Dr. Mary Ward: I think we are in the historical phase of this pandemic, whereas all of my colleagues have suggested, we’re beginning to recognize the unintended consequences of the isolation orders that went into place in March and from a clinical standpoint, I would say overall, I give families an enormous amount of credit for how well they’ve done in supporting their children through all of these changes and all of these stressors. In general, I plead with parents to be patient with themselves and patient with their children.
That said, there is a frightening level of mental health challenges that are basically unseen. The children that we all see are those who have ready access to care, who have no concerns about coming in for care and who can feel comfortable saying to a professional this is a stressor for our family. But that does not cover all kids. I think those of us who are advocates for children have to speak strongly and loudly about what is happening to children.
Kids are resilient. Kids can adapt to changes and eventually they will learn again, but I worry greatly about children whose parents don’t have the resources to assure they have a learning pod or a tutor or online resources and so forth.
And then finally, the family strife is significant. Parents being thrust into the role of doing the work that Dr. Kernie’s wife is expert in doing or my colleagues are expert in doing. Parents feel that they are not up to the task. They feel highly stressed. I strongly advocate and support the position of the American Academy of Pediatrics, saying that we should be doing everything humanly possible to get children back to school. As my colleagues have suggested, children belong with professional educators and they belong with their peers. That is the work of children and we have taken that away from them for the past almost six months and it’s our responsibility as adults to find a way to get them back where they belong.
Sharon Cotliar: Well, I know all parents are striving for that. Dr. Bracho-Sanchez, given your work with underserved communities, I imagine you share Dr. Ward’s concerns about the importance of getting kids back in school. What kind of challenges do at-risk populations face when it comes to whether or not to attend school in person?
Dr. Edith Bracho-Sanchez: I think an important thing to remember is that some of these parents truly have no choice. They need to work and if they don’t work, they don’t get paid for the day because there is no sick paid leave for some of our families. And so they are really scared. They’re terrified to send their kids to school. No matter how much I’ve reassured them, they’re really scared to send their kids to school and some of this has to do with they’ve seen COVID up and close, right? Sometimes in their household, sometimes in their communities. And so we also have to remember that these parents are scared, as we’re guiding them through some of these things.
Again, I think we’ve all alluded this, but the mental health aspect of things. Some of the kids in these vulnerable communities are coming to school and back to school potentially very likely behind from their peers because spring semester came to a very abrupt end and because the summer has been difficult for some of our families. And I think some of them may continue to struggle a little bit because their parents may not be able to provide the level of support that other parents are providing and they themselves may have witnessed some level of illness, some level of food insecurity in their household, even housing insecurity in their household that some of their peers may not have witnessed.
All of these things, we just have to remember that families are bringing with them and are taking into account when making decisions and the kids are bringing with them to school even if we can’t always see it.
Sharon Cotliar: I’m really glad you raised that. Dr. Ward, I want to stay on this topic of mental health and social-emotional well-being. This is obviously really important and as a child psychologist, I wonder, what advice can you offer parents about what they can do to try to combat the lack of normalcy and restore it to the best of their ability?
Dr. Mary Ward: Two major pieces of advice: The first is for adults to find support with other adults so that they can clearly maintain generational boundaries. It’s a little bit of a jargony term, so let me just emphasize what that means. It means that there are certain topics and certain ways of explaining things, certain expressions of experience that belong with other adults, are not the concerns of children and indeed are overly burdensome for children.
So if I, as a parent, if I am feeling anxious and uncertain and worried, I should not be sharing that with my young child. Children cannot process that information and the way all of my colleagues have spoken about their own children, that’s what they did. They made decisions based on the child’s need and they told the child this was what was going to happen. So I cannot emphasize enough the importance of assuring that adults are supported in sharing their fears and anxieties and upset with other adults.
The second of these issues is assuring, taking all possible measures to assure that there is peace within the family even at the expense of school, at the expense of activities, at the expense of neighbors and friends, assuring that peace reigns within the family. That often means cutting way back on other activities. It means setting priorities about what will maintain peace in the family that is at the core of children’s well-being. If there is peace within their home and they feel confident that their parents are in charge, children can withstand a lot. Children are resilient, children are strong and children are fine when they feel safe.
Sharon Cotliar: That’s such a good point. That feeling of security is so important for children, especially in such an uncertain time. Dr. Kernie, what guidance could you offer to other parents so that maybe they could feel a sense of peace?
Dr. Steven Kernie: You know, we’re all learning in this process. I really appreciate Dr. Ward’s point around keeping that family dynamic productive. In other words, having peace within the family, which to us has really meant keeping as many routines together that you can, but also, just realizing that we all need to be a little more flexible. I think we all need to be a little more kind and understanding than we might otherwise be.
The other point that I’d really like to make is I don’t believe this is the new normal. I believe we are going to get back to a time where kids just go to school and play with each other and they don’t wear masks and they don’t distance. And we need to keep it in perspective. It seems like we’ve been doing this for a long time and we have, but we’re not going to do this forever. And so I do believe people and families need to keep the perspective that we’ve gotten used to a new way of life, but it’s not permanent and we will get through this.
Sharon Cotliar: That is important to remember, to keep everything in perspective and remember that this won’t last forever. Of course, at the core of this is a real concern about health. So I want to turn to Dr. Salvatore. What counsel would you offer to parents?
Dr. Christine Salvatore: Try not to scare the kids, especially the younger ones. I think sometimes unconsciously they put some fear in these children, as well, and of course, that is something that I advise trying not to do. Try live the situation like Dr. Kernie said.
For example, for me, I have a 4-year-old. I didn’t tell him anything really. He seems the happiest thing in this world, has no idea what’s going on. And I heard some of the kids, they don’t want to go out. They want to stay home because they are scared. So I see the perspective from an infectious diseases doctor, but also, as a mom. And so that is one of the things that I would advise. Try to make the situation simple, especially now. Try to be as much natural as possible and try to encourage them to do the best instead in school.
Dr. Mary Ward: I think this is a good place to come back to a point that Christine made in the very beginning and that is you need to distinguish what you say based on the child’s age. She talked about distinguishing age groups from the standpoint of infectivity, but for very young children, very simple explanations are the best. And if they say why are we wearing masks? Because that’s what we’re told to do. That’s what we do. Why are we not hugging our friends? Because that’s what we’re told to do. For families who want to give a little bit more information, saying something very simple like “the virus was out there and we wanted to keep everyone safe, so we’re being very careful.”
I have a 3-year-old granddaughter and that’s what her mother told her without checking with me because I probably wouldn’t have said it. But when I tell you she is utterly unconcerned because she was not burdened with more information than she could manage. Again, for early school age children, the very basics is all they need. I’m advocating strongly for restricting children’s free access to the internet, letting parents decide what they’re allowed to read and they’re allowed to hear about and certainly for children under 12. And then the early teens perhaps giving them a bit more information that they’ll be able to only discuss with their parents and then with teenagers, offering them more balance, older teenagers 16 and up.
The last thing I want to say is a huge issue is the age-appropriate sense of invincibility that you see in adolescents. The sense that it’s never going to happen to me. I’m going to be fine. Throughout the country, we’re seeing spikes in college-age populations because they’re not following the rules. So rather than parents getting authoritarian and laying down the law, it’s best to discuss this in a rational way and to talk about the expectable consequences.
If you break the rules and don’t wear your mask and don’t maintain distance and people in your group start getting sick, they’re going to close school. So now you won’t have your school. If you take these measures, you can have it both ways.
Sharon Cotliar: Those are really excellent points, Dr. Ward. Thank you. I want to turn back to Dr. Kernie. I do wonder, given all that is happening, what do you think will happen with outbreaks? We’re already seeing outbreaks on college campuses, as Dr. Ward pointed out. For younger kids, what’s the likelihood of people testing positive and we find ourselves back dealing with at-home schooling regardless of our best efforts.
Dr. Steven Kernie: I think it’s something everybody needs to be prepared for. You know, I’ve said that one of the upsides about going through all this is there are no more snow days, right? Snow days become just learn at home virtual days and that’s probably going to be a permanent effect from the pandemic. And I think going forward at least for the next several months, you know, through the first of next year, I believe most schools will experience the equivalent of snow days, which are that there will be a cluster or there will be a single child or a teacher who tests positive and there needs to be some evaluation around having a break from in-person school, kind of doing the contact tracing, doing all of the things that need to occur to ensure it doesn’t become widespread.
It’s one of the challenges that all the schools will face, but at the same time, I think we know enough now, as opposed to last March and April that this is all very doable and it’s particularly doable in the New York area where there is so little disease. I at least, believe that we will be pretty nimble in our ability to both identify with those little outbreaks and mitigate it. Parents are going to have to be prepared because I think there will be starts and stops. And as best we can, hopefully the learning environment will continue throughout it. As schools have gotten better about being able to do these things virtually and I believe most schools are going to have a virtual component going on all of the time anyway, but the ability to flex between the two will be there. But yeah, everybody needs to be prepared. This is going to happen and it’s probably going to happen relatively soon after school starts. If we’re prepared for that, it won’t be a big surprise. If we get surprised and we don’t have to have those interruptions, that’s going to be great.
Sharon Cotliar: Thank you Dr. Kernie. Dr. Salvatore, what are you anticipating will happen? Do you think we’ll just have interruptions, or snow days, as Dr. Kernie describes them. Or do you think we’ll end up where we were last spring, where people don’t return to school?
Dr. Christine Salvatore: Hopefully nothing is going to happen. But one of the things that is extremely important is in medicine, there is never 100%, ever. We always have to keep in mind that even if we do everything correctly, the parents need to know that we are trying to mitigate as much as possible. It’s possible that we will never be able to completely eliminate.
So can it potentially happen that one child, two children, two adolescents will become positive? Yes. Then of course, we will have to see what is the next step. Is there going to be the need to close the entire school? Hopefully not. If the cohorting, for example, is done correctly, maybe just a couple of kids could be staying at home or maybe just one class.
I would love to anticipate that nothing is going to happen, we will be all happy, they are going to be going to school, they will be happy, we will be happy. But as I said, I do anticipate that there might be some cases in the schools, but I think containment is the best approach, not just canceling everything.
Sharon Cotliar: All the points you all made have been so helpful. And I want to try to end on a hopeful note. There is so much uncertainty and anxiety. Are there any positives? Dr. Kernie, let me start with you.
Dr. Steven Kernie: At this point, it’s a little hard to say enjoy the kind of time you’re getting with your kids because you’ll never quite get this. I have the advantage. I’ve got two young adult children who ended up spending an inordinate amount of time with us and that was really one of the unexpected true blessings of this is the ability to spend some time with your family that you otherwise couldn’t have. And I think keeping that in perspective that will probably never happen again, at least in that context, is something that even when it becomes frustrating and everybody’s tired of it to try to cherish some of those moments that have come about really as an unexpected consequence of all of this.
Sharon Cotliar: That’s great advice and a good reminder that good things can come out of times like these. All right, Dr. Ward, we’ve talked a lot about the mental health of children and their social-emotional well-being. But what advice would you give for parents and their well-being? What should they keep in mind as they approach the school year?
Dr. Mary Ward: I think what everyone has said is this, too, shall pass. That maybe there will be changes that are permanent, maybe not. Maybe we’ll just return to our lives. That’s my dearest hope is that we get our lives back. I think children are best characterized as resilient. That’s what the message has been about their physical health. That’s the message I’ll give you about their mental health. So long as children have their parents available to provide them with information and protection, they’re going to be fine. They’re going to miss their peers. They need peers, but if they live in a home where parents can exercise some kind of control to assure peace, kids are really going to be fine.
Final sort of plea I’ll make is for families who are afraid their children aren’t fine, please reach out to us. We are here to support you. Some very simple changes have seen very positive results with the distress reducing and everybody feeling better. Unless people come to us, we can’t help. And so that’s a really important thing.
Sharon Cotliar: Thank you for that important reminder for parents to seek out support, especially during such a challenging time. I hope you found this to be a conversation helpful and I want to thank our experts again for sharing their knowledge and perspective and for offering parents information as they navigate the beginning of the school year. Dr. Steven Kernie, Dr. Christine Salvatore, Dr. Edith Bracho-Sanchez and Dr. Mary Ward — thank you all so much.
And thanks to all our listeners. And if you’d like to read more of our experts’ recommendations be sure to check out healthmatters.nyp.org