Managing Children’s Mental Health During the Pandemic

Pandemic stresses are increasing anxiety, depression and overeating in children

Disruptions to daily routines, stress from remote learning, social isolation and anxiety over illness during the pandemic are taking a toll on children’s mental and behavioral health, leading to physical problems such as weight gain from overeating.

Mamilda Robinson, a specialty director and clinical instructor of psychiatric mental health at Rutgers School of Nursing, and Daniela Moscarella, a pediatric clinical instructor at Rutgers School of Nursing and president-elect for the New Jersey Chapter of National Association of Pediatric Nurse Practitioners, discuss signs that a child needs assistance and how parents can seek clinical help.

What changes have you seen in behavioral and physical health of children since the start of the pandemic?

Robinson: Children are showing symptoms of increased anxiety, depression and even self-injury and substance use. Anxiety is intensified by the challenges of remote learning, concerns about becoming ill and isolation from peers, leading to decreased coping skills. As a result, a significant number of children are gaining too much weight due to overeating, whether from emotional issues or simply out of boredom. Weight gain, which can have an impact on lifelong health, can also have a serious impact on behavioral health, which in turn becomes a vicious cycle.

Children are routine oriented and benefit from structured activities. Leaving the house to attend school is an integral part of this necessary routine. School attendance allows for peer-to-peer interaction, which is essential during every developmental stage. Pandemic life is not conducive to normal developmental events and this is having a significant impact. During well visits, primary care providers often discover children are not getting adequate sleep, are less physically active and are eating calorie-rich, nonnutritive foods.

What interventions can be done to decrease emotional eating and obesity during the pandemic?

Moscarella: Emotional eating typically occurs when children are depressed, anxious, stressed or frustrated. Parents should ask questions and determine if their children are eating for the right reasons. Is it out of hunger or just boredom? Questioning children about what they may be feeling can be difficult. Since some children may not feel comfortable discussing concerns with their parents, using a therapist may be the next step. During the pandemic, many therapists have started providing telemedicine services, which may help to decrease a child’s anxiety about becoming ill when visiting a clinician.

Encourage healthy eating routines. Children who attend virtual learning should have structured mealtimes and should not be allowed to snack all day long. Have healthy options with portion control on hand for snacks. Make a daily schedule that is visible to the child and consists of activities, meal/snack times and exercise. Do not use food as a reward for good grades or behavior. Avoid mindless eating, such as eating in front of the television or while doing schoolwork. Separate eating times from other activities to decrease the chance of overeating. Steer children to diversional activities, such as board games or arts and crafts, to lessen overeating.

Although it can be difficult to structure exercise during the winter, parents can consider creative ways to encourage movement, like shoveling snow, dancing or stretching to music.

If a child has gained weight, parents can talk to him or her about how improving their eating habits will lead to better health. A behavioral health provider can assess a child for a binge eating disorder due to anxiety and/or depression and provide appropriate treatment.

When should parents seek behavioral health assistance for their child and what steps should they take?

Moscarella: Children often have a difficult time verbalizing feelings and often demonstrate emotions in a different way than adults. Younger children generally have regressive behaviors like bed-wetting, clinging excessively to a parent or caregiver and increased periods of crying. Older children may lose interest in activities they previously enjoyed, perform poorly in school, have difficulty concentrating and being attentive and become irritable. Children may report more headaches, stomachaches and generalized body discomforts. Adolescents typically become more agitated, withdrawn, act out or turn to alcohol and drugs. A decline in school grades can be seen across all age groups. Parents should look for a change in patterns of their child’s behavior and daily activities, including sadness, reports of being tired and changes in patterns of sleep, appetite and interaction with others.

Parents with concerns should make an appointment to see their child’s primary care provider. Children are comfortable in familiar environments, and this may help to facilitate a constructive conversation. Primary care providers can screen for both behavioral and physical health concerns. If significant behavioral health issues are discovered, the child will be referred to a behavioral health provider for further evaluation and treatment.

Comprehensive mental care should include a formal psychiatric evaluation, individual and family psychotherapy and referrals to community resources. However, the scarcity of psychiatric behavioral health providers can be a challenge. In these cases, primary care providers may begin treatment while a relationship with a behavioral health provider is established.

What types of therapies can be tried before turning to medication?

Robinson: Treatment typically begins with non-pharmacological interventions such as relaxation techniques that include art therapy, walking, reading, listening to music, exercise, spending time with a pet, playing an instrument, journal writing, completing puzzles or meditation. When children are anxious, it is often necessary to begin regular routines and to ensure that they are getting a healthy diet and a sufficient amount of sleep.  

Non-pharmacological interventions are more effective when paired with psychotherapy and are often recommended to learn coping strategies. Valuable resources for parents regarding behavioral health concerns can be found on the Centers for Disease Control and Prevention website. If these interventions do not result in improvement, parents should seek the guidance of their pediatric primary care provider or a behavioral health provider.