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WebMD: Quarantine Having Lasting Impacts on Kids’ Health

Originally published at WebMD

May 15, 2020 — After just one week in coronavirus quarantine at home with her family of four, 14-year-old Grace from Virginia says she started noticing she felt more relaxed than usual.

“I know I am less stressed because I feel happier, more organized, and I am doing things I enjoy doing,” says Grace, who asked that her real name not be used..

Grace says her school stress is reduced with online classes just 2 days a week, no tests or quizzes, and no worries about being late to class. Her schedule is now far more open, too. She’s sleeping well past her former 6 a.m. wakeup time. Without commitments to dance, flute, and band, she’s had time to learn to make sourdough bread, play online backgammon with her grandfather, connect with friends over video chat, color, craft, make slime and soap, and eat dinner every night with her family.

“I miss my friends, but overall I feel calmer and I’m having fewer headaches too,” Grace says. She has had chronic migraine headaches since she was 10. Earlier in the school year, she was having at least 15 a month, but in April she had just three, and all resolved quickly.

“It doesn’t surprise me,” she says. “I know the less stressed I am, the less likely I will be to get headaches. So it made sense to me when school went online and we had to stay home that they would improve.”

Grace isn’t the only teen noticing she feels different as a result of the quarantine. Stay-at-home orders are drastically changing the lives of children and teens, so it’s not surprising that is impacting their health. While the changes for Grace are positive, that’s not true for all kids.

“There are clearly both positive and negative health impacts on kids and teens as a result of staying home this long,” says Tim Kearney, PhD, chief

behavioral health officer at Community Health Center, a statewide organization based in Middletown, CT, that provides medical, dental, and mental health services. Between March 15 and April 4 of this year, they saw nearly 4,000 patients ages 18 and under for more than 17,000 therapy visits — most by telehealth.

“Some are experiencing lots of benefits, including reduced stress, increased creativity and outside time, and more family together time, while others are experiencing a rise in negatives, including an increase in hunger, domestic violence, and child abuse,” Kearney says. “Those who were higher-risk before the pandemic are at even higher risk now.”

Positive Impacts of Quarantine

For children whose families are financially stable, food secure, and able to provide the tech resources needed for distance learning at home, the quarantine seems to be providing a reset that Lenore Skenazy has long argued children in the U.S. need. Skenazy is president of the nonprofit Let Grow and author of Free-Range Kids: How to Raise Safe, Self-Reliant Children Without Going Nuts with Worry.

“It’s almost an insult to the human spirit the way we have been raising kids,” she says. “Their lives were overly packed and structured before the pandemic. They had unforgiving schedules, and there was very little if any time on this unrelenting hamster wheel to just play outside or be bored.”

The American culture, she says, “lost sight of what childhood can be. Everything kids might have done out of enjoyment or curiosity became an organized activity, and there was a real disbelief that they could learn anything on their own.”

Now, with an abundance of free time thrust upon kids, no place to be, no need to rush, plenty of time to make mistakes, and many parents too busy to keep them occupied at all times, Skenazy says children are trying new things, helping more, discovering new interests, spending more time outside and with family, and learning in new ways.

“When you start discovering things for yourself and doing them on your own without someone helping you, watching you, pushing you, and grading you — it’s a totally new world for a lot of kids whose every moment had been adult supervised and organized,” Skenazy says. “Giving them freedom is a relief. It’s like they all just quit a super-stressful job and cool things are happening as a result.”

Peter Gray, PhD, a research professor in the Department of Psychology at Boston College, has written several articles since the start of the quarantine calling the pandemic the “course correction” kids in the U.S. desperately needed to play, learn, and simply have fun.

“We have created a really abnormal world for our children. As a society, we have gone berserk and lost our way. We’ve taken away play and creative activities and piled on homework, tests, and scheduled activities,” says Gray, a board member of Let Grow.

Before the pandemic, he says, studies showed record levels of anxiety, depression, and suicide in the past few decades. “Reports of children being happier and less stressed now, with all that pressure taken away, doesn’t surprise me at all,” Gray says.

Mixed Impacts on Kids

The impact of quarantine isn’t 100% clear-cut in all kids though. Kearney says some may be having positives and negatives on different days or even on the same day.

“One student I work with who has special needs and ADHD, for example, has a lot of educational support in school, so going online and doing work from home is really, really hard for him,” Kearney says. “But on the other hand, he’s no longer experiencing bullying, which has drastically reduced his stress. He’s getting more sleep because he’s not staying up late, worrying what will happen at school. And he’s no longer purposefully missing the bus, so family conflict is reduced. So there can be plusses and minuses for one kid over time.”

Anna Gassman-Pines, PhD, an associate professor of psychology and neuroscience at the Duke University Sanford School of Public Policy in Durham, NC, sees that too. She and her colleague Elizabeth Ananat, PhD, started studying families of nearly 1,100 hourly service industry workers in a major metropolitan city in 2019. The study provided data on this group’s mental health before and during the pandemic.

“What we are seeing is that these low-income families are really struggling financially. They have experienced a tremendous amount of job loss. These are hourly workers who don’t get paid when they don’t work, so they’re struggling with basic needs like food and rent. And stress among parents and children in this group has really exploded,” Gassman-Pines says.

The service industry, which includes restaurants, retail stores, and more, lost more than 18 million jobs from January through April, according to the Bureau of Labor Statistics. The unemployment rate topped 14.7% last month as the country lost more than 20.5 million jobs.

Those lost jobs and wages are having a terrible effect on families and children. According to the Brookings Institution, at the end of April, more than one in five U.S. households, and two of every five with mothers with children 12 and under, were what’s known as “food insecure.” That means the family doesn’t have enough food and not enough money to buy more, and that children in the home were not getting enough to eat.

These challenges are affecting parents’ emotional and mental health. Preliminary data Gassman-Pines and colleagues have shared through the online publication Econofact show a 4-percentage-point increase in the number of parents who feel anxious, sad, or angry all day, and a 2-percentage-point increase in the number of parents who say their children are uncooperative all day.

“I think that goes to the idea that kids are resilient and parents across income levels work to shield their kids from a lot of stresses that they are experiencing,” Gassman-Pines says. “Another positive is that while there was a rocky start with distance learning among this group, which is quite disadvantaged, surveys in recent weeks show a vast majority are now getting access to distance learning materials.”

Experts say there is no question that populations that were marginalized before the pandemic are struggling the most with traumatic stress and fatigue, trouble sleeping, and increased feelings of anxiety and hyper vigilance.

“I do think a primary lens which we have to look at this question of positive versus negative impacts of quarantine is through socioeconomic inequalities and differences,” says Ariel Kalil, PhD, director of the Center for Human Potential and Public Policy at the University of Chicago.

“In the day-to-day for people with means, there are plenty of short-term and maybe long-term upsides of staying at home. But it’s really hard to think any of that is possible when your parents lost their jobs or people around you are sick and dying. There is a great risk of many more negative outcomes for lower-income families,” she says.

She is just beginning to survey low-income families in the Chicago area to get a better picture of how the pandemic is impacting their physical and mental health.

Kearney says his organization is already seeing many of those negative outcomes in children it counsels. “We are seeing a lot of kids literally locked in their homes because there is no safe place to play outside. They can’t even go into the hall of their apartment building because there are too many people there.”

Increased time with family isn’t always a good thing when there are issues in the home, either. “Our clinicians have actually been doing telehealth sessions with one child and heard another child screaming, ‘Mommy, Daddy stop!’ in the background,” he says. “We are able to file a report and at least have an eye into the home in these cases, which is helpful, but some children are definitely suffering.”

If financial resources are scarce, taking part in online school may be difficult without computers or internet access at home — further isolating disadvantaged kids and setting them further back academically.

Disrupted Schedules

Neurologists at Children’s National Hospital in Washington, D.C., say they have noticed a mix of changes, too. Marc DiSabella, DO, director of the hospital’s headache program, says the coronavirus can increase stress in many patients who already had headaches, since headaches are one of the possible symptoms of the virus. Quarantine is also impacting learning, sleep schedules, daily routines, exercise, and the ability to socialize, all of which can protect against headaches.

But he says his department has seen a dramatic decrease in appointment requests since the beginning of the pandemic quarantine. Before the pandemic, he says, they scheduled as many as 100 urgent headache appointments a week and still couldn’t meet demand. But since March, the volume of calls for help has plummeted, even though all doctors in the department are now practicing telemedicine.

“Normally I would see 15 to 20 patients in a busy headache clinic, and now we are seeing a small fraction of that, some days with no patients at all,” DiSabella says.

As a result, his department is launching a survey of families to get a better sense of what children are experiencing.

“There has been a huge shift in routine and sleep schedules,” says DiSabella’s colleague Raquel Langdon, MD, co-director of the headache program. “Maybe it is a reduction in stress, or maybe it is easier at home to do the things that help minimize headaches, like drinking the appropriate amount of water and getting 8 to 10 hours of sleep. We are trying to tease those factors out to understand this phenomenon a little bit better.”

Looking Ahead

Kearney says no matter how the quarantine is impacting children, this experience is likely to end up being a defining moment in their lives, not just because of what happened to them, but also because of the lessons they learn.

“Children are going to talk about what happened, how they managed it, and the changes that came about as a result of this pandemic for a long time,” he says. “What’s happening now feels different because of its size and scale, but ultimately, we want all children to walk away from this realizing there will always be challenges, and no matter what life brings you, you can meet it, understand it, and figure out how to get through it.”

Experts say there are policy implications for these health impacts on children that will have to be factored into decision-making to support increased food and economic security as this pandemic stretches on. There will be academic and mental health impacts for those who have struggled, too.

“What I try to convey to them, no matter their situation, is to maintain hope and focus on what they can control,” Kearney says

To do that, he recommends that you:

  • Talk with kids about what they miss the most and what their strengths were before the quarantine to see if there are ways to put them in touch with those things and build on them.
  • Look for new sources of support — either through telehealth counseling or increased video chats and phone calls with friends and family.
  • Get creative. He says online art therapy sessions are a great outlet to help the children who work with his organization be creative and express themselves. Drawing, coloring, and painting are calming activities than can be done by others at home, too.
  • Take virtual tours of places like aquariums and zoos. If you have access to the internet, he says, these are encouraging, calming, and hopeful for children.
  • Try not to watch the news in front of children, and limit pandemic-related conversations in front of them.
  • Encourage children to focus on the present and what’s real, vs. their fears, and discuss or write down five things they are grateful for each day.

Kalil, the Center for Human Potential and Public Policy director, who’s also co-director of the Behavioral Insights and Parenting Lab at the Harris School of Public Policy at the University of Chicago, says if it’s too overwhelming to take on a bunch of new habits, just focus on small changes you can make.

“It’s probably more important to do a little bit every day to support kids’ learning than to think you have to do it all,” she suggests. “For low-income families who may have higher levels of stress, demands on their time, and complications in life, we want to stress that even just reading one book a day with a young child can build a good habit and strengthen and preserve important skills.”

As for children who’ve had benefits from more time and less stress, experts say the challenge will be to figure out how to hold on to positives when returning to whatever the new normal is.

“What I hope people take away from this is that children need free time,” Gray says. “If parents are seeing their children benefit physically, emotionally, and socially from having free time to find their own passions and hobbies and have more control over how they spend their day, please don’t force them to return to overscheduled, fully adult-directed lives.”