Many of us can now say we have experienced the trials and tribulations of parenting during a pandemic. We have attempted to juggle full-time work and regular household duties, along with being a full-time teacher or daycare worker and entertainer for our kids. While we’re all doing the best we can in taking on these new and challenging roles, some parents and caregivers may be wondering about their child’s mental health after they have missed out on so much and dealt with new stress and uncertainty – certainly as many of us know that our own mental health has been affected.

If you’re worried about your child’s mental health or noticing any issues, read on for tips and knowledge shared by Magellan’s Linda Y. Evans, MD, FAPA, child psychiatrist and medical director, and Greg Dicharry, CPRP, youth empowerment director.

Children behavior changes

Changes in your child’s behavior may be a sign of mental health difficulties that should be closely monitored. Depending on the age of your child, stress can manifest in different ways. Toddlers and young children aged 2-6, may show signs of regression and lose the ability to do things previously learned, like toilet training. School-aged children and teenagers may show a disinterest in going to school and/or begin to see falling grades. The most common symptom in teenagers is irritable mood. Kids of all ages may experience vague body complaints, like a headache or belly ache, changes in sleep or appetite, difficulty concentrating, loss of pleasure in activities previously enjoyed, and withdrawal from social interactions.

Often, even the child may not recognize these symptoms as the result of mental health issues. It is important for parents and caregivers to be a barometer for behavioral or other changes in their children – as they may be the first to notice – to be able to identify if their mental health may be suffering. When parents keep the lines of communication open, allowing their kids to share their thoughts and feelings, they are better equipped to identify any troubling signs of childhood depression, anxiety or other mental health conditions.

The child’s primary care physician (PCP) also plays a role in screening for mental health concerns and can be a good first point of contact if parents are seeking additional help. With the shortage of child psychiatrists and mental health professionals trained to work with children in our country, PCPs are increasingly adopting a model of collaborative, or whole-person, care to screen and treat children for mental health issues before they get worse because of potentially waiting long periods to see a specialist.

Interrupted school and family routines

While there’s not much we can do about changing work, school and social arrangements due to the pandemic, it’s important to consider the stability of our kids’ environment and instill predictability in their lives to the extent that’s possible.

Additionally, there are many things that parents and caregivers can do to keep their kids content and engaged amid the chaos and unprecedented change we’re all experiencing. To make up for lost in-person social time with friends and family, virtual meetups can be scheduled. That could be a fifteen-minute Facetime call with grandma and grandpa every Wednesday night at 7:00, or a periodic Zoom/interactive video game gathering with friends. Parents can also take time with their kids away from the screens to play a board game or do a project to make home-time more fun. Exploring and supporting your kids’ passions is a way to get them involved in activities that will bridge the gaps of interrupted routines and help prevent negative mental health outcomes.

Family stress affecting children

We have all been affected by the drastic changes, uncertainty, loss and isolation caused by COVID-19. And it’s not hard for our own stress and worry to be noticed or even absorbed to some extent by our kids. While we’re focusing on our family’s well-being, it’s important to practice self-care and recognize that our own mental health is of paramount importance. Having healthy caregivers is an essential component in the normal development of kids.

When parents are navigating divorce and co-parenting arrangements during COVID-19, it can be even more difficult to filter out the negativity for our kids, especially when parents have different points of view about things like in-person vs. virtual learning, the vaccine and mask wearing. Although it can be difficult to share your kids with an ex-spouse, it’s important to remember they need both of their parents. When parents work together for the benefit of their children and keep the focus on them, the impacts of divorce can be mitigated. Implementing a flexible custody arrangement during COVID-19 is also encouraged; for example, if the child wants to see a parent when it’s not their day for visitation, it might be beneficial to the child to honor their request.

To alleviate stress and some of the burden, parents and caregivers can consider connecting with others who understand the struggles and support each other. They can look for parent support groups in their communities.

Back to school and bullying

For kids who experience any level of social anxiety, the transition back to school, or even a new school, from the comfort of home may be more difficult. While some kids may be happy to get right back to the in-person learning environment, a gradual adjustment may work better for others.

Teachers can be especially helpful in ensuring that children are adjusting well and that a child withdrawing from the group is noticed. When the teacher has a trusting relationship with students, they can initiate conversations to try to understand how a child is doing and if their emotional needs are being met. The teacher’s insights are critical for parents and caregivers who cannot be with their kids at school.

Parents and teachers should be especially sensitive to look for bullying and have a zero-tolerance policy for kids being cruel to one another. Children must understand that bullying is unacceptable, as it can lead to serious and disastrous consequences for those who are targeted.

In general, what kids need for healthy development is a stable routine, predictability, a safe environment and healthy parents or caregivers. COVID-19 has disrupted all of these conditions, leading to increased mental health disorders and interrupted development. There are many things that parents and caregivers can do to nurture their child’s mental health and address what they need for healthy development. We encourage you to explore Magellan’s following resources for additional information and support:

• Mental Health Month website for comprehensive tips and resources to support yours and your family’s mental health.
  • Be sure to check out the recording of our webinar, How are your kids doing? under “Previous events”
• Understanding and Meeting the Needs of Children and Adolescents at High Risk: Foundations of a Model clinical monograph highlighting evidence-based research on the prevention and treatment of problematic behaviors and various types of behavioral health challenges in children and adolescents.
• Stay Home for MY LIFE virtual youth fest, featuring inspirational speakers, uplifting entertainment, fun activities and more, taking place on the 4^th Thursday of each month, from 6:00 – 7:30 p.m. ET, for youth and young adults who have experience with mental health, substance use, juvenile justice and foster-care-related issues, as well as professionals and caregivers across the country.

By: Linda Y. Evans and Greg Dicharry

Before the COVID-19 pandemic started wreaking havoc on various aspects of our “normal” lives, including our mental health, 1 in 6 children aged 2-8 years in the United States was diagnosed with a mental, behavioral or developmental disorder.[1] While these children have endured the impacts of drastic changes over the past year, so too have others who did not previously have a mental health diagnosis; some children have been newly diagnosed with a mental health condition as a result of COVID-19. When considering how to nurture the mental health of our children during a pandemic, we must understand their pre-pandemic mental state and monitor how they are coping.

Children diagnosed with a mental health condition before COVID-19

For children who experienced mental health challenges before COVID-19, the pandemic may have imposed new complications. In many cases, before COVID-19, families practiced a routine in their daily lives, which helped everyone manage their feelings and behaviors. When routines changed – kids were no longer going to school, adults were working from home, or not at all, and in-person interactions with friends, extended family, and even doctors were cut off – that familiarity and rhythm, and the associated therapeutic effects, were lost. Another part of the pre-pandemic routine for many children with a mental health diagnosis was the special help received by trained teachers and therapists in schools. While this support could be a vital lifeline, it was completely cut off for the kids who depended on it. Other treatment options, through primary care and other outpatient settings, also dwindled due to office closures caused by COVID-19. As a result, an increasing number of children were seen for mental health-related care in emergency departments (EDs). From mid-March to October 2020, the Centers for Disease Control and Prevention reported an increase in the proportion of mental health-related ED visits among children aged 5-11 years (24%) and 12-17 years (31%) compared with the same period in 2019.[2]

Serious mental health impacts for children as a result of COVID-19

Children and youth who started off 2020 without a mental health diagnosis may not have ended the year in the same way, as newly developed depression and other mental health conditions were caused by the pandemic. A CDC report on mental health, substance use, and suicidal ideation during the COVID-19 pandemic shows that while 11% of adults seriously contemplated suicide in June 2020, the same was disproportionately reported by young people aged 18 to 24 (26%).[3] The serious effects on younger children include delays in social and emotional development, as their brains are forming amidst irregular human activity. In some cases, when parents weren’t adjusting or handling the increased stress and uncertainty well, maltreatment in the form of child neglect or abuse has resulted.

Negative mental health consequences of COVID-19 for all children

Because of COVID-19, all children are coping with unprecedented change and loss. Children feel the family stress of economic hardships, health concerns, social isolation, exhaustion, bereavement, and worsening mental health and substance use. And children have stressors of their own. When healthy outlets, like school, sports, and social engagements, are lost, that energy may become more negative and unproductive. The impacts of missed once-in-a-lifetime childhood events, like birthdays, graduations, and family vacations, may not even be fully realized until later in life. Children and youth may also experience their own anxiety and stress about what the future looks like.

The state of mental healthcare for children

There have always been barriers for children to access mental healthcare. Among them are stigma, availability, misinformation, and lack of information. While these factors impact access to care for adults, as well, they may be more pronounced for children. Parents are afraid or do not want to accept that their child is affected by a mental illness. There is a shortage of child and adolescent psychiatrists and therapists trained to work with children in our country. In addition, many parents and caregivers are misinformed about child psychiatric services that are meant to improve a child’s mental state, and not necessarily their behavior, although the latter may be a secondary effect.

With the pandemic, parents may be so preoccupied that they cannot see potential conditions in their children. The advent of a pandemic has stretched an already thin system of specialized mental healthcare for children at a time when it may be needed the most. And misinformation continues to plague our news sources and social media.

Where to go from here

There are many things that parents and caregivers can do to support and nurture their child’s mental health. We encourage you to learn more in a recording of the webinar, “How are your kids doing?” where I was joined by Greg Dicharry, CPRP, youth empowerment director, to share knowledge and our years of experience working with children to improve mental health and wellness and answer audience questions.

[1] https://www.cdc.gov/childrensmentalhealth/data.html

[2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6945a3.htm

[3] https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

As more people are working from home to limit the spread of the novel coronavirus (COVID-19), what was once a perk may now seem like a punishment. It can be hard just to find and set up a workspace and connect with work, let alone deal with the isolation.

If you are used to going into work, you may miss opportunities for regular social interaction and connection with co-workers. Regardless of which life stage you’re in, working from home may cause feelings of isolation, frustration or stress that can impact your mental health.¹ Here are some tips to help you manage your new work-life balance:

Set yourself up for success

Find the most quiet place you can to set up your home work area. Make sure you have good lighting, a comfortable chair and plenty of outlets to plug in your computer, monitor, phone charger, etc. Put everything you need nearby so that you don’t need to constantly hop up to find a report, get supplies, etc. Maintain as much of an office-like demeanor as you can. If you are using video for meetings, remember, you’re on camera too.

Establish your routine

When you’re away from the workplace, it’s important to set specific hours—and stick to them. It’s easy to work more hours than normal, but that may cut into your family time and affect your sleep schedule. You may also feel pressure to prove that you are spending your time productively, and this can result in increased anxiety and stress. Set your boundaries and develop a routine: wake up at the same time every day, take a shower, get dressed, etc. Keep as much of your non-work life as it was before the pandemic: eat well, exercise and get fresh air—just remember to maintain a 6-foot distance from others.

Practice self-care

Self-care is any proactive activity that we do to take care of our mental, emotional and physical health. Good self-care is the key to improved mood, reduced anxiety and a good relationship with yourself and others. While so many normal activities are disrupted, take some time to practice gratitude, eat healthy, get enough sleep and maintain or start an exercise program. You will feel better for it.²

Increase communication

You might find it easier to be productive without your most chatty coworkers constantly buzzing in your ear. But social interactions—even with coworkers—can alleviate feelings of isolation and loneliness. Try to maintain normalcy by setting up regular check-ins with your team or manager that allow you to provide progress updates, sort through problems or brainstorm ideas.

Cherish children

If you have children at home due to school closings, helping them make sense of what is happening in the world will help you process the situation too. Kids of all ages are as vulnerable as adults to feelings of anxiety, stress and sadness. Do the best you can to manage childcare, plan for different age groups and ask for help from those near to you, while staying mindful about social distancing. Be flexible to accommodate your children’s needs and those of your employer. This is a unique moment in history. Move through it as gracefully as you can and create good memories for your family.

Take breaks

In the office, there’s usually time for coffee breaks, lunch walks and chats with colleagues that give some breathing room from work. Just because you are working from home doesn’t mean you aren’t entitled to the same breaks. Hitting the pause button throughout the workday can be good for productivity. Get up and stretch, take deep breaths and look up from the computer at regular intervals. Remember to eat, and check with your supervisor for permission to take a break for a quick walk.

For more information and tips, visit MagellanHealthcare.com/COVID-19.

To learn more about Magellan Health’s corporate response to the COVID-19 pandemic and to view Magellan’s available resources click here: https://www.magellanhealth.com/news/covid-19/

¹Smith, P. (2020, March 10). How To Deal If Working From Home Is Hurting Your Mental Health. Retrieved from https://www.huffpost.com/entry/working-from-home-mental-health_n_5afd88e2e4b0a59b4e014602?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAALPysx5taWAnltmdXV9uEcuIXzXyRxgs3xGUH0ztFrzmyZfyFKQUQo1BetFTXXoiY1lnEVcXeQbFXLffHW2baI7Yr9eG5nDkYyB5iecH6hx8iRFumbBwpzRVhn1H7uRr-3ZngjIoto2Ctd1o-7Sl4sEDdIr-GAyVlgsNUEul-5MM

²Michael, R. (2018, July 8). What Self-Care Is – and What It Isn’t. Retrieved from https://psychcentral.com/blog/what-self-care-is-and-what-it-isnt-2/

Humans are social beings, and the social distancing that is necessary to flatten the coronavirus curve is hard on everyone. The forced change in social behavior and the resulting isolation can affect people’s mental health in many ways. Whether you are home alone, with a sick family member or with kids out of school, isolation can increase stress and anxiety.

Depending on your situation, isolation can impact you in different ways. From loneliness to feeling cramped, dealing with these feelings on top of worrying about the COVID-19 outbreak can be overwhelming.

General tips
• Keep in touch with your social support groups virtually through social media, FaceTime, Skype, online games and other digital platforms.
• If the weather is nice, go outside and get some fresh air. Maintain a 6-foot distance from others.
• Stay busy. Read, play games or work on a project.
• Decrease the time you spend watching or listening to upsetting media coverage.
• Draw on skills that you have used during difficult times in the past to manage your emotions. That may include deep breathing, meditation, positive self-talk, etc.
• Maintain a healthy lifestyle. Stay hydrated, eat nutritious meals, exercise and get enough sleep.
• Avoid using tobacco, alcohol or other drugs to cope with your emotions.
• Access information that can help you cope with stress, worry and confusion during the pandemic. Visit Magellan Healthcare’s COVID-19 response website for information and links to self-assessments, videos and other resources.
• Get the facts about your risk and how to take precautions. Use trusted national and international resources including the World Health Organization, Centers for Disease Control & Prevention and State Departments of Health.

For people living with children
• Remember that during times of stress, it is common for children to seek more attachment and be more demanding on parents.
• Be honest when discussing COVID-19, but do so in an age-appropriate way. If your children have concerns, help them ease their anxiety.
• Make sure you model good behavior. Children will observe adults for cues on how to manage their own emotions during difficult times.
• Help children find positive ways to express their fears about the situation. Every child has their own way to express emotions. Sometimes engaging in a creative activity such as drawing can help this process.
• Maintain a safe and supportive environment and practice familiar routines in daily life as much as possible, especially if children are confined to home.
• Provide children with engaging activities

For caretakers of older adults
• Provide practical and emotional support by sharing simple facts about what is going on.
• Give clear information about how to reduce risk of infection in words older people with/without cognitive impairment can understand. Repeat the information whenever necessary.
• Engage their family and other support networks in providing information and helping them practice prevention measures (handwashing, proper sneezing and coughing techniques, etc.).
• Be aware that older adults in isolation and/or those with cognitive decline/dementia may become more anxious, angry, stressed, agitated or withdrawn during this time.
• Encourage older adults with experience and special skills to help others by providing virtual peer support, reading to children over the phone, and the like.

To learn more about what Magellan Healthcare is doing to support clients during the  COVID-19 pandemic, visit  MagellanHealthcare.com/COVID-19.

To learn more about Magellan Health’s corporate response to the COVID-19 pandemic and to view Magellan’s available resources click here: https://www.magellanhealth.com/news/covid-19/

Adapted from Miller, H. (2020, March 10). WHO gives advice on handling mental health toll from the coronavirus. Retrieved from https://www.cnbc.com/2020/03/10/who-gives-advice-on-handling-mental-health-toll-caused-by-coronavirus.html. March 13, 2020.