In nearly two years of lockdown interruptions, I’ve often been asked for my professional opinion about the impact of Covid-19 measures on children. A great many views have been expressed on this, and I’ve hesitated to add to the fray. But the questions keep coming, so from my experience as a child psychiatrist seeing children in cancer wards, after accidents, falls, fractures, and now seeing children and adolescents in emergency departments, mainly for depression, self-harm, anxiety or suicidal thoughts, here are the things I’ve observed of children in distress over the pandemic.
Kids need connection
This is first and centre with family and caregivers, then of course, with friendship groups, and in adolescence with a wider circle, along with their growing independence. Children do a lot of implicit learning, from being with children and being at school.
But it’s not the same for each child, as parents know. Some children are sad without their friends, some miss group work and social learning. Some parents see their child less stressed, more secure, happier learning at home. Some kids like face-to-face interactions, some are as comfortable connecting through gaming or social media. Parents notice that some are constantly connecting online and others spend more time alone and this can be their preference or due to factors outside their control.
I find even children who spend a lot of time alone, including shy children and children with autism, usually still need to feel acceptance and belonging. Exclusion and rejection hurt. Children with disabilities need connection and respect for their social, intellectual, emotional, health and safety needs.
Children also feel responsible for bad things that happen. So, for example, if they bring Covid-19 into the family, even if they didn’t do anything wrong, they can feel guilt, and blame themselves for what happens.
I’ve seen many adolescents with dark thoughts and many who have self-harmed over the last year. Some can describe their feelings but some find this very difficult. Nearly all, however, leave open the chance, even if small, to make a connection. It’s through that connection we can work on a way forward.
Kids are observant, curious and intuitive
I find they usually take in more of the world than we adults give them credit for. I’m struck by how much they notice, from current affairs to classroom, peer and household interactions. For many their understanding is greater – sometimes vastly greater – than their ability to put thought into words. When we talk about feelings like depression, hopelessness, low self-worth, I ask if this is because of lockdowns. They shake their heads.
“Is it part of it?”
“No.” “A bit.” “Maybe.” “It’s mainly other stuff.”
Some have given me thoughtful, sophisticated appraisals of ways the pandemic has made life (school, relationships, sport) more uncertain. They’ve weighed negatives against benefits (family time, online learning content and assessments). They’ve observe changing capabilities in themselves and others. Asked about teachers: “they’re trying”, “don’t think they like zoom”. About hanging out with friends online instead of in person: “It’s both good and bad.” Others say, “We’re allowed online more because we can’t see them.”
Many have an astute awareness of what adults think. Some have misgivings about adding more worry to important adults in their lives. They also see the “meta” overview of the worrying-about-worrying loop.
On the question of mental health and Covid, the short answer is: it’s not that simple.
Kids are open to new ideas and new ways
They understand complex concepts discussed at an age-appropriate level (think fairness and equity, climate science, marriage equality, privacy, even sun safety). I’m surprised how they’re across concepts such as viral contagion, airborne disease, how lungs work, almost as soon as adults are. They remember being younger and have ideas about how to make pandemic measures fun: “play outside”, “dress-ups with masks”. Most can discuss measures to keep themselves and others safe. They’re quick and open to adapt. For example, on the question of masks, I’ve discussed with colleagues the effect of mask-wearing in appointments, on kids and on us, how this affects rapport. Most kids can talk about it. Many don’t mind. Since the pandemic I’ve yet to see an adolescent in hospital not wear a mask properly when asked. Adults are less consistent.
Kids are not one entity
This is important. Different kids have different needs, different responses, different family situations, risks, priorities. But each child and adolescent notices when we’re genuinely interested, when they’re heard and seen for who they are. Some discussions refer to kids as if a homogenous morass. Kids can be keenly aware when they’re being co-opted for a wider adult agenda and they don’t buy it.
I think kids usually have something to say and need us to hear it. And we need to hear it. As we know, our kids are our future.
In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978. In the UK, the charity Mind is available on 0300 123 3393 and ChildLine on 0800 1111. In the US, Mental Health America is available on 800-273-8255.