As schools reopen and COVID-19 cases increase, the emotional issues children suffered during the height of the pandemic could arise again, say those who treat young people’s mental health.
At the same time, parents and mental health caregivers may have a better idea of how to handle regressive behaviors and kids acting out their stress and anxiety.
Whether wearing a face mask will hinder young children’s speech and language development, however, is uncertain.
In an article in Scientific American, David Lewkowicz, an adjunct professor at the Yale Child Study Center, said studies have shown that babies begin lip-reading as young as 8 months old.
“Overall, the research to date demonstrates that the visible articulations that babies normally see when others are talking play a key role in their acquisition of communication skills,” he wrote. “Research also shows that babies who lip-read more have better language skills when they’re older. If so, this suggests that masks probably hinder babies’ acquisition of speech and language.”
One thing not to be worried about is whether wearing masks will delay speech and language development, said Alicia Kent, a speech pathologist at Bridgeport Hospital. While she agrees with Lewkowicz that masks decrease facial cues, “Speech doesn’t happen in a vacuum,” Kent said. " ... The importance of face-to-face time with your child is immeasurable.”
She said it is vital that parents and caregivers spend a lot of time playing face-to-face with babies and young children when they are unmasked at home.
For children in day care or preschool, she said, wearing masks should not be a problem. Much speech development happens between ages 2 and 5 and “we’re not masked for your entire day. You’re home with your families,” Kent said.
As children move into school, “they’re in an environment with professionals who have an expectation of what they should be seeing,” Kent said. While masks reduce the ability to recognize facial cues, she said it’s too early to know for sure how wearing masks might affect speech and language, since the pandemic is still with us. “Our primary responsibility in the pandemic is to ensure safety,” she said.
Dr. Yann Poncin, medical director of outpatient clinical services for the Yale Child Study Center, said COVID has become a background stressor for everyone, but children may have a hard time dealing with negative events.
“For example, they can’t go on a play date because someone in the other family got COVID, or their aunt got COVID and they know someone else died of COVID,” Poncin said. “So now they’re worried about their aunt having COVID. So there’s a lot of stress and anxiety. But then there’s the non-specific stress and anxiety in the world. I think there’s a background stress that we all know is there.”
But while many children were learning online, especially in spring 2020, “they will be going mostly back in person across the state, certainly more in-person than they did last year,” Poncin said. “And that’s very important for their social development. That’s very important for their mental health. And so being back in person will be a protective factor.”
According to the Centers for Disease Control and Prevention, the pandemic has increased emotional issues for children. Emergency department visits for 12- to 17-year-olds increased 31 percent between March and October 2020, compared with a year earlier, Yale Medicine reported, and 24 percent for children aged 5 to 11.
Poncin said suicidal thinking, anxiety and depression have increased among children, in females more than males. “At the end of the year, our ED was full. It’s gone down a bit over the summer without school pressure, but we expect all of this to start up again when school starts up again,” he said.
Not all children fared poorly, especially at the beginning of the pandemic. They had “more family time, better sleep, school pressures were down in early pandemic because everything got put on hold to a good degree,” Poncin said. “So a lot of kids were doing fine and better.”
But as time has worn on, “some of those protective effects aren’t there. It’s one thing to be at home for three months in the spring, less school pressure, better sleep, more family time. It’s another thing to drag it on for another school year, quarantining, can’t see family and friends, so that those aspects have declined.”
The Children’s Hospital has 16 to 17 beds, which were full much of the time in 2020, and the children’s Emergency Department was handling up to 20 at a time, Poncin said. “So you’re spreading the staff very thin,” he said. “You are the front-line nurses who have to interact with the families every day. Their specialty is medicine. And yes, they’re used to working with kids with behavioral concerns coming in, but they’re not used to managing essentially the equivalent of an inpatient unit and the emergency room. ... So it was very demanding for the staff to manage that.”
Parents should reassure their children, but not before listening to their concerns, Poncin said. “For kids that are worried and express their worry, I think the main thing is to acknowledge the worry and the concern. And it’s normal to be worried, not to prematurely say everything is going to be OK. ... Let kids feel what they’re feeling and then address it, validate it, and then talk about some positive ways of thinking or coping.”
For teens, who may not be open about how they are feeling, Poncin suggests inquiring, letting them know they seem different. “It might not lead to a conversation right then, but it leads to the idea that you’re open to a conversation,” he said.
He said some children may become irritable or oppositional, refusing to do their chores or talking back. It’s important to recognize where the behavior is coming from, Poncin said. “Some kids don’t connect their behaviors to their feelings, so they might be irritable and angry. And you know, they’re not aware that they’re feeling all this stress, they’re not in touch with it.”
A parent may point out that they are unable to see their friends because of COVID or that school has gone into quarantine, and say, “‘I’m just wondering if you’re more cranky because of all of that,’ ... and then helping a child link their behaviors with their feelings so they can become more aware of it and it can lead to a discussion.”
Nancy Close, associate director of the Yale Program in Early Childhood Education and an assistant professor in the Child Study Center, said she has seen more children regressing during the pandemic. “Now it’s a little bit more settled because summer’s a little more comfortable ... but what I’ve seen is more tantrums than usual and some of them lasting longer than usual,” she said. “Certainly, when the children had to be in virtual school, there was a lot of angst and conflict for both the children and the parents.”
Some young children had more toilet accidents and engaged in baby talk, while others had difficulty sleeping or were hyperactive. “All of these things happen anyway, but all of these things seemed to be more extreme,” Close said.
Speech doesn't happen in a vacuum. ... The importance of face-to-face time with your child is immeasurable.
What made things more difficult was that adults were dealing with the stress of the pandemic as well, including losing family members. “Children depend on their parents to be able to support them and it was so difficult and overwhelming that it was hard,” Close said.
She said not to be worried if children return to more immature behaviors. “Regression is an important development, and it happens to all of us,” she said. “A little step backwards gives them a chance to consolidate what they’ve accomplished so far.”
When it comes to returning to school, Close said she is not concerned about the mandate that everyone wear masks. “The kids that I have encountered are really good at wearing masks,” she said. “I do worry about the children under 12 who can’t be vaccinated yet and what the delta variant is going to mean when they go back.”
It will help “if parents can be aware of their own worry level and know that children have great antennae for the feelings that we think we’re hiding from them,” Close said. “They can pick up on the stress.”
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