Key Takeaways

  • During this challenging time, children may exhibit regression due to heightened stress and disrupted routines. Children with preexisting mental health conditions may be especially vulnerable.
  • Parents can help children cope in a variety of ways, for instance, by developing coping plans, maintaining familiar routines where possible, and communicating openly about symptoms.
  • Parents can partner with mental health care providers and school professionals to explore new ways to support children “virtually” through Telehealth.

As physical distancing measures and school closures persist in the midst of the COVID-19 pandemic, and families continue to face a prolonged departure from their normal routines, many parents and caregivers are concerned about their children's well-being—particularly children with preexisting mental health challenges.

Under times of heightened stress and disruption, it is common to see regression in children across the age-span.

“Children with preexisting mental health conditions may be particularly vulnerable to these unpredictable changes in their daily structure, as stay-at-home orders will likely reduce access to a range of special education services or other necessary therapeutic interventions,” says Sarah Shea, PhD, a clinical child psychologist with the Pediatric Behavioral Medicine and Parenting at a Challenging Time (PACT) programs at MassGeneral Hospital for Children. She adds that children with preexisting mental health issues may experience a recurrence of old symptoms, or loss of newly acquired gains—though these setbacks are typically temporary and improve as routines normalize and treatments get back on track.

Dr. Shea shares a few tips for parents and caregivers to help children cope with the mental health challenges during the COVID-19 pandemic.

Be Kind to Yourselves

During this challenging time, families are working very hard to care for and teach children who are cooped up at home, often while simultaneously juggling increased work demands, financial pressures or medical caregiving responsibilities. Dr. Shea encourages parents to be kind to themselves.

“It is not realistic or feasible to expect that parents can provide the same range of academic opportunities and therapeutic interventions for their children that a team of professionals could offer,” says Dr. Shea.

Keeping your expectations reasonable—including cutting yourself some much-needed slack—will help you respond to your children’s needs more flexibly.

Prioritize a Few Goals Each Day

Setting measurable, achievable goals can set your family up to feel successful and help bolster children’s sense of accomplishment and mastery. When developing these goals, parents should consider what they already know about their child's learning and emotional profile.

“This is not a time to be perfectionistic,” says Dr. Shea, “but rather, to model flexibility and resilience.”

Don't forget to track progress, modify goals as needed, and find ways to celebrate your child's victories—big or small.

Help Your Child Develop Coping Plans

Like adults, children often feel more grounded and prepared to tackle an unfamiliar stressor when they have a plan in place.

“Children and their parents can respond more effectively to challenges in the moment if they have rehearsed a plan in advance,” says Dr. Shea.

Coping plans can be specific to COVID, for example, rehearsing with children a plan for when to wash their hands or how catch a sneeze in their elbow, or they can target specific symptoms.

“For instance, parents can help their children compile a ‘menu’ of coping strategies for what to do when their ‘worry alarm’ is bugging them,” says Dr. Shea.

When developing a coping plan, reflect about past challenges your family has faced and identity tools and strategies that helped.

Stick to a Routine When Possible

Children thrive on consistent routines and expectations, many of which have been upended by the COVID-19 pandemic. Parents can help children cope during school closures by developing a flexible, modified version of their daily schedules, and previewing anticipated changes in advance when possible.

If new caregivers need to step in during this time—perhaps because parents face health challenges or new work schedules—encourage caregivers to maintain typical household rules and routines. And while it may feel like an act of kindness to bend the rules when children are distressed, say by skipping homework or pushing back bedtimes, Dr. Shea points out that these “errors of kindness” may actually amplify children’s sense that their environment is unpredictable.

Connect with the Child’s Existing Care Team

“Parents should partner with teachers, special educators, therapists and other care providers to brainstorm about approaches that have been helpful to your child at school or in therapy, and may be transferable to home,” says Dr. Shea.

Your child’s care team can also help think creatively about appropriate online learning resources and modifications to assignments and may be able to offer ongoing phone or video check-ins with teachers and other staff.

Bolster Your Child’s Social Supports

“There are all sorts of creative ways to help your child feel socially connected, even when we are physically distant,” says Dr. Shea.

Helping children feel close to family and friends can enhance mood and reduce distress. Parents of young children can scaffold these connections by setting up a FaceTime or Zoom playdate or exchanging letters or drawings with friends or relatives by mail. Older children and teens may be particularly well positioned to connect to peers using technology, but will continue to require adult guidance and supervision.

Ask for Help When You Need It

Be on the lookout for any persistent pattern of concerning behavior that is not improving with parental support or is getting in the way of your child's ability to function or maintain their safety. Examples of concerning behavior could include:

  • New or heightened worries
  • Problems with feeding
  • Significant sleep disruptions or frequent nightmares
  • Increased agitation or aggression
  • High risk behaviors
  • Social withdraw
  • Frequent tearfulness
  • Loss of interest in hobbies or otherwise pleasurable activities
  • Thoughts or urges to harm oneself

“I encourage parents to be open and curious with children about their mental health symptoms, and if you are concerned that your child is struggling or at risk, don’t worry alone,” says Dr. Shea. She advises parents keep in close contact with their mental health care team and explore opportunities to connect virtually through video- or phone-based platforms. Providers may be able to arrange more frequent, brief sessions, or perhaps mobilize colleagues to try to augment care.

There may also be resources for more intensive levels of care—like intensive outpatient programs—that can be accessed remotely.

“Monitoring symptoms and communicating with your treatment team early and often can help keep children safe, and ideally, out of the emergency room, during this challenging time,” says Dr. Shea.