When bad things happen to children, we might share the comforting words “it’ll be all right” — kids bounce back. But, for many, those reserves of resilience are flagging under the weight of the COVID-19 pandemic.
Surveys suggest that children are absorbing the same grown-up worries and stress that are driving a surge of anxiety or depression among U.S. adults, while the normal outlets for defusing those tensions have evaporated.
Special education teacher Alexis Camacho said that she and her 12-year-old twin daughters were living a happy life in San Diego before the virus. Like many pre-teens, her sixth-grade girls revolved around their friends, though one daughter is more introverted than the other. They were excited about entering middle school and could not wait for what life had to offer, making plans for things like spring break and summer camp.
But the pandemic upended home life while giving her family nowhere else to go and upset their sense of predictability. Even the promise of school reopening for in-person classes kept being yanked away whenever coronavirus cases surged. By mid-November, Camacho’s more introverted daughter declared, “‘I have nothing to look forward to.’” Camacho said her heart felt broken and she didn’t know what to do.
Their story is far from unique. Families that were struggling to make ends meet before this crisis are suffering now. When schools shuttered, virtual classrooms and playdates often came with feelings of disconnection. Typical sources of joy have dimmed — playgrounds closed, family gatherings postponed, birthday parties canceled. And public health experts warn the next months of the pandemic, with a surge of new infections, will be the hardest yet.
When you overcome real hardship, that’s called resilience. Some people are able to push past potentially traumatic events, such as abuse, neglect or when parents divorce, while other people experience emotional or physical consequences long after the event is over. The question of who bounces back and who doesn’t can be determined by “protective experiences” and “responsive interaction” such as holding a child when they cry, as well as coping skills, research suggests.
For children, having at least one stable, supportive and committed adult consistently in their lives makes the biggest difference. Feeling a sense of control, fostering an ability to adapt and connecting to community and hope all strengthen a child and bolster their resilience, according to Harvard University’s Center on the Developing Child.
One of the hard parts of the pandemic has been that lack of predictability. Knowing what’s coming next helps ease a child’s stress. It also provides them a framework so they aren’t as overwhelmed when they are old enough to perceive the world around them. They know what’s coming and that routine calms them down. On the other hand, a lack of predictability heightens stress for both children and parents, putting both on edge because neither know what might happen next or how disastrous it could be.
When it comes to the ways that the pandemic has reshaped life, child development specialists say it could be years before life feels normal again, and that the negative effects on well-being could sow stress and trauma that take root for generations.
But there are things that caregivers can do now to build up children’s resilience to help them maintain stable, healthy minds and bodies when faced with adversity.
What research tells us about trauma and resilience
Disasters, both natural and human-caused, have been shown to increase mental health issues, but they have also taught us how kids are able to cope with uncertainty and hardship.
In 2005, Hurricane Katrina summoned a storm surge that broke the levees meant to safeguard New Orleans, flooding the city and wiping out some neighborhoods. More than 1,500 people are known to have died in Louisiana alone. A botched response to the sudden devastation slowed recovery and rebuilding efforts for families, schools struggled to reopen and many who evacuated never returned home. In the aftermath, children and adults alike reported higher levels of anxiety, depression, post-traumatic stress and mental illness. In one 2010 study published in the journal Child Development, researchers examined how 387 children between ages 9 and 18 adapted to life two and three years after the hurricane, and their responses spanned everything from “stress resistant” to “breakdown without recovery.” Over time, symptoms of posttraumatic stress and depression decreased among most children, and researchers said supportive relationships made a difference in children’s outcomes.
According to years of research, conditions like those post-Katrina can also lead to toxic stress, which lingers with kids and their families long after life appears to have resumed normal rhythms. In young children, toxic stress occurs when the body’s fight-or-flight hormones are triggered repeatedly without relief, and go unchecked by the presence of a trusted adult, who acts as a buffer against scary things beyond our control. That person reassures the child they are safe and things will get better. When the U.S. separated migrant children from their caregivers along the nation’s border with Mexico, many regressed, cried constantly or, worse, eventually stopped crying and appeared numb, according to advocates who were allowed to visit some of the U.S. detention centers. They had lost their emotional shock absorbers, making it easier for their bodies to enter high alert and stay that way. That can turn into toxic stress — the result of the body’s chronic exposure to stress hormones that can rewire developing brain architecture over time and, though not a foregone conclusion, increase the lifelong risk of negative physiological, mental and emotional outcomes, such as heart conditions or struggles with substance use.
In 2007, researchers studying the effects of toxic stress and neglect on children’s development in Romania found that the IQs of kids raised in orphanages were stunted significantly compared to children who spent time in foster homes or were never removed from their biological families.
Thirteen years and a pandemic later, Jessica Bartlett, who directs early childhood research for Child Trends, said she is concerned that amid the stress of the pandemic, children’s disrupted brain development could prime them to either become over-reactive to stress and lash out more frequently, or under-reactive and withdraw from others altogether.
She is not the only child development and welfare expert who is concerned about children and parents as the pandemic drags into the winter months. Early data suggests there has been a rise in domestic violence, parental substance use and child abuse as schools and communities have closed, then opened, and then close all over again, Bartlett said. Pressure on parents is going up, whether through loss of child care or feeling anxious about getting, keeping or doing their job during an historic recession. “They’re just being asked to do the impossible,” Bartlett said.
As a general rule, experts rarely recommend widespread social isolation to benefit public health. It is a massive disruption of work, society and life, saved for extreme circumstances (such as a pandemic) when the only alternatives are the collapse of the health care system, risk of illness with no cure, and death. That’s exactly what happened in mid-March, when many states adopted shelter-in-place orders to prevent worsening outbreaks of the coronavirus, and many health care services went underutilized because people were afraid of catching or spreading the virus.
At that time, there was a 43 percent drop in how many children with mental health concerns visited emergency rooms, which are “often the first point of care for children experiencing mental health emergencies, particularly when other services are inaccessible or unavailable,” a Nov. 13 report from the Centers for Disease Control and Prevention showed. That might mean that kids were not getting the care they need, rather than kids needing less care. Starting in April and running through October, those visits rose dramatically — up 24 percent for children ages 5 to 11, and 31 percent for children ages 12 to 17, compared to the same period in 2019. In recent years, data were already showing a rise in reported mental health issues among children and youth, including suicide and suicidal ideation. But 2020 has been “a year of great anxiety, and it’s spilling over into pediatrics,” said Dr. Moira Szilagyi, a pediatrician and expert on child trauma and resilience at UCLA’s Mattel Children’s Hospital.
Typically, pediatricians are better trained to spot when things are going awry, not necessarily when there is an opportunity for prevention, said Dr. Joshua Gordon, who directs the National Institute of Mental Health. Still, even that insight can be helpful if your child has an outburst and you want to know if their behavior is a normal response to stress or needs professional intervention, he said.
The degree to which pediatricians and teachers coach parents in nurturing resilience in their children varies, Gordon added. Part of what makes this particular moment difficult is that there is no clear beginning or end, experts say. Natural disasters such as earthquakes or tornadoes quickly destroy life and livelihoods, but they can also end just as suddenly as they began. The coronavirus pandemic “really is changing and changing and changing again,” Bartlett said. “There are more shifts for kids, parents and communities to have to make, which is hard on everybody.”
What research says parents can do
Before COVID-19, Amanda Myers said her 8-year-old son was a creative, whip-smart boy who enjoyed imagining make-believe societies with classmates in Austin, Texas. But when the pandemic began, he stopped being able to see his best friend, who is immunocompromised. Her son grew quiet and lost his appetite. During her son’s first Zoom call for Spanish class, his teacher asked him to turn on his camera so she could see him and they could work on building his vocabulary. He refused, saying, “‘I don’t want anyone to see me anymore,’” a moment that still gets Myers teary when she thinks about it.
As the months dragged on, Myers noticed her son alternated between withdrawing into himself and having outbursts. She said she felt “ill-equipped to manage these symptoms manifesting in a child so young.” By early August, his pediatrician confirmed what Myers suspected — her little boy was depressed, and told Myers many of her patients were similarly struggling. “He was not like that before,” she said.
Much like their parents, kids are undergoing lots of stress and deserve some slack, Gordon said. Their caregivers shouldn’t expect pre-pandemic levels of performance in school or at home because “kids are going to need to let off steam.”
But when should you ask for help? When kids are depressed, they sometimes act irritable or agitated rather than withdraw, Gordon said. When kids are anxious, sometimes they shy away from people and experiences they once enjoyed because they are nervous, he said. When those behaviors start regularly interfering with what the child needs to do in the classroom, virtual school or at the dinner table, and they are not able to settle down and engage in activities they had liked to do, Gordon said, “That’s a sign they may need further help.”
When California shut down the state, Camacho said she and her daughters “just watched everything be canceled.” Their social lives unraveled, and plans came undone. Then, their downstairs neighbor whom they often visited was diagnosed with COVID-19, forcing them to quarantine for two weeks overlapping with their birthday. Camacho had to call everyone she had seen recently, including her mother who lived nearby, and tell them her family may have been exposed to the virus.
“That was a wake-up call,” she said. “Everyone thinks they’re fine, that you’re safe, but you don’t freaking know. I want to have some semblance of normal life, but also I feel so scared.”
In June, right before her daughters turned 12, Camacho purchased smartphones for them as a gift. Most of their classmates owned phones, and Camacho thought the phones (initially intended in part as a lifeline when her kids planned to walk home from middle school) would keep her daughters connected to their friends. Almost immediately, they became transfixed by the social justice movement propelled by the police killing of George Floyd. News about police violence and racial tension, combined with the coronavirus pandemic, gave Camacho’s more introverted daughter anxiety. She became withdrawn and rarely emerged from her bedroom. Her more extroverted daughter threw tantrums before adapting to online schedules, but seeing a therapist helped her, Camacho said. Her shy daughter, however, was not yet ready to talk to someone.
“It’s hard for me to tell what’s the pandemic and what’s being a teenager,” Camacho said. “There’s a lot of feelings.”
Szilagyi said she has seen fewer kids with physical illness so far this year (crediting social distancing for that dip in those pediatric visits) but is seeing more kids presenting with symptoms of anxiety and depression.
“Increased isolation has been very difficult for children to deal with,” she said.
Caregivers are dealing with so much, and kids take their cues from trusted adults in their lives. One thing grown-ups can do to help kids “is to admit, ‘I’m stressed. There’s a lot going on. I understand how you feel,'” Szilagyi said. That validates a child’s feelings.
“We all have to learn to take care of ourselves,” she said. “We all experience stress in life, and children learn to manage stress from their parents.”
While no one wishes stress on anyone, Szilagyi said those experiences “can become tolerable because the adults in the environment buffer that stress for children.”
Strategies such as reassuring them that they’re safe and that things will get better can help. During the holidays, rituals and traditions also help bolster a child’s sense of what to expect and that life is not in complete upheaval.
Camacho makes time to spend quiet moments with her more introverted daughter. Every now and then, they get in the car, buy a Subway sandwich, drive to the beach and watch the sun set. Her daughter takes comfort in being with Camacho. Sometimes, she opens up a little bit, but Camacho says, “There’s very little reassurance I can offer her.”
For Myers, she said she has learned when to push her son and when to back off. She said she now knows her child better than she did before because months of social distancing made them inseparable and has “come to understand him better in terms of what’s good for him and what’s not.”
Yet researchers suggest simple coping strategies can make a difference. Telling jokes, using meditation or yoga to relax and even encouraging optimism can ease a child’s anxiety and nurture resilience, according to a 2016 study published in the Journal of Clinical Psychology.
Parents can rely on the three R’s — reassurance, routine and regulation — to help them help their kids, Bartlett said. That can include:
- Reassure them about their safety. Younger children want to know grown-ups are working really hard to protect everyone. Older kids have probably heard stories or rumors about the virus and may be ready for more age-appropriate conversations about what’s happening and what’s being done to help their household and community get through this pandemic.
- Stick to a routine. There’s a time to sleep, a time to wake, a time to learn and a time to play. Preserve those schedules as much as possible. And when things do change and there’s any notice, let the child know so they can mentally prepare. Even a small heads-up can help a child navigate uncertain times.
- Regulate. Different coping mechanisms work for different kids — exercise, deep breathing, movement, quiet time. Whichever strategy works can improve a child’s capacity to deal with big feelings, their ability to learn and relate to other people.
It’s also important for parents to model good behavior for their kids, and part of that is by taking care of themselves, Szilagyi said. When you’re starting to feel overwhelmed, take a bath, drink a cup of tea, call a friend, move around or go outside for a walk, if you can do so safely. It will revive you, she said, because “if we don’t take care of ourselves, it’s hard to take care of others.”
Things won’t always go as they’re supposed to — 2020 has clearly offered a master course in that concept. Szilagyi said parents should try to keep their children at the center of what they are doing and thinking, without losing sight of or shortchanging their own needs. “You almost can’t go wrong if you do that,” she said. “Even if you feel as a parent that you’re not doing the best job in the universe, you’re doing the best you can and your kids know that and they’ll be okay.”
Why families need more support
For kids who have a stable, caring adult nurturing them throughout all of this, and a deep well of reserves, they are most likely going to be fine. But for children whose families were already living on the edge and concerned about joblessness, housing insecurity or not having enough food to eat, this can drain a child’s already limited resources.
“We cannot rest easy saying, ‘Kids are resilient, and they’ll be fine, and we’ll just let it ride,’” said Dr. Jack Shonkoff, who founded and directs Harvard University’s Center on the Developing Child. “We should be very worried.”
While well-functioning families “may be thrown off for a little while,” Szilagyi said, “they may find their way back more easily than a family that’s living with a multitude of issues” linked to housing, food, health, job loss and poverty. “When you start piling them up, it just becomes more difficult.”
Some kids are physically healthy, emotionally healthy and have been reasonably protected from significant adversity by their family circumstances. Then there are some who are in relatively safe and comfortable circumstances based on their environment, but they have health problems — physical, mental, emotional or behavioral challenges. These kids may be more sensitive and more susceptible to the negative consequences of elevated levels of stress. Finally, some do not live in safe or stable homes or communities, and rely on their school system for a large part of their nutrition needs, access to mental health and special education services. While all children are at risk when catastrophe strikes, this last group of children are the most vulnerable to tectonic shifts in daily life, like the coronavirus pandemic.
Right now, researchers don’t know exactly how many kids nationwide have fallen off the educational map due the coronavirus, according to Child Trends. But in 2019, Pew Research Center reported that 44 percent of families living below the poverty threshold did not have broadband internet access. Kids need that regular rhythm of daily life provided by school, Bartlett said, and indefinite closures amid an unbridled pandemic should be deeply troubling for the country. Since March, she added, calls to child welfare hotlines have spiked.
Those who had exhausted their reserves and struggled to make ends meet before the pandemic came along need a social safety net to catch them, Bartlett said. Researchers have learned “how important it is to prepare so your immediate response [to disaster] can be supportive of kids,” she said. For local, state and federal officials who are designing that response, prevention is the best and most cost-effective tool.“When you’re unprepared, your systems aren’t responding well,” she said.
In June, the international Organisation for Economic Cooperation and Development asked governments to align “short-term emergency responses with investments into long-term economic, social and environmental objectives to ensure the well-being of future generations.” The fear was that overwhelmed health care systems and communities would drown out concerns about children and youth, especially the impact on mental health. Those concerns remained five months later. In a report, UNICEF demanded that all countries need to “protect the mental health of children, and young people,” while also restoring children’s access to education, health care and nutrition. Globally, UNICEF estimated, 70 percent of children’s mental health services have been disrupted.
U.S. researchers have conducted nationally representative surveys of families with children age 0 to 5 since April to see how they are carrying those burdens during the pandemic. Philip Fisher, a psychologist and child development expert at the University of Oregon, said in July that 20 percent of these families worried about paying for basic needs, like food, housing or utilities. Weeks later, many of these parents said they endured higher emotional stress. In the weeks that followed, their children did, too, forming “a chain reaction of hardship,” Fisher said. By August, 40 percent of families surveyed had these concerns.
But Fisher said something else is interesting. Many people say they are “finding more comfort in their young children,” and emotional support networks have become more hyperlocal, shifting away from friends and workplaces to grandparents and neighbors. Research shows, Fisher said, those emotional supports offset stressors.
As much as parents are straining, Fisher said, they are also showing incredible resilience themselves, and their children are learning from those tiny moments scattered across so many months. During Zoom calls for his work, he said his colleagues are “juggling these impossible tasks” — work, kids and life. “Parents are the true heroes of this pandemic,” he said.