Serving as a caregiver to a child is one of the most important, rewarding and difficult roles one can have. Being a caregiver during a pandemic has made the role even more challenging. It goes without saying that the past two years of the COVID-19 pandemic have also been challenging for children and teens, especially as they navigate normal developmental milestones on top of challenges that may have been present prior to the pandemic.

Stephanie Parmely, Ph.D, a psychologist with Dignity Health Mercy Medical Group, answers common questions about anxiety in children and teens. Dr. Parmely identifies signs to watch out for, and actions that parents, guardians and/or caregivers can take to address issues.

What challenges are behavioral health professionals seeing in children and teens right now?

Dr. Parmely: Most of the children and teens I have worked with weathered the pandemic fairly well — even in light of mental health issues they may have been dealing with prior. We were already seeing an uptick in psychological distress among children before the pandemic, and it appeared to increase during the pandemic. Some reasons for this include increased family stress, school closures, exposure to media that flamed fears, decreased time with friends and family, and increased stressors such as job loss and divorce. In many cases, caregivers have helped children build resilience by keeping consistent routines and limiting access to media.

The pandemic has unevenly affected families who were already financially insecure. Children and teens who were caught up in the stresses that came to their families resulting from job loss, home loss, family strife and addiction, have had more difficulties. This is not specifically due to the pandemic, but because of the effect the pandemic has had on families.

Some children have experienced challenges returning to school, especially if they had anxiety before the pandemic. This could be related to them experiencing decreased stimulation in quarantine, having more control over their day, and having more time with their family who they are most comfortable with.

Many children and teens diagnosed with depression before the pandemic experienced worsening symptoms during the early periods of quarantine. Their symptoms may have improved upon returning to school, benefitting from physical activity, peer interaction and fulfillment of in-person school routines.

What are signs of physical and mental stress in children and teens that caregivers should watch out for and when should they seek professional help?

Dr. Parmely: For children of all ages who have access to the internet, caregivers should pay close attention to the content they are exposed to. Teens are more likely to try dangerous activities they see or hear online. Parents and guardians should periodically review internet use, and areas online where communication takes place, because teens may express feelings to peers online that could indicate signs of anxiety or depression.

When a child or teen is expressing thoughts of killing themself or others, seek professional help immediately.

Also seek professional help if you notice the following changes in children or teens for a majority of days within at least a two week period of time:

• Significant increase or decrease in eating and sleeping
• Decreased interest in former hobbies
• Negative changes in interactions with peers and family
• Decreased activity level/motivation
• Changes in mood
• Increased need for high stimulus-seeking behaviors, such as media consumption (including video, social and gaming platforms), substance use or risk-taking behaviors

Can a distinction be made between normal behavioral development and signs that may indicate an issue to be monitored?

Dr. Parmely: The brain does not finish developing until a person is in their mid to late 20s, which means that caregivers will experience numerous phases of developmental changes as children grow. When the young brain is going through periods of significant growth, there can be what appear to be "emotional storms." These are normal as long as they don't involve dangerous activities and don't last consistently for more than two weeks. If you have concerns about your child’s behavior, talk to other parents and caregivers about their experience raising children at that age. Talk to your child's pediatrician about what is normal, and what could be a sign to seek help from a behavioral health professional.

What steps can caregivers take to address anxiety in children and teens?

Dr. Parmely: Caregivers are the most important factor when it comes to a child's well-being. Within the home, kids are most resilient when they have consistent rhythms and routines. Try to keep consistent eating and sleeping schedules, limit time spent online, and carve out regular time for physical activities, creative play and family time.

During the COVID-19 pandemic, exposure to technology and the internet increased for both young children and teens. There is a strong addictive potential for digital media — including social media, and children of all ages have become more addicted during the pandemic. We can observe the same signs of addiction in alcohol and substance users. Caregivers will be able to spot an addiction to devices or digital media if the child displays significant withdrawal symptoms, including irritation and little to no interest in other activities when it is taken away.

Is there a benefit to modeling healthy behaviors for children to help reduce levels of anxiety or stress? What would those behaviors be?

Dr. Parmely: It is important for caregivers to take care of themselves in order to take care of their children. When parents and guardians are healthy, they tend to be healthier role models. How can parents and guardians do this? Make sure to demonstrate the value of physical exercise, healthy eating, and limited time spent scrolling online.

Caregivers should also model healthy coping skills for stress, such as expressing their emotions verbally and talking to their children about how they are going to cope with challenges. When caregivers are overt in their verbal expression of feelings (filtering based on developmental and emotional levels), it teaches children and teens to do the same. Validating what a child is feeling without trying to fix it, can help them become more comfortable in sharing their feelings.

My favorite skill to teach caregivers is summarization. Repeat what you think your child is feeling, and then pause. Let them either express what they are going through without interrupting, or give them the permission to be silent and think about their feelings. Let them know you are there when they are ready to talk. Don't try to provide solutions proactively. Instead, ask them to think of a potential action or solution for an issue or ask "can I give you a suggestion?"

What other resources are available to provide guidance?

Dr. Parmely: Don’t ever hesitate to contact your child’s pediatrician for guidance. They can help provide resources and recommend behavioral health therapists.