Don’t Worry Alone
AHN Pediatrics — Pediatric Alliance Bloomfield
In the future, I suspect many of us will recall the spring of 2020 with the words “coronavirus” and “Zoom meeting” at equal intensity. The world has changed very quickly in ways most of us could not have predicted even a few months ago. We are building the airplane as we are flying it, and our children are with us on board for the test flight.
As a developmental-behavioral pediatrician, I spend my days with children who have delays or differences in development. About half my patients are diagnosed on the autism spectrum, while others have ADHD, anxiety, or genetic conditions. Many struggle with changes to their daily routine, and most receive community therapies or special education services. About 20% of all children have special educational needs or receive accommodations at school, and a similar number have a mental health diagnosis.
This spring, as COVID-19 reached our area, I watched my colleagues step up to meet the medical needs of our families. How do we provide testing? How do we protect well children from infection in our offices? What visits can be safely provided by video?
Meanwhile, I’ve been working to address the social-emotional needs of our patients. Providing video visits from my living room, I have talked with many families and keep encountering two related questions:
What about mental health?
And, what about school?
Underlying both of these is the related problem — the loss of our daily routines.
Mental health:
Young children pick up more on the emotions and anxiety of those around them than the specific concerns. They may be extra clingy, whiny, or tearful. Expect them to ask “why” many times. There may be regression in toilet training or bedtime routines.
Preschool children may find masks scary to wear or to see on those around them. Mister Rogers used to invite actors onto the show to demonstrate that the person is the same under the mask or costume. You may need to practice or demonstrate this.
Older children will likely have a lot of questions and you may not have all the answers. They may worry about themselves or loved ones becoming sick. They may worry about family members who are out of work. Share with them the facts we know, and be truthful about the uncertainty.
Talking points:
• Most people do not get very sick. Many children who get sick feel like they have a cold.
• If someone does get very sick, people at the hospital work to help them get better.
• Schools are closed and people are staying at home to make it harder for the disease to spread.
• We are wearing masks if we are around other people outside the house.
• We don’t know how long these changes are going to last.
Consider limiting news consumption (for you and for kids). Set aside a plan to check the news at certain times, and to try to step away at other times. Videos can be very distressing for some people.
Everything else may be closed but the outside is still open. Go outside if possible. Try to give siblings physical space apart from each other.
If your child has anxiety or other mental health needs, reach out. Many outpatient therapists and some school counselors are providing video sessions right now.
School:
Over the last month, I’ve talked to students and parents who have experienced “remote school” in every model, from paper work packets to live online classes that take attendance. Some are thriving. One family solidified their decision to enroll in cyberschool for the fall. Working from home can make it easier for a student to move around and take breaks as needed and plan their work for the week.
But many children are struggling. High school students tell me, “the pre-recorded videos aren’t really teaching.” Children may have more difficulty focusing on live video classes than they do in the classroom. And it can be tougher to get clarification on directions.
In addition, some families are trying to assist their children while working full-time from home. One parent tells me they were sent a copy of the child’s daily school schedule, with a suggestion they try to follow it. Other families have essential workers who are still working full-time outside the home. In some homes, an adult is not able to help a child with academics until later in the day. Over and over, I am finding that families feel alone. If nothing else, I can hopefully provide assurance they are far from alone.
Some advice about learning remotely during a time when a Dallas Morning News headline predicts “2020 will be the year of the coronavirus asterisk”:
• I don’t recommend we try to replicate our usual spring academic goals.
• We should be helping students keep thinking and learning, to try to prevent an increase in the “summer loss” of skills that many students experience. But this may not be the best time to start new content (such as a new unit on long division taught by YouTube video).
• Second graders can pick up in the fall a month or so behind where second graders usually start the year. It will be OK — they’ll catch up.
• What is realistic for your child and your family is enough.
• Keep in touch with the school. Let them know if your child is having difficulty understanding or completing assignments. Also let them know if the expectations are not realistic for your child or family. They may be able to provide more support or adjust priorities.
I was a special education teacher before I was a doctor and of course believe education is important, but academic expectations should not be pushed at the expense of your relationship with your child or your child’s mental health.
What about the changes to routine?
The autistic community, full of people who struggle with uncertainty and change, have a recommended strategy: the visual schedule. A schedule should be flexible and as detailed as it needs to be. “Visual” can be any combination of words, drawings, or photographs that are meaningful. Include your child or children in the development as much as possible. Younger children may want to draw pictures for activities.
If the plans for the day are uncertain, use Post-its or a whiteboard and start with what you know. If three meals are it, write down breakfast, lunch and dinner. Put an empty box, a question mark, or a blank post-it on the schedule as a placeholder. You can go back later and fill in the hole, even at the last minute when the sun comes out and you decide to go for a walk. Add phone calls or FaceTime with relatives and friends who you are missing right now.
You can use a schedule to build in choices. You will probably end up relaxing some of the usual limits on electronic usage, particularly if you are trying to work from home. A visual schedule can show when electronics are “on the menu” and when a child needs to pick other activities.
And finally, some advice I give families all the time, even under more routine circumstances:
Don’t worry alone! If things are not going well, reach out. If you don’t know where to start, we may be able to help.
Dr Bethany Ziss specializes in developmental and behavioral pediatrics. She sees patients at the AHN Pediatrics – Pediatric Alliance Bloomfield office located at West Penn Hospital. To schedule an appointment with Dr. Ziss, please call the office at (412) 578-4003.