things like seeing friends, teachers, but also lots of unenjoyable things like it students are going into class, they may have to wear masks and participate in physical distancing. Those that are doing distance learning, are not going to have the opportunity to give their friend a hug because they’re attending class virtually.

And third, we can ask them about their concerns. For example, asking our children what do you know already about going back to school and what do want to know. Is there anything you’d really like to know before going back to school that’s on your mind? We may have this assumption that they are most worried about being able to pass certain classes if they are participating in distance learning when in reality, their biggest concern is knowing if they are going to have any friends, anyone to talk to.

Finally, decisions are changing everyday so it goes back to my point about routine, any constancy you can establish for your child now going into the fall, the better.

Host:  What are some self-care activities that can be calming for children during this wild time?

Dr. Westers:  Deep breathing exercises have become very helpful in mediation and or prayer. There are apps that can help with the mediation, with learning how to do deep breathing. A lot of kids are learning this now than they may have not learned previously. And so there are a lot of apps even if they do charge for certain content, there are certain pieces or aspects of those apps that are free. Such as like deep breathing exercises and there are other aspects of those apps that you may have to pay for, but parents may not necessarily need to have purchase those.

Maintaining consistent play and checking in with friends. Checking in with family. And one neat recommendation that I like to give is to write a letter to a loved one, writing a letter to someone who has been affected by COVID. Caring for other people can be a way of caring your ourselves and vice versa. So, self-care also can be a way of caring for other people because we’re better at caring for other people if we’re in a good spot ourselves.

But sometimes, finding meaning beyond the difficulties related to the pandemic can bring a sense of optimism and in a way, self-care.

Host:  Wrapping up here, you touched on this in the beginning of the episode. But at what point should parents seek help from a mental health professional when it comes to just how their child is reacting to this pandemic?

Dr. Westers:  First, I think it’s important to emphasize that anyone can benefit from meeting with a mental health professional. Anyone can benefit from therapy. We don’t need to have significant problems in our lives to benefit from talking to someone. It’s amazing how being stressed and just talking to a friend or a loved one decreases our levels of stress. And so, finding some that’s a third party, neutral, can also be beneficial. So, I think that’s important to highlight that your child doesn’t necessarily have to have significant problems to benefit from talking to someone unless they want to talk to someone anyway. You may make that offer but they don’t necessarily have to be forced to go if they don’t have anything to talk about.

Second, if there’s any doubt, if you’re concerned about your child’s behavior because you know your child best and if it’s a change in behavior that you are just not sure if it rises to the level of a clinical concern; you can always consult with a mental health professional. And third, like I had mentioned before, about the sub-threshold levels of anxiety and depression and how the fact that your child may not necessarily have to have significant levels; if you are worried, your child may benefit from addressing their sub-threshold levels of anxiety and depression to learn healthy coping strategies moving into the future. And that can be a plus.

Host:  Great. Doctor, is there anything else you want to add to this conversation that maybe I didn’t touch on?

Dr. Westers:  I think that two aspects that I think about are mask wearing and physical distancing. And with mask wearing, for some families, this may not be a concern, but the discomfort associated with masks and how can we expect our children and adolescents to attend school if they are going in person at any point to wear masks if it’s required. And there’s some creative strategies a lot of parents can use. They can practice wearing them in advance a couple of weeks before school starts, starting off with just thirty seconds, asking your child how does it feel. What’s comfortable. What’s uncomfortable. And then building up that time. Doing family competitions. Who can wear their mask the longest. And also, I want to highlight validating that no one finds masks comfortable for the most part. And no one enjoys – I don’t enjoy wearing a mask. No one enjoys wearing a mask but sometimes we have to do uncomfortable things to care for other people. And this is one of those times were a temporary discomfort by wearing a mask can really go a long way and prevent someone who we might not know is even medically compromised or vulnerable to contracting COVID. We can actually prevent them from being at risk for contracting it by wearing a mask.

So, some families, some parents talk to their children about even super heroes wear masks. So, wearing masks I think is an important recommendation I like to make. And then with regard to physical distancing, appealing to altruism, and the empathy of our children and particularly adolescents is going to be a lot better than coercion. In other words, rather than just forcing our teenagers and children to participate in physical distancing, we can talk to them about how physical distancing can decrease not only their risk of contracting the virus but their risk of spreading it to other people including vulnerable members of the family and again, vulnerable members of the community who we don’t even know are vulnerable. And so part of being a dutiful community member is participating in physical distancing and thinking about other people and appealing that to that aspect of our children. And then of course modeling that. We need to model all this if we are going to expect our children to follow our recommendations.

Host:  Absolutely. Well thank you so much for all of these tips during this tumultuous time. That was Nicholas Westers, a Clinical Psychologist at Children’s Health and Associate Professor at UT Southwestern. For more information on dealing with the pandemic, visit www.childrens.com/covid-19. This has been Children’s Health Checkup. I’m Caitlyn White. Thanks for listening.