Chris Ladish, MD
Chief Clinical Officer of Pediatric Behavioral Health
Mary Bridge Children’s Hospital & Health Network
The COVID-19 pandemic has left our families’ and children’s lives disrupted in ways most of us has not ever imagined. Parents not only worry about their health and their family’s health, many are also struggling with job loss, food insecurity, child care needs, and many other factors influencing day to day stress levels. On top of raising children, parents are being called to step in as home-school teachers, counselors, nurses, music instructors, special educators, activity coordinators, coaches, technology experts and a host of other roles. Parenting in a pandemic has become an ultramarathon journey of multiple responsibilities that parents did not see coming, a survival race for which there was no time to train or prepare. Fortunately, like their children, parents are resilient, imaginative and amazing. They are the less-celebrated heroes of COVID and as providers, we need to remind them.
As parents approach care providers, their stress is evident in their questions about their child’s education, mental health, loss of learning, reduced activity, and in their own exhaustion and perceived inadequacy in meeting their child’s needs. I have found it particularly helpful to remind parents during this time that like all other times in parenting, perfection is neither expected, nor possible; rather, their consistent loving presence in their child’s life remains the single most important factor promoting their child’s well-being and ability to positively cope with the multitude of change and stress of the current time. Depending on the child’s age, some specific guidance will also help parents.
Parents of young children ages 2-5 may notice stress signals that include toileting issues, sleep pattern disruption, behavioral skill regression (baby talk, etc.) and increased desire for reassurance. It is helpful to remind parents that children this age live in the moment and unlikely appreciate nor worry about “the big picture.” Toddlers will express frustration via behavior as their language skills, under stress, are less accessible to them. It is much easier to test limits to find out if one needs to still eat his/her vegetables, than to articulate overwhelm with change or the need for security. Discussing the 4 Rs can help parents of children in this age group: Respond with patience and love, provide reassurance and items that comfort, set routines and provide safe outlets for expression of difficult emotions to help children self-regulate. Short-term flexing of rules to help a child this age feel secure will not cause harm. Rewarding and noticing desired behavior will also go a long way in helping toddlers feel motivated to please.
School-aged children have an increased ability to process what is happening. They will ask many questions and should be provided truthful answers in small, bite-sized doses within the child’s developmental level of understanding. Misinformation should be corrected. Engaging children’s minds via school work, art activity or other enjoyable learning activity is helpful in preventing boredom, as is daily movement and exercise, even if within the home or backyard. Parents should be encouraged to set routines which can promote a sense of predictability in what feels like an ever-changing situation, but also to adapt as needed, and not feel that it is essential to pick battles over small things. Patience and flexibility are critical in this age group. Limiting exposure to news media is also recommended.
For those parents of children in high school, the management of both the parent’s and teen’s sadness over loss of proms, games, graduation photos and many other pivotal educational and social celebrations is both poignant and difficult. Virtual access to friends, opportunities to “vent” and time to simply have feelings validated are all important. Parents should be reminded that listening and understanding, as opposed to “fixing” are most meaningful to the teenage experience of COVID. Finding creative ways to mark important events and helping teens focus on what they CAN control versus what they cannot will help them feel empowered, engaged, and hopeful. It is also helpful to remind parents that teens enjoy feeling useful, helpful and part of a meaningful solution. Opportunities to help others within the community can be a powerful way to create a sense of mastery and strength in a very challenging and enduring situation.
For children with special needs, the changes created by COVID restrictions are particularly challenging. Educational and behavioral needs, loss of predictability and familiarity, constant transitions and a parent’s inability to predict the “end” of this crisis all pose difficulties. Parents should be reminded to utilize what has worked with their child in the past, to extend themselves and their child grace during challenging times, and to work to create order in chaotic circumstances. Specifically, routines, visual reminders and schedules, access to a special preferred object, sensory experience or toy as a reward and/or distraction when difficult circumstances arise (placement of a mask on a child, for example) may help the child harness his or her inner ability to regulate in shortened time periods. Parents should also be given permission to let go of minor things and to embrace family harmony in lieu of power struggles. Now is not the time to feel the need to push a child to get out of pajamas, to force new foods, or to enforce new challenging behavioral routines.
Parents have lived “in the trenches” before…. and have survived. Heroes are not always well-kempt nor put together. During this difficult and enduring circumstance, following the airline attendant directive of putting on one’s own mask prior to putting on his/her child’s is critical. Breaks are not only allowed but are essential. Immaculate, orderly homes and families in matching clothing with perfect hair are generally things of magazines. As appropriate, encourage parents to reach out to supports both for their child and themselves and to remember basic care. It is normal to need support and to feel fatigued. None of us should be doing this alone. Even superman occasionally needs his dose of Kryptonite.
Dr. Chris Ladish is a clinical psychologist and the Chief Clinical Officer of Pediatric Behavioral Health at Mary Bridge Children’s Hospital & Health Network. She serves on the steering committee of the Kids’ Mental Health, Pierce County collaborative and resides in Washington with her spouse and two teen-age children. Further family COVID support information may be found at the following sites: https://www.kidsmentalhealthpiercecounty.org and https://www.marybridge.org/covid19/additional-resources/