Growing Resilient Kids amidst COVID-19

Tim Culbert, MD

Integrative Developmental Pediatrician

If you feel terrified, freaked out, unsettled or completely confused about life in the past few months, you are not alone. COVID-19 has created unprecedented levels of isolation, despair, and harm to parents and children. 

• According to the Stress in America Survey (APA, 2019), the pandemic has led to increased stress and mental health challenges for people of all ages.
• Since the pandemic started, rates of anxiety, depression, divorce and addiction have increased. In fact, the prevalence of symptoms of anxiety disorder was 3 times higher in the spring and summer of 2020 compared to the same seasons in 2019 (MMWR). 
• Parents are also more likely to feel higher levels of stress than adults without children.
• One study in China indicated that clinging, inattention, and irritability were the most common psychological changes seen in children in all age groups during 2020. The rates of anxiety and fear were higher in children living in highly epidemic areas.

In addition to pandemic-related stressors, we are also as a society, concurrently experiencing heightened stress from a variety of additional issues including civil unrest related to recent events like the murder of George Floyd and others, increased awareness to racial inequalities and uncertainty, political polarization, natural disasters, and heightened economic disparities. 

During the pandemic, families also report experiencing lifestyle behavior changes that might contribute to poorer health. For example, a Canadian study of middle to high income families showed that during the coronavirus pandemic:

• 57% of moms, 46% of fathers and 42% of kids stated that they were eating more than before COVID-19. Also, an increase in the eating of snack foods was reported by 67% of moms, 59% of dads, and 55% of kids in the study.
• Screen time increased in 74% of moms , 61% of fathers, and 87% of kids.
• Physical activity decreased in 59% of moms, 52% of fathers and 52% of kids.

Clearly, all of these stressors can adversely impact the health and wellbeing of entire families. And unfortunately, the consequences of this ongoing stress, social isolation, and other factors related to quarantine are likely to be cumulative and can tend to get worse over time. That's why it's important to do everything possible to support resilience and wellbeing amidst these stressors to reduce the risk for long-term mental and physical health issues (DiGangi & Negriff, 2020).

COVID-19 and Adverse Childhood Experiences (ACE)

ACE's are key factors in a child’s life that have potential impact on future health (Bryant, Oo, & Damian, 2020). ACE’s can include things like physical and emotional abuse, neglect, caregiver mental illness, experiences of violence and other stressful events in a child’s life.

The more ACE’s a child experiences, the more likely he or she is to suffer from mental health problems (like depression and substance abuse) and physical health issues (like diabetes and obesity). 

The coronavirus pandemic and its associated challenges, is an ACE.

COVID-19 and its related stressors can impact kids directly, but also indirectly via the wellbeing of their parents and caregivers. Experiencing too many ACE’s without relief and without help from supportive adults, can create toxic stress. Toxic stress involves excessive activation of the stress response over time and can lead to wear and tear on the body and brain.  

The Brain-Body-Pandemic Connection 

Biological systems within our bodies respond to stress. They interact with each other and are influenced by and adapt to the bio-psycho-social context within which they are developing. Environmental stressors can trigger the body’s stress response systems and these systems then spring into action. Systems related to brain, autonomic nervous system, endocrine functions, immune regulation, gastrointestinal organs, and cardiovascular systems can all be impacted. Exposure to the excessive and persistently stressful events, especially early in life (ACE’s and toxic stress) can lead to overloaded biological systems and result in long-term consequences on health, behavior, and learning. 

The brain’s developing circuits are highly sensitive to the disruptive effects of this increased stress system activation. One outcome can be overactivity of the immune system which is linked to inflammation. Some inflammation is good as it helps us attack viruses and bacteria and also initiates repair processes in the body. However, too much inflammation is associated with diagnoses like heart disease, depression, arthritis, GI problems, autoimmune disorders, and cancer. 

Bounce Back with Resilient Childhood Experiences (RCE)

Some of the negative impact of ACE’s can be eased by utilizing resilience-building strategies and activities. NMH is here to help (from handout) kids and families build resilience and bounce back from the negative impacts of COVID19 pandemic.

“The health and well being of young children is inextricably tied to the health and well-being of the adults who care for them”

Jack Shonkoff, MD; Director, Center on the Developing Child at Harvard University

Below are some strategies to create more Resilient Childhood Experiences (RCE). We believe that RCE's are the essential antidote to ACE's.

• Serve and return interactions. Interactions between adults and kids help to buffer the physical effects of stress while building connection. Think of serve and return like tennis between a child and an adult. The child “serves” by reaching out for interaction. This may include eye contact, touch, a facial expression, or via voice (even babbling). The adult then returns the serve by offering back full attention and interaction (e.g., playing along, sharing something, speaking back, giving a cuddle). 
• Reduce sources of stress. If any stressors can be eased or eliminated, tend to those ASAP. Of course, COVID-19 has presented stressors completely outside of our control. To ease the impact of these, families need to be supported financially, educationally, socially, psychologically and physically in various ways to reduce stress burden on parents. Less stressed parents = healthier parents who grow healthier kids. 
• Practice calm with a schedule. Keeping a consistent daily routine and staying calm throughout shared activities will promote physical, social and emotional development. 
• Exercise. Keeping active and exercising supports the brain’s natural release of chemicals that reduce anxiety and support mood, energy, and attention.
• Go outside. Time in nature supports mental health... it's really that simple. Go outside! Learn more about outdoor grounding techniques.
• Sleep. Adequate sleep supports immune function and emotional regulation. Most kids and teens need at least 8-10 hours.
• Try some stress management activities. A variety of mind-body skills like mindfulness, deep breathing, mental imagery, biofeedback, and progressive muscle relaxation can help to balance you nervous system while reducing stress. 
• Practice kindness. Being kind to yourself and to others is really good for your mental health. A practice like loving kindness meditation can build resilience, enhance energy, and boost creativity.
• Eat healthy. Your brain and body need the right mix of nutrients to provide energy to get things done and to make the right amount of neurotransmitters. Try our Resilient Diet to set a good foundation.
• Stay connected. We know how exhausting Zoom feels right now... but, do all that you can to stay in touch with other parents, teachers, and friends. Don't be shy to share with them your struggles (they probably feel the same way).  

Learn more RCEs by joining in for our free and on demand Resilient Kids Summit!

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