On December 18, 2020, four experts from MassGeneral Hospital for Children (MGHfC) shared their knowledge about the impact of COVID-19 on children’s physical and mental health and safety. They also discussed the contrast between the early days of the pandemic during March and April 2020 versus now. Experts included Vandana Madhavan, MD, MPH; Alexy Arauz-Boudreau, MD, MPH; Alice Newton, MD, FAAP; and Aude Henin, PhD.

While COVID-19 affects children physically, the largest toll has been on children and families’ mental health. This especially a concern for school-age children and adolescents and their families. Underserved communities, such as communities of color or those of a lower socioeconomic status, are disproportionately affected.

According to recent research, between 21-47% of parents reported that their children experienced changes to health and learning because of the pandemic. Another study reported that 5 out of every 100 18-25-year-olds had significantly increased mental health needs.

“The pandemic has disrupted children’s daily services, such as school or daycare, and leisure time,” said Henin, co-director of the MGH Child Cognitive Behavioral Therapy Program and director of the Cognitive Behavioral Therapy Program in Pediatric Psychopharmacology at MGHfC. “These daily services are what children rely on for structure, routine and a sense of thriving. What we’ve seen is that the effects are consistent not only locally, but around the globe.”

What experts have also seen, however, is that children and families are resilient. “With the proper support, including family and community systems, children and families can grow stronger,” said Henin.

The COVID-19 pandemic has also highlighted instances of child abuse and neglect. In the early days of the pandemic, doctors were puzzled to see a dramatic drop — between 20-70% — in reports of child physical abuse. “We were curious as to whether this was because of more parental or caregiver supervision or if children weren’t being brought in for medical care as often,” said Newton, medical director of the Child Protection Team at MGHfC.

From April to September 2020, concerns shifted to children being left alone when parents or caregivers were admitted to the hospital with COVID-19. Concerns now surround children’s exposure to chronic stress, including parental substance use, dysfunctional family dynamics and ongoing economic stress.

“The common denominator in all of this is social isolation,” said Newton. “It is really important that we continue to increase support for families in terms of shelter, food and access to the internet and technology. We also need to decrease the sense of social isolation through support groups, Early Intervention and family outreach, and advocate for underserved communities.”

With the advent of a COVID-19 vaccine, Madhavan stressed that vaccines are another tool, but not a replacement for wearing masks, proper handwashing and following physical distancing guidelines. “Vaccine data in adults has been favorable, but we are waiting to see what will happen with children when they are included in vaccine trials,” said Madhavan, a pediatric infectious disease specialist at MGHfC.

The exact number of children who have or had COVID-19 is difficult to estimate, especially with data from the beginning of the pandemic. Many children were not tested if they did not show symptoms of COVID-19, even though they may have had the virus or been exposed to it in their communities.

“Even with the estimation from March and April, children make up a very small percentage of the overall cases in the total population,” said Arauz-Boudreau, medical director of Pediatric Primary Care and Population Health Management at MGHfC. In areas of the US and other countries where schools have re-opened, children, especially those in elementary school, are not infected in high numbers or are they a significant source of transmission. Schools can be safely re-opened.

In closing, the four experts emphasized the importance of recognizing school as an essential service to a functioning society, supporting parents in the workforce and continuing to provide access to medical and mental health care. They also focused on recognizing signs of distress in children and families and learning how to cope with stress in healthy ways.