When COVID shut down life as usual in the spring of 2020, most doctors in the United States focused on the immediate physical dangers of the novel coronavirus. But pediatrician Nadine Burke Harris soon began to think about the long-term emotional damage the coronavirus was causing and those who would be particularly vulnerable: children. “The pandemic is a tremendous stressor,” explains Burke Harris, a California general surgeon. “Then you have kids home from school, economic hardship, people unable to socialize.” These stresses may be particularly toxic to children, she and another state health official wrote to health care providers in April 2020. This week, US Surgeon General Vivek Murthy issued a similar warning about children in the entire country.
The toxicity became very real after 20 months, not only from the chaos, but from death as well. As of last June, more than 140,000 children have lost a close caregiver — such as a parent — to COVID, according to research published in the journal. Pediatrics. Since 2019, there has been a rise in suicide attempts among people under 18, researchers at the Centers for Disease Control and Prevention found when they examined mental health emergency room visits over the past three years. A study of child insurance claims submitted between January and November 2020, conducted by the nonprofit FAIR Health, found a sharp increase in mental health issues, particularly generalized anxiety disorder, major depressive disorder and intentional self-harm. These and other troubling trends have recently led the American Academy of Pediatrics and two other health organizations to declare children’s mental health a national emergency.
These patterns arise from what child health professionals call adverse childhood experiences (ACEs), Burke-Harris says. These events include 10 types of specific trauma that range from direct abuse and neglect to more general domestic dysfunction. Adverse experiences activate the brain’s fight-or-flight system – a natural response to immediate physical danger like a bear rushing towards you. But “what happens when the bear comes every night?” Burke asks Harris. As adverse events put children at prolonged and repeated risk, they increase their stress response and cause harm.
Lisa Gantz, a pediatrician with the Los Angeles County Department of Health Services, She is one of more than 20,000 health care providers in California who have received a free two-hour online training offered in the state. By teaching her how to screen for and respond to adverse events, Gantz says the training has changed the way she approaches clinical care. She remembers a recent date with an underweight four-month-old and his mother. “We went through all the food [methods], and I couldn’t really come up with a reason why this baby wasn’t growing,” Gantz says. But when I spoke sweetly to the mother about potential changes in the home, Gantz learned that the baby’s parents had recently separated. And the family faced newly discovered financial difficulties — a circumstance that is nearly true of half of American households by August 2020, according to a national survey.
“Once the mother felt safe, we learned that the husband had been repatriated, that finances were tighter, and that the mother needed to lighten her son’s formula to make ends meet,” Gantz says. “I was so embarrassed that she had told me this before, plus Mom wouldn’t come in for a check-up and say, ‘By the way, Dad is no longer here. “But the shows create space for these larger conversations about what’s going on at home.” Using this information, Gantz was able to connect the mother and her baby with a social worker and public services that could help them pay more for milk.
Gantz describes the work of addressing adverse experiences as creating a “medical neighborhood” – a cohesive unit that responds to the multifaceted nature of children’s mental health with equally multifaceted resources.
Efforts in other countries It is trying to reduce the plight of children by helping parents address their problems related to the pandemic. In North Carolina, for example, the Raleigh-based nonprofit SAFEchild offers the Circle of Security Parenthood Program (COSP). Small groups of parents in the program meet weekly to reflect on their behavior and improve their relationships with their children. Before teaching parents how to listen, the program first helps them feel heard.
This step is critical if interventions are to go beyond “telling people what to do” and create lasting change, says Ginger Espino, COSP facilitator at SAFEchild. She points out that many parents in the groups are victims of negative events in their childhood. “It’s about breaking that cycle of abuse and empowering parents to have confidence that they can meet any of their children’s needs, even if those needs weren’t met during their childhood,” Espino explains. By inviting participants to affirm their strengths, talk about concerns, and build what safety looks and feels within a safe support group, the program aims to help parents create the same loving and caring environment for children at home. “They realize, ‘Oh, my kid isn’t trying to drive me crazy. My child has a need, and I need to figure out how to satisfy that need,” she says.
A few other countries have recently made efforts to respond to the increase in adverse events caused by the pandemic. In May, Maryland issued an executive order to create an ACE Awareness Day and announced a $25 million fund to expand the state’s youth development programs to every county. Wyoming is using California’s approach to reimbursing health providers for ACE screenings for eligible Medicaid patients, says Elaine Qian, who helps executive director of the National Academy of State Health Policy, who co-published a paper on the different ways states are trying. Prevent or mitigate negative experiences.
Nationally, there have been some moves to help deal with negative events. In May, bipartisan congressional representatives from Georgia and Utah introduced a bill expanding ACE research and data collection. That month, the nonprofit ACE Resource Network launched an awareness campaign called Number Story. the program, It is so named because the Clinical Adverse Events Questionnaire gives a person a score based on the number of such experiences, and uses conversations with celebrities such as john legend and Camila Cabello to educate the public about negative events and how to recognize when they are experiencing one or more.
Such recognition can help change behavior and motivate people to seek help, says Sarah Maricus, executive director of the ACE Resource Network. “In my grandparents’ days, it was a habit to smoke, but it’s not now. It’s the same thing we want to do with ACEs.”
If you need help
If you or someone you know is struggling or having suicidal thoughts, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK), use the internet lifeline chat Or call the Crisis Text line by texting TALK to 741741.