The months since spring 2020 have been tough on all of us. Navigating pandemic safety measures and staying on top of information that changes frequently has been a challenge for many. While much attention has been paid to returning life to as it was pre-pandemic – conversations that largely focus on adults and businesses – children aren’t exempt from the tribulations.
“They’re watching the news and hearing the controversies and listening to people talk about the controversies and thinking about all the changes and uncertainties that are out there,” says Dr. Stephen Jewell, director of psychiatry and psychology for Akron Children’s Hospital. “There’s more anxiety, as you might imagine.”
Across the Mahoning Valley, professionals are seeing firsthand the toll the pandemic – and all the changes it brought along – is taking on children.
“We’re seeing acute chronic stress, worries about handling health and even handling unexpected bereavement and loss. Of course, there are disruptions to school, which comes with separation from friends,” says Jamie Miller, clinical services director for Alta Behavioral Healthcare. “In terms of isolation, adolescents – and kids in general – are spending increasing amounts of time on the internet and social media, which brings a whole other story.”
Adds Katie Cretella, director of access for Coleman Health Services: “In the emergency room [unit at Trumbull Regional Medical Center], we’ve not only seen an increase in adolescents but also an increase in symptoms. Even if there’s a history of mental health [problems], it’s looking like their symptoms are more severe when they’re presenting.”
Early in the pandemic, one of the larger conversations that cropped up around lockdown measures was the effect of isolation and the minimizing of contact with those outside one’s immediate household.
For most of 2020, Akron Children’s Jewell observes, those fears didn’t necessarily come to pass. Children are resilient and held up pretty well, he says, especially as one of the largest stressors in children’s lives – school, which brings both social and academic pressures – was taken out of the equation. But as 2021 arrived, schools had children return to the classroom and cases began to rise again.
“It wasn’t until 2021 that we started to see the impact on kids that had been predicted,” Jewell says. “We saw an increased frequency of suicide attempts, especially by overdose. In the past, we might get two or three per week. Then we started seeing one or two a day, with days where five or six kids would show up in the emergency room. The research we saw indicated that was happening elsewhere also, as well as through my interactions with colleagues at Nationwide Children’s Hospital [in Columbus] and Cincinnati Children’s Hospital.”
Now, as schools return to in-person classes while the delta variant is causing the number of coronavirus infections to rise, typical concerns – it’s not uncommon for pediatric patient volumes to drop over the summer, the professionals say – are mixing with pandemic-era challenges.
“Kids may be concerned about anxiety from new situations and they may be facing new teachers, a new school, new classmates,” Miller says. “Now kids are worried about if they’re going to be wearing a mask in school, if school will be in-person, if they’ll be exposed to COVID. All of that’s on top of the typical anxiety kids feel. I see that it’s increasing right now.”
When it comes to mental health and its effects, Cretella notes that it’s often not limited to just one person in a family. If a parent is dealing with his or her own concerns such as depression or anxiety – two of the more common issues – that can affect children and adolescents.
“We’ve had cases where parents have come in because of all the extra stress of working from home while also being a teacher. Parents as well have these increased symptoms,” she says. “When parents are exhibiting symptoms, we can sometimes forget that it affects the entire family unit and vice versa.”
Since the effects of the pandemic began being widely felt in March 2020, new conversations have sprung up about the importance of mental health. In a health care field already plagued by understaffing for pediatric care – Trumbull County, for example, has no practicing psychiatrists who specialize in pediatric care, according to Akron Children’s 2019 community health needs assessment – delivering that care has been an extra challenge.
“There’s a high level of long-term impact from this past year and a half from things like fear, isolation, anxiety, depression. Those are in a high rise now. In general, it’s important for children’s and adolescents’ treatment to look into those,” says Dr. Muhammad Momen, director of psychiatric services for Trumbull Regional Medical Center.
When minors present mental health symptoms that require inpatient services, he says, they’re often sent to Trumbull Regional’s sister hospital, Sharon Regional Medical Center across the state line. While the hospital in Warren has several spaces dedicated to mental health care – in addition to the new space in the ER, there are two inpatient areas for adult and geriatric psychiatry – Momen says more is needed for children.
“In this area, unfortunately, we don’t have any child’s or adolescent psychiatric unit. I wish that leaders could come up with a plan for placing them when they need care,” he says. “I believe that the community should come up with a more comprehensive plan to get their needs met.”
Also challenging, says Alta’s Miller, was the delivery of care via telehealth. Without the language to communicate their emotions effectively, children often turn to play and art to show what they’re feeling, he explains. Without that in-person interaction, professionals had a harder time working with patients, he says.
“In moving to virtual work, it sometimes challenged our therapists who needed to do those things,” Miller says, noting that also complicating things was that virtual communication is hard, even when having conversations, for some people.
As families begin a new school year and brace for rising coronavirus figures, the mental health professionals say that for parents, one of the most effective tools in helping their children’s health is to be open about it and keep an eye on changes.
“Parents usually know their children best. So keep an eye out for changes in behavior: a child that goes from extremely social to isolated or hesitant to socialize, changes in appetite, changes in sleep patterns and things that just don’t align with milestones,” Cretella says.
And, Jewell adds, parents shouldn’t necessarily be looking for specific symptoms, but rather their overall behavior.
“Kids have three domains within which they need to function: getting along with family, getting along with friends and school,” he explains. “Broadly speaking, if your kid is having significant problems in one of those areas or moderate problems in two or more, an evaluation is warranted. That’s a broad way of thinking about social and academic functioning rather than homing in on symptoms, which are sometimes easy to hide.”
Pictured: Cutting the ribbon for the behavioral health unit in the emergency department at Trumbull Regional Medical Center are Krista McFadden, Dr. Robert Moosally, Dale Bungard, Dr. Muhammad Momen, Marsha LaPolla and Dr. Sarah Momen.