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NPR Ed
With School Buildings Closed, Children's Mental Health Is Suffering
Anya Kamanetz
May 14, 2020
Nightmares. Tantrums. Regressions. Grief. Violent outbursts.
Exaggerated fear of strangers. Even suicidal thoughts. In response to a
call on social media, parents across the country shared with NPR that
the mental health of their young children appears to be suffering as
the weeks of lockdown drag on.
Most U.S. states have canceled in-person classes for the rest of the
academic year. This week in Senate testimony, Dr. Anthony Fauci, the
director of the National Institute of Allergy and Infectious Diseases,
sounded a cautionary note on the prospect of reopening school buildings
nationwide, even in the fall.
He pointed to the emergence of serious inflammatory illness in a
handful of children. "We don't know everything about this virus, and we
really better be very careful, particularly when it comes to children,"
Fauci said. He was responding to this comment by Sen. Rand Paul,
Republican of Kentucky: "I think it's a huge mistake not sending our
kids back to school."
Dr. Dimitri Christakis, one of the nation's most prominent
pediatricians, agrees with Paul, who is a physician by training.
Christakis, who directs the Center for Child Health, Behavior and
Development at Seattle Children's Hospital, is the editor-in-chief of
the journal JAMA Pediatrics. And in a new piece published in the
journal, he argues that the risks to children's learning,
social-emotional development and mental health need to be better
balanced with the risks of spreading the coronavirus.
"I don't care if I die"
Sarah, a mom in Northern California, is one of many parents who
responded to our query about how their children are handling the
shutdown. She and her husband work in the tech industry and have two
daughters. Their older daughter, Phoebe, turned 5 just as their area's
stay-at-home orders went into effect. Her birthday party had to be
postponed.
"She has happy moments and laughs about things and plays and gets
excited," says Sarah (we're not using her last name to protect her
daughter's privacy). But, she adds, Phoebe has also "started saying
some things that were really freaking me out."
One day, Sarah says, she asked her daughter to be more careful on the
stairs in their house. "And she got indignant and she was like, 'Why?
It's my choice if I fall and kill myself.' "
Another day, Phoebe asked to join her mother on a trip to the post
office. "I told her no. And she's like, 'Why? I don't care if I die.' "
Sarah asked, "'Can you tell me more about that, please?' And she's
like, 'Well, you have an extra kid [her baby sister] and [she]'s a good
kid and I'm a bad kid.'"
Sarah says she's lucky that she has been able to take administrative
leave from her job to be with her daughters full time during the
lockdown and that they have mental health coverage. But it has been
difficult finding a therapist who can treat a young child over video
chat.
"An imperative"
Christakis says the serious effects of this crisis on children like Phoebe have been overlooked.
"The decision to close schools initially, and now to potentially keep
them closed, isn't, I think, taking the full measure of the impact this
is going to have on children," he told NPR. "Not just the short term,
but the long term."
The problem, Christakis says, isn't just learning loss, which is
expected to fall particularly hard on low-income children with unequal
access to distance learning. Recent research from a large testing
association on the "COVID-19 slide" suggests children may return in the
fall having made almost a third less progress in reading, and half as
much progress in math, compared with what they would have in a typical
school year.
Mental health and social-emotional development, Christakis argues, have
been less discussed: "The social-emotional needs of children to connect
with other children in real time and space, whether it's for physical
activity, unstructured play or structured play, this is immensely
important for young children in particular." A new study in JAMA
Pediatrics, he says, documents elevated depression and anxiety among
children under lockdown in China.
A third major risk, says Christakis, is child abuse. With schools
closed and activities canceled, adults who are mandatory reporters,
such as teachers, are less likely to catch wind of abuse or neglect.
Hospitals around the country are reporting a rise in admissions for
severe child abuse injuries and even deaths — a rise that coincides
with lockdown orders. And a sex-abuse hotline operated by the Rape,
Abuse & Incest National Network reported that half its calls in
March came from minors, for the first time in its history.
In his editorial, Christakis calls for a panel made up of
interdisciplinary experts to make school reopening a priority in the
United States. "I think we should sort of reason backwards from the
expectation that children do start school, that that's an imperative.
And then how do we make that happen safely?"
Safety, of course, is the reason schools closed around the world in the
first place. It's still considered very rare for children to become
seriously ill from the coronavirus, but recently a handful of children
have died from an inflammatory illness related to COVID-19, the disease
caused by the coronavirus.
The science on children's role in spreading the virus is also a moving
target. A new analysis of Chinese contact-tracing data in the journal
Science, co-authored by Maria Litvinova, suggests that children are in
fact less susceptible to coronavirus infections. But because they have
so much close contact at school, canceling in-person classes plays a
key role in flattening the curve of an outbreak.
Litvinova says she is doubtful that schools, especially in big cities,
can reliably enforce social distancing to reduce the number of
contacts. "It's very difficult to explain to children that they
shouldn't stay with their friends or talk with them or be close to each
other."
Christakis is himself an epidemiologist by training. But he says these
concerns are exactly why experts from different backgrounds need to be
consulted, so that the risks of reopening schools can be properly
balanced with the risks of keeping them closed. "If we declared the
meat supply a national emergency, we should do the same with the brain
supply."
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