The multitude and magnitude of coronavirus stressors on children

The perfect storm of insecurities and isolation creates a setup for mental health concerns and crisis. At BMC, at least 10 percent of parents have requested behavioral health support.

By Barry Zuckerman and Katherine Gergen Barnett

We’re months into the “new normal’’ of the coronavirus pandemic: social distancing, economic lockdowns, isolating ourselves from one another. But this new normal creates stress and even trauma, especially in Black, Latinx, and immigrant communities. And while we are hearing about the devastating emotional impact that COVID-19 has had on adults in these communities, it also has long-term emotional and physical impacts on children.

Many studies show that the more adverse childhood experiences a child has — violence in the home, parental mental health problems, substance abuse — the more likely they are to suffer chronic health problems, mental illness, and lower education and job opportunities during adulthood. The consequences of adverse childhood events exacerbate the well-documented disparities in health, education, employability, and income due to poverty and racism.

At Boston Medical Center, New England’s largest safety-net hospital, where one of us is a pediatrician and the other a family medicine doctor, we have never seen such high levels of food insecurity, financial stress, anxiety, and fear. Many patients worry about paying rent and utilities. In a not yet published survey of BMC pediatric families, about 50 percent reported trouble affording groceries, and 12 percent said they didn’t have enough food for three days. These stressors are worsened by current sheltering policies and the accompanied isolation. The perfect storm of insecurities and isolation creates a greater risk of mental health concerns and crisis. At BMC, at least 10 percent of parents have requested behavioral health support. And these are only the parents seeking care; many are still too afraid to come in, for fear of exposure to COVID-19.

This is happening across the nation. According to a recent Kaiser poll, 45 percent of adults reported poorer mental health compared to pre-COVID times. Stress and isolation among parents can lead to abuse and neglect of children. It can also lead to increases in domestic violence among partners with its accompanied injuries and fears to mothers and fathers, which can impair their ability to nurture their children. Witnessing violence, especially when one person you love hurts another person you love, has negative consequences on children’s brains and behavior. At this time, the number of cases is unknown, due to isolation from mandated reporters.

Beyond the consequences related to the upheaval of parents’ fears and sense of security, the impact on children is probably exacerbated by their isolation from peers, teachers, and extended family. Children’s education and their participation in such activities as athletics, music, and group activities have been disrupted. Technological disparities further exacerbate learning challenges. Summer camps, including those subsidized for low-income children, are largely unavailable. Although some children are resilient due to their biological makeup and relationship with a nurturing parent or another adult, the magnitude and multitude of stresses from the pandemic present an assault on children’s developing brains, sense of security, and future.

The short-term policy response of providing funds, such as stimulus checks, unemployment benefits, and eviction protection, is critically important. However, local, state, and federal policy makers need to prevent the longer-term impact of the present disruption and trauma on the lives of children; the number of children affected by adverse childhood experiences is likely to be greater than observed in studies prior to the pandemic.

Leaders need to go beyond incremental change and expand access to mental health care, especially in lower-income communities and schools; provide universal access to free or lower-cost child care; and increase connections and supports for low-income adolescents to good-paying jobs. The cost of doing nothing will most certainly be more expensive in the long run due to financial burdens on health care, child welfare, criminal justice, special education, unemployment, and impairment of societal functions.

Citizens, businesses, and community organizations must also reorient themselves to a shared vision of racial justice and income equity so everyone feels they are in the same boat, rowing together. Though the details can be debated, we cannot debate the fact that significant attention and funds must be devoted over the next 10 or more years in order to meet the needs of traumatized children and mitigate significant adverse repercussions.

In 2020, we found ourselves unprepared for this pandemic. Let’s be prepared and do what’s needed to prevent its predictable consequences.

Dr. Barry Zuckerman is professor and chair emeritus of pediatrics at Boston University School of Medicine and Boston Medical Center. Dr. Katherine Gergen Barnett is vice chairwoman of Primary Care Innovation and Transformation and program director of the Department of Family Medicine at Boston University School of Medicine and Boston Medical Center.