COVID-19 Q&A Behavioral & Mental Health

It’s a stressful time to be a parent—or a kid of any age—as COVID-19 has changed our lives in this unprecedented season. We’re all navigating new challenges and anxieties. In this episode of Just Kids Health, pediatric behavioral health experts Dr. Jennifer McWilliams and Dr. Mike Vance field questions from parents regarding anxiety in children, routines, screen time and more—all to help you and your child.

Topic Breakdown

3:19 – Taking family breaks together
4:22 – Managing everyone’s different schedules
7:19 – Anxiety during the COVID-19 pandemic
10:52 – Addressing the disappointments that your child may experience
13:31 – Creating routines, schedules, and opportunities for socialization
18:27 – Reassurance and comfort
20:03 – Giving yourself grace


Transcript

Here at Children’s Hospital & Medical Center in Omaha, Nebraska, it’s all kids — all day, every day. Our pediatric experts are here to answer your questions and weigh in on hot topics, helping you keep your child healthy, safe, and strong. We’re here for you. Listen in.

It’s a stressful time to be a parent or a kid of any age as COVID-19 has changed our lives in this unprecedented season. We’re all navigating new challenges and anxieties. In this episode of Just Kids Health, pediatric behavioral health experts, Dr. Jennifer McWilliams and Dr. Mike Vance, field questions from parents regarding anxiety in children, routines, screen time, and more. All to help you and your child.

Dr. McWilliams: Hi, I’m Dr. Jennifer McWilliams, the Division Chief for Child and Adolescent Psychiatry here at Children’s Hospital & Medical Center.

Dr. Vance: Hi, I’m Dr. Mike Vance and I’m the Director of Children’s Behavioral Health at Children’s Hospital & Medical Center and a psychologist by training. And we’re here for the next 25 minutes or so to discuss some of your questions about COVID-19.

Discussing how contagious COVID-19 is with your child

Dr. Vance: Our first question came around the area of, “How much should we discuss COVID-19’s contagious nature with our child?”

And I’d answer that question with, “Make sure it’s developmentally appropriate.”

You’re not going to have the same conversation with your preschooler as you would with your high schooler. And I also would encourage you to definitely have the conversation, and don’t allow their voids of info to be filled by the internet or local news. And listen to the questions they ask. They may be asking about COVID-19, about a different angle than what you’re doing — so take their questions to lead to your answers. And then, revisit the question later in the day. Say, “Hey bud, you got any more questions about that?”

But I’d also give them some concrete examples. Talk about the importance of social distancing and handwashing. I don’t think you need to be concerned about getting them overly anxious about this because it is a realistic area of concern.

Doing laundry

Dr. McWilliams: Thanks, Mike. Another question that I often get from friends and family is, “How often should we be washing our clothes, our outerwear, etc.?”

At Children’s, we’re really recommending that it’s a good idea to do frequent loads of laundry, particularly any items that you wear out in public. Even things like coats and gloves — hopefully we won’t be needing those for too much longer — but remember things like hats, as well. If you have a healthcare worker or another essential worker in your family, it may be a smart idea to have that person wash all their work clothing and take a shower prior to really interacting with the family, just to minimize any transmission of the virus.

Dr. Vance: Yeah, and also along those lines, it’s a great time to train your children how to do and fold laundry. You can be very, very successful.

Taking family breaks together

Dr. Vance: Next question we get is about, “How often should the family take breaks together?”

And I’d say a reasonable interval, and that depends on your family and how large it is, and what sort of break. But I’d definitely encourage you to do breaks. Some of the breaks could actually be with purpose and scheduled. For example, how about family picnic time or do an inside lunch date that you schedule as a group, especially if a parent is working from home?

And even adding the chance for the child to learn some new skills. Maybe teach your youngster how to ride the big wheel for the first time or get your child interested in fitness by going on a jog with you. Maybe they’ll be ready to do their first 5K by spring. So little bias there. But then also consider some activities to add to your lives, like meditation, yoga, daily interactions. Walk the family pet, they’d love to play ball. We’ve been really busy lately, so that’s a great time to do that.

Managing everyone’s different schedules

Dr. McWilliams: That leads into the next question about how to manage all of these different schedules.

You know, one family may have a grade school kid on Zoom, a teenager on another social media app, a college student home suddenly and unexpectedly. So a lot of parents are wondering how to manage all of these schedules and sanity. And keep time on not only quality together-time, but also really looking at what screen time is appropriate and what screen time isn’t. And this really has to be addressed at the age level of each kid.

For families who have a college student who came back unexpectedly, recognizing that that person was living independently, prior to coming home, and that they really may need some more independence than they had when they were a high school student and living there. For grade school kids, really trying to maintain a balance of quality screen time. Recognizing that suddenly we’ve kind of turned their schooling on its ear, and there’s a need for a lot more screen time — but trying to make sure that that’s quality time and not just playing Roadblocks for 12 hours a day. And then setting up technology and sharing schedules so that everybody kind of knows what everybody else is doing.

One tactic that my family and I have taken is we each have our own little sequestered office where we’re working, doing our schooling and work during the day. But we try to open our doors any time we’re not busy so that we can interact with each other and just touch base. And then we’ve really put an emphasis on having family dinners together and making sure that we have that family time to sit down and talk. At the end of the day though, giving yourself a little bit of grace and recognizing that perfection is the enemy of good enough and sometimes we may just have to play some Roadblocks and let it be.

Dr. Vance: Those are all really good points, Jen.

I was talking to a peer the other day who is a little bit technology-challenged, we’ll say, and I was asking them what their greatest accomplishment has been since working at home for the last month. And they said they actually sat down with their young adult/teenager and they now understand how to use social media and they now understand how to talk the language to their kids, so a great accomplishment. You have to use the media, so learn about it and understand from your kids. Because oftentimes when we’re doing telehealth, it’s the 7-year-old that can figure out how to get the device working on the other end as opposed to the adult. So take advantage of that wisdom.

Anxiety during the COVID-19 pandemic

Dr. Vance: The next question that comes up frequently is — adults are definitely having more anxiety this time. No matter where we work, we’re definitely exposed to more thoughts. In talking to a lot of my patients and other folks, we have to normalize this level of anxiety. If you’re not a little bit anxious about COVID-19, then you’re not probably appropriately aware. A little anxiety is often not bad and can increase a little bit of caution. So what signs should we watch for in our children?

Regardless of the source of anxiety, the signs can be the same: A child that is becoming excessively withdrawn, overly preoccupied with discussions and seeking excessive reassurance about their health and safety. Children that demonstrate significant changes in appetite, energy level, disrupted sleep. At more younger ages, kids will tell you that they’re anxious, and adolescents will, too. But listen to their language. You guys are the experts on your kids. Yes, we’re mental health experts, but you’re the ones that know them inside and out. Take that level of anxiety that your child is showing and put it in context. Understand that it’s going to be a little higher now than what it was pre-COVID-19, but check for the level of interference. And if you do have a significant concern, contact — if you have connections with the school mental health providers, school psychologists, their pediatrician’s office, or our office, as well, or other mental health offices in town. But it is a good time to just stay in touch with your feelings.

Dr. McWilliams: Thanks, Mike, and that really flows into our next question of how to address your child’s anxiety.

I think working on that is not only good for the child, but for the entire family. And again, stepping back, giving ourselves some grace to recognize that anxiety in this time is completely normal, but monitoring for when it does start to cross that line into impacting the way that we function and are able to interact with each other.

You know, some different strategies that we can take are to make time just to sit down and talk with each other about what we’re feeling, what we’re experiencing, what our frustrations are, and what our worries are — whether that be worries about whether or not our job is secure, or whether or not the virus is going to impact Grandma.

I had one little guy that I was talking to who was really worried about food security. He had no reason to with his family’s situation but was so used to being able to go to the grocery store that suddenly he was really worried about having to ration out food. So being able to talk to your kid and finding out what their worries and anxieties are. And then incorporating some mindful routines, whether that be yoga or a daily walk, and just really trying to find some peace and calm and normalcy in the day.

And then finally, everybody is kind of hunkered down here right now. But at Children’s Behavioral health, we’re offering telehealth appointments. We’re seeing patients in their homes. So if need be, help is still available.

Addressing the disappointments that your child may experience

Dr. Vance: Thanks, Jen.

One thing we’ve realized since things have been canceled is, we do an awful lot as a community in the springtime, ranging from sports seasons to religious celebrations and family activities, graduations. Wow, there’s so many things that have been canceled or in some cases, postponed. And a number of parents have asked us, “Well, how do I explain this to my child or my young adult? Because we can never relive these.”

And I think part of that is your answer — that is you’ve got to acknowledge that it’s disappointing. It’s a chance to learn and understand some disappointment, as well. But you can be creative. I was driving into my neighborhood the other day and there was a 6-year-old standing on the corner with his mother, and he had a huge sign that said, “Honk to wish me a happy birthday!” I live near that corner and for the next 45 minutes, I heard nothing but honking horns. It was pretty imaginative and I’m sure that little guy was continuing to smile ear to ear.

The other piece is using technology. If we have concerns about our grandparents, why not create a video and send it to them? Or do a more elaborate than traditional Facetime with them to encourage what they’re doing and to share some of your creative activities with them? I’ve seen a number of things on the news where local sports talents have been posting videos of their pitching or their softball hitting, tennis playing, all of the above. Pretty cool stuff and it can be pretty creative. It won’t replace the state competition, but it definitely does give them a chance to highlight these skills. And I think having quality conversation about that, and then coming up with a solution…we’re really big on solution-focused thinking. So identify the issue but then come up with a solution. I think we all surprise ourselves at how creative we can be when we have to be.

Dr. McWilliams: And to kind of add on to that, I think another important thing that I learned recently is also to be careful about the “yeah but” statements. When your fifth grader tells you that she’s sad about missing her fifth grade graduation, acknowledging it and just letting it be, rather than saying, “Well yeah, but at least, you know…blah blah blah.” Really like you said. Mike — just acknowledging where that disappointment lays. It’s different for all of us.

Creating routines, schedules, and opportunities for socialization

Dr. McWilliams: Another question that we got is one that I’ve actually been asking myself. You know, suddenly I’ve gone from just working every day, to working and teaching and trying to keep everything organized. I have a very new and robust perspective for all of the teachers in my life as we try to work out lesson plans and ways to keep everybody occupied.

One thing that’s really important that I’m learning — andi emphasize learn-ING — is you try to keep a routine and stick to it. Try to develop a rhythm of the day. Exercise is a great way to deal with stress, so making sure to build that into the schedule as well, especially now that the weather is getting better. And really focusing on the present moment and again, recognizing that, you know, this isn’t going to be the end-all-be-all. That I may not be as great at teaching fifth grade math as my daughter’s teacher is, but we’ll get by and it’ll work out. And at the end of the day, we’ll continue to move on as a family.

Dr. Vance: Great feedback, Jen. It’s nice to see you back in the teaching role.

Dr. McWilliams: I’m learning my fractions again

Dr. Vance: Well I’m sure it’ll make your daughter’s teachers look much better down the road, so thanks for helping the team.

The next question that comes up is what about routines and schedules, and why are they so important?

If we think of stress in general and change in general, one of the components that we use to cope with that is predictability and control. While there are a ton of parts of COVID-19 that we have absolutely no direct control over, there are areas we can set up in our day to give us predictability and give us a schedule.

You’re trying to do a lot of different hats, as Jen was just discussing — with her being a teacher and her husband helping with teaching, and they’re both still working, and they have their youngster at home. I think you need a schedule on the board that says, “Here’s what we’re going to do today.”

It doesn’t have to be set in stone, but it should have some highlights that are pretty good anchors. And maybe one of the best anchors on that is a family dinner together or a family game night or a family movie night. But something that you guys can know that despite the stress of your day, and the unpredictability of working from home and internet crashes and all of those fun things, or the dog having trouble with digesting its lunch and anything that happens like that, is to know, “Hey — we’ve got movie night tonight.” And take turns picking out the movie, and actually then you won’t be in a rush to leave it immediately, so enjoy it and discuss it afterwards.

Come up with that family activity, if you can, at least once or twice every two or three days. I’d love to see you guys doing it every day and I think you’ll reap great rewards from it.

Dr. McWilliams: I agree completely, Mike. Although some movie choices need to be avoided — we’re not doing any more Westerns at my house.

One thing that I also want to mention is socialization. A big part of going to school for kids isn’t just learning, but it’s the social aspect — learning how to get along with each other and having that time with peers is vitally important to development. And so one question that I’ve also been getting is how do we continue to promote that kind of socialization when we’re doing social distancing? How does that jive and mesh?

And again, this goes back to what you were saying earlier about how this is a time to be creative. Certainly things like technology, using Facetime and Zoom and things like that so kids can interact with each other. Allowing online chats and stuff like that — keeping an eye, making sure that everything safe and appropriate is reasonable — but really recognizing that this is a part that kids need. A half an hour a couple times a week of sitting on Zoom listening to their teacher is fantastic, but it’s not the same as running around the playground with their friends. And so what can we do to sort of create those experiences from a safe and healthy distance so that kids can continue to thrive and enjoy those social experiences.

Dr. Vance: Thanks, Jen. As we think about all of these questions — these were great questions that were presented to us — hopefully we’ve shed at least some thoughts on generating your creativity as an audience to tackle some of these issues. I think it’s awesome that people are asking these questions.

Reassurance and comfort

Dr. Vance: I was going through our neighborhood yesterday and a neighbor came up and said, “Mike — how do we explain to our kids that we’re still going to work when everybody else is staying home? How do we assure them of our safety?” And I had to remind myself of what the age of the child was, and then, once again, be age-appropriate in the explanation.

Don’t make any false promises, but I think just describing your practice. For instance, if I was talking about going to work in the hospital, “Hey, our hospital is super safe. We take all of the precautions, we’ve got protective equipment, our hospital — thank goodness — is not at the level as some of the hospitals you’ve seen on TV in the national news stories. You know, Mom or Dad is very careful about being safe and I take those precautions every day. And it’s really cool that I know that you’re home safe and doing these things with Mom, or whoever’s staying home and I’m really looking forward to our movie night tonight. Thanks for showing that you are concerned about my well-being. but I got this bud, we’re good. I get to help kids every day and then I’ll be home to interact with you. So thanks for letting me know you love me.”

Giving yourself grace

Dr. McWilliams: That’s an excellent, excellent point, Mike. And just to kind of wrap up and end, — the theme of our entire talk today has been kind of creativity, but also, I think, grace. These are completely unprecedented times. We’ve never been through anything like this before as a generation. I think we need to give ourselves some space to recognize that we’re all going to get through this and at the end of the day, when we’re all done with it, things will be maybe a little bit different. But we’re going to be on the other side of it. We can shake each other’s hands and clap each other on the back and go out to a ballgame and have a burger together. But in the meanwhile, just to give ourselves some grace to allow that we’re not going to have to be perfect right now.

Dr. Vance: Well, in summary, thank you guys very much for your questions. As you all know and have seen, this is a rapidly evolving situation. And please stay tuned for more podcasts addressing this topic from Children’s and other professionals. We will solicit your questions in the near future. And please — stay safe and take care.

Dr. McWilliams: Thanks, everybody.

For the latest info about COVID-19 visit childrensomaha.org. Thank you for listening to Just Kids Health.

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