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Scott Webb (Host): As a dad of two teens, I know how hard the pandemic has been on my children, whether it's virtual learning, physical distancing, or simply being stuck in the house; it's been hard on all of our kiddos. And I'm joined today by Dr. Lauren Strelitz. She's a Pediatrician with additional training in Adolescent Medicine at Stanford Children's Health, and she's here to help us keep our teens mentally and physically well, anytime, but especially during the pandemic.

This is Health Talks from Stanford Children's Health. I'm Scott Webb. So doctor, thanks so much for your time today. I have a couple of teens myself, so this is particularly relevant for me. The pandemic is obviously a stressful time for all of us. So, how can that kind of stress affect adolescents in particular?

Lauren Strelitz, MD (Guest): Well, I think one thing that, is especially difficult for adolescents during this time is not being able to be around their friends. Teenagers really need an opportunity for independence and that independent growth, and not being in school and having to social and physical distance, is a real challenge for meeting some of those social milestones that they should be meeting at this time in their life.

Host: Yeah, definitely. And as I mentioned, you know, I have two teens, 13 and 17, and I know one of the more social things that they do is they play video games. So, my daughter plays Minecraft with her friends and yeah, they're playing the video game, but I think it's really just an opportunity for her to connect with her friends, because she been in school all day, so, she looks forward to that time because she knows because of COVID and physical distancing, that maybe gaming with your friends and that social experience is maybe the best she's going to get most days. And, speaking of virtual school and virtual learning, how does that affect teenagers instead of the in-person that they're used to, that they probably need?

Dr. Strelitz: The quality of virtual learning varies tremendously based on the resources that the school and the parents have. And I think one of the things that's missing from every type of distance learning is that opportunity to interact with friends. And so, I think during this time, it's good for parents to be a little bit more relaxed about some of that extracurricular screen time. And I actually love that you brought up playing video games with friends, because I think that's a great way for teens right now to be able to be social and engaged with their friends during the pandemic.

Host: Yeah. And I know in the case of my son, who's 17 and he has a car and of course he wants to go out and he wants to do things. He wants to be with his friends, but he knows that that's not really the safe thing to do right now. So, how in general does spending so much time at home affect adolescents?

Dr. Strelitz: It's not what's normal for adolescents to just be at home all the time, and I think, it affects adolescents in some similar ways as it affects us as adults, but it's harder for them to understand that this is a temporary situation. It's really challenging. I think I've seen a lot of more worsening of anxiety and depression in teenagers that may have already had a little bit of underlying anxiety and depression, but it's gotten worse with this feeling of isolation from their peer group.

Host: Yeah, I think you're right. And I think that one of the things, all of us parents worry about is what are the, well, what might be the long-term effects on our teens and adolescents that adults, like we can sort of contextualize? And even though none of us have ever lived through a pandemic like this, we understand that this is "temporary." And that we will come out on the other side of this and we will have other Thanksgivings and Christmases, for example, but with our teens and our adolescents, I think we worry about the long-term effects. Do you have any sense of what the long-term effects might be on adolescents?

Dr. Strelitz: I think it's really hard to say, what the long-term effects are going to be. I mean, I think the most important thing is recognizing if there's a problem other than just like the normal boredom, frustration at not being able to do what you want to do and trying to get an intervention early if you do notice that things seem to be worse, that your teen seems to be struggling more.

Host: I think that that's the tricky part for parents, of course, because as we know, teenagers are moody in general. So, how do you distinguish normal teenage moodiness from something that is COVID or isolation related? So, what can we look out for with our teens and preteens? Are there certain behaviors or signs that our children might be struggling with their mental health?

Dr. Strelitz: Absolutely. I think, you know, the level of irritability or frustration or annoyance with you that your teen usually has, right? So, I'd be looking for things outside of that, like extreme frustration or irritability, or even the opposite, just like shutting down and not being their normal, like argumentative self, avoiding their friends and avoiding the things they normally like to do. Overeating or not eating like skipping meals, not seeming hungry. And then also looking at sleep, are they sleeping all the time? Are they just staying up all the time? Those are all kind of signs that something more serious is going on than just the normal, how we're feeling with all of this.

Host: Have you noticed any changes in the number of patients who are reporting stress, anxiety, or other issues with mental and emotional health?

Dr. Strelitz: I'm noticing more teenagers reporting low levels of stress that hadn't at previous exams. And then I'm noticing that the teenagers who already had some low levels of stress before the pandemic things seem to be worse.

Host: Of course, as parents, one of the things that we want to do, the many things we want to do for our kids is to try to help them deal with these things. So what can we do to help our children deal with these stressful, difficult times?

Dr. Strelitz: I think it's important to give your teenagers some space, so that they are able to explore their interests and interact with their friends in a socially distant, and physical distant way. But I also think it's really important to check in with your teenager. Make sure they're feeling okay. Give them an opportunity to participate in like decision-making about even things like what do you want me to get for dinner? Do you want to do something as a family tonight, or would you prefer to not do that? Giving them an opportunity to have some amount of control in what's going on in their life, can make a difference.

The other thing I would say is it's really important to have the healthy options and have a plan for mealtime. What I am seeing a lot is kids rolling out of bed, getting straight on virtual learning, skipping breakfast, and then binging on snack food all day, which is not really healthy either. The other thing I would say is taking breaks from the screen. So stepping away from the screen for a little walk, walk outside, even in the backyard, if there's a backyard space or around the block, if they can, or even just standing up and moving away from the computer and stretching. Sitting in front of the computer all day is not good for any of us.

Host: Are there any strategies parents can use to encourage the healthy approaches, that we're talking about to mental health at home with our adolescents?

Dr. Strelitz: It definitely depends on the adolescent. I would say having a plan to get up and walk around every two hours or so during class, or some sort of plan for the teenager to be able to get some kind of exercise is something that is a strategy that can help their mental health. I think the sleep stuff is really important too. So trying to make sure that they're not doing their virtual learning in their bed so that when they're in their bed, they can use it as a place to sleep. Having them sit up at a desk somewhere, ideally outside of their bedroom, but most people don't have that space, so it might have to be in the bedroom.

But just keeping learning away from the bed. So, the bed can be used just for sleep. Having light like trying not to have them be in a dark room all day to have some natural light come in, even if they aren't able to get outside. And having, like I said, healthy options for food throughout the day. And then also having like snacks that have protein in them, healthy fats, carbs, not just chips and cereal and things like that.

Host: I think that the tricky thing here is, we’re dealing with these teens and their normal moodiness and then everything else that we've discussed here today, stress, anxiety, online learning and distancing; this whole ball of wax, if you will.

So when should parents know, how do they know when to ask for help from a doctor?

Dr. Strelitz: I think it's hard to know, because I think sometimes teenagers can be really private about these feelings. Some of this stress that teenagers are having is stressing out over how their parents are coping with this and what their parents are going to be able to do for their jobs and for supporting their family and everything like that.

So, some teenagers might not want to tell their parent everything about how they're feeling, because they worry about how it's going to make their parent feel. But I would say, you know your child better than anyone. And if something seems off, talk to the doctor, I don't think you need to wait until there's a crisis situation to reach out to your child's pediatrician.

And when you do see the doctor, whether it's virtual, which it likely will be given how bad the pandemic is right now, or in person, giving your teenagers space and time to talk to the doctor by themselves. And when you schedule the appointment, letting the scheduler know what your concern is, so they can try to give the provider extra time to spend with you and with your teenager so there's enough time to go into everything.

Host: Yeah, that's a great suggestion. And I'm wondering along these lines about Telehealth and virtual visits and how this is playing out for you and other pediatricians, especially as we talk about mental health?

Dr. Strelitz: So, I think a virtual visit can be a great platform for being able to talk to a teenager about mental health, but it has to be in a way where the teenager feels safe to open up. It's helpful if it's a provider that they've met before, and it's also really important that the parent give some time and space for the teenager to privately talk to their provider.

Host: Doctor as we wrap up here today, anything else we can tell parents as they navigate all of this, the stress, the anxiety, the virtual learning, the distancing, the masking, everything? And we're trying to keep happy and healthy, mental and physically, well teens and adolescents. How do we do that? Anything else we can tell people?

Dr. Strelitz: I think it's important to acknowledge that this is hard, and that, this is a hard situation for everybody and it is normal to not feel that this is normal, it's normal to be having a hard time with this. Because this isn't what we're used to in our lives. And it's set up a lot of challenges, particularly for parents and children. There's nothing wrong with asking for help. And just because your child is experiencing symptoms that look like anxiety or look like depression, it doesn't mean that anything is permanently wrong with them.

It doesn't mean that there's anything wrong with getting help. And these are just responses, largely just responses to the situation we're in right now. And the sooner you can get them help and get them away to just get out of it a little bit, the better it is for them. I would also say that for people who are struggling, for parents who are struggling financially, reaching out to your kid's doctor can also help get you lists of resources for food banks and things like that, so that you are able to provide nutritious meals and that that takes one kind of piece of stress off of your plate.

Host: Yeah. And we've talked about today, the things that we can do, ways that we can support them and encourage them is as simple as just making sure we've got good food in the house, healthy foods in the house, encouraging them to take breaks and get natural light and go for walks. And all of these things can help. As you say, we don't need to wait till there's a crisis, right? If we think, because we know our kids well, if it's gotten to a point where they should speak with someone or we should speak with someone, then it's okay to do that because there are no rules, really when it comes to our children. We want happy, healthy, physically and mentally well kids. And we as parents want to do that and have the responsibility to do that. And we've talked about a lot of great ways that we can work our way through all this today. So, Doctor, thank you so much today for your time, expertise and compassion, especially. Stay well.

Dr. Strelitz: Oh my pleasure.

Host: For more information on Pediatric Services at Stanford Children's Health, visit Stanfordchildrens.org. And we hope you find this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full library for additional topics of interest. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.