As someone who has struggled with their mental health, Danny Quin of Ashby, Mass., understands just how important it is to be open about it. “Since starting our family, my wife and I prioritize talking about mental health because we know how it can create a tidal wave of anxiety and anger if bottled up too long,” says the dad of three. 

One day, Quin’s eldest son told him and his wife that he didn’t want to go to school. “I could tell this wasn’t one of those days where he just wanted to stay at home and watch TV or play Legos. There was something more going on behind those eyes that he wasn’t telling me.” 

Children and teens in the U.S. are facing increased isolation and anxiety since the start of the pandemic.

Between learning disruptions, social isolation, and ongoing uncertainty, children and teens in the U.S. are facing increased levels of stress, anxiety, and behavioral issues. And as the COVID-19 pandemic passes the two-year mark, it’s clear that adolescent mental health continues to suffer. In fact, the mental health crisis among children and teens is such a top concern that pediatric health experts have declared it a national emergency. 

While it’s clear the pandemic has taken a toll on adolescents, caregivers may not recognize how directly and deeply it affects well-being. “Some problems, like feelings of sadness, anxiety, or a loss of security and safety may be less obvious,” says Dr. David Elvin, M.D., a pediatrician and chief medical officer at Tufts Health Plan. 

“It’s easy to forget how much of an impact the pandemic has had on our children,” explains Quin. “Imagine being a kid that couldn’t go and hang out with their friends. Imagine being six years old and being told you need to sit in front of a computer for hours while your teacher is on the screen.” 

The pandemic’s impact on children’s mental health

With the pandemic taking a toll on nearly everyone’s physical and emotional health, children especially are having a tough time coping. Beyond losing a loved one — more than 140,000 children in the U.S. have experienced the death of a primary or secondary caregiver due to COVID-19 — many other pandemic-related issues have driven mental health concerns among children.

Learning disruptions can negatively affect children’s well-being.

Disruptions to learning have greatly impacted students nationwide, isolating them from their peers. According to the Saul Zaentz Early Education Initiative’s Early Learning Study at Harvard, educational instability — such as switching between in-person, hybrid, and remote learning formats — negatively affects children’s social, emotional, and behavioral well-being. The loss of social interaction and connection can increase anxiety and depression, especially for teens. School closures also impacted the ability of students to access mental health care, as many children receive this necessary care through their school system.

“My son struggled with remote learning in his final months of preschool,” says Quin. “We went into this school year knowing that it wasn’t going to be a seamless transition. And after hearing him say that he didn’t want to go to school because everything was moving too fast, I knew I needed to figure out the best way to comfort him.” 

Challenges at home can also bring on mental health challenges for children. As families face their own obstacles such as unemployment, reduced income, and limited social support, there can be a trickle-down impact on their children. “Parents should check in on themselves too,” says Jill Borrelli, LICSW, vice president of behavioral health at Point32Health. “Kids react to their parents’ stress level and are often the ‘canaries in the coalmine’ when it comes to externally exhibiting signs of stress being felt within the family. Modeling self-care for our children is essential when we face tough times.” 

How to protect and support children’s mental health

Creating a routine for your family and being open to conversations about mental health can help.

Many children will exhibit different moods and behaviors at various times, which can be part of normal childhood development. That’s one reason why it can sometimes be challenging to differentiate whether a child is exhibiting normal behavior or symptoms of mental illness. 

“Kids will be affected differently depending on their age. Especially as the world begins opening up, we may feel distance and worry that our children are struggling to get ‘back to normal,’” says Elvin.  “For younger children, watching for trouble sleeping, more frequent or intense tantrums is important. Older children may exhibit mood changes, trouble sleeping (too little or too much), a decline in school performance, or increase in risky behaviors.”  

There are many ways that parents and educators can support a child’s mental health, including:

• Creating an open, safe space for dialogue. Whether it’s at home or in the classroom, having a safe space encourages children to be open and share anything that may be bothering them. It’s important that children can approach someone that they trust with an issue and that the person will be receptive and provide the support they need. “Talk with them about the pandemic in words they can understand. Encourage them to express their feelings and let them know you’re there to help,” explains Dr. Elvin. Whether it’s over dinner or in the car driving to an activity, try and ask open-ended questions to allow the child to react. For example, asking a simple question like “What was the best part of your day?” can get a child to open up and share their feelings. Remember, being a good listener allows you to fully understand what’s going on and gives you an idea of what the child’s current emotional state is.

Quin explained that reassurance is also key. “Reassurance was an important first step in getting him on the bus that morning,” he says. “Our son needed a little extra help, but he didn’t know how to say it because he was still finding his footing in school. After reassuring him that my wife and I would take a little time after school to ensure he understood his school tasks made him feel more supported.” 

• Emphasizing healthy habits. Physical health and mental health go hand in hand. Healthy habits such as regular exercise, sleep, and healthy food choices have been shown to help support mental health and improve overall well-being. Modeling and encouraging healthy activities and choices can help children cope and deal with their emotions better. For example, going for walks outside or using coloring books can create focus and help support mental and emotional health. 

• Creating a routine. While life can be hectic, fluctuating day-to-day schedules can cause increased stress and anxiety for children. Having a general routine — whether it’s a set meal schedule, a consistent time for bed, or a weekly family activity — and setting boundaries can provide comfort and a sense of safety for children. “Don’t be too hard on yourself. Many of us feel we have run out of ideas about what to do. It’s time to find some activities that you feel comfortable with and give you and your children something to look forward to,” says Dr. Elvin.

Seeking additional support

“Aside from the increased focus on behavioral health, one of the silver linings of the pandemic is that there is a bigger recognition that mental health and physical health are intricately connected,” says Borrelli. To this end, staying in touch with your child’s pediatrician is a critical starting point. 

A primary care provider can offer parents advice for keeping their children healthy — physically and mentally.

“Not only can we help your child stay healthy, but your provider can offer advice about the best way to help children and determine whether your child is appropriately upset about difficult situations or if more serious mental health issues need to be addressed,” says Elvin. “The good news is that symptoms typically improve when children have someone experienced to talk with, and many of these services are covered by most health insurance plans.” 

A primary care provider can be the starting point for more holistic forms of care for children who may require it. “There’s really exciting work being done in terms of collaborative care,” says Borrelli. “This team is usually led by the primary care doctor, but will include behavioral health experts and care managers that are working together in an integrated way to help their patients.” 

Expanded telehealth options are another way for children and parents to better access care, and Borrelli sees a hybrid approach to behavioral health as the way of the future. Harvard Pilgrim Health Care and Tufts Health Plan members have access to various virtual behavioral health resources and tools, such as Talkspace, Sanvello, and Teladoc, which can help support you and your children by connecting you with mental health professionals and self-support options. 

“No matter the age, I urge parents to continue communicating with their children about how they’re feeling mentally,” says Quin. “If they need additional help that you can’t provide, consult with your children’s primary care provider for the best course of action.”

A brighter path forward

While we should anticipate that children will continue to face mental health challenges stemming from the pandemic, we can feel hopeful that the world is returning to “normal.”

“Life won’t look the same as it was pre-COVID but there will be less acute stress related to the pandemic,” says Borrelli. “When you experience a huge emotional challenge, you can’t just turn it off. Parents should be gentle with themselves and their children.” 

What’s most important is that we recognize behavioral health is just part of good health care and giving as much attention to your child’s mental health as their physical health can lead to better outcomes.

From digital tools to access to therapy, Harvard Pilgrim Health Care and Tufts Health Plan are committed to helping members of all ages connect with the care they need.