HJNO May/Jun 2021

HEALTHCARE JOURNAL OF NEW ORLEANS  I  MAY / JUN 2021 45 HOW CAN WE RESPOND TO STRESS IN HELPFUL WAYS? Demonstrate calm: Children look up to parents and other important adult role models and often mirror how they react during challenging or stressful sit- uations. It is vital that adults strike a bal- ance between conveying the seriousness of COVID-19 and the need to follow both public health and specific household safe- ty measures without adding unnecessarily to the emotional burdens and other pres- sures youth are experiencing inherent to the pandemic. Reassure honestly and realistically based upon the child’s age, developmen- tal level and individual temperament: There is a difference between calm reas- surance that eases children’s worries and being too reassuring or even unrealis- tic in our responses and explanations to children. The realities of the pandemic do include many very real challenges related to school and interactions with extended family and friends. Additionally, some fam- ilies are experiencing economic hardships. Parents and other adults should reassure children about specific matters when they can but be careful not to promise out- comes and opportunities that are outside of adult control or may not be possible. Keep positive structure and routine: Virtual learning, even when mixed with regular attendance in “brick and mortar schools,”has posed unique challenges. The often-daily unpredictability of the last year has contributed to increased anxiety and feelings of uncertainty for many children. In response to the rollercoaster of ups and downs over the past year, youth typical- ly find routine and predictable schedules helpful and reassuring. Children often find that knowing what the day will bring keeps life “on track” in addition to being com- Mary Lynn Dell, MD, DMin Service Line Chief Behavioral Health Children’s Hospital New Orleans In “normal” times, the periods of child- hood and adolescence are critical for the formation of self-identity and the devel- opment of critical skills that support and carry us throughout our lives. Social and emotional development can be affected significantly by mental and behavioral health issues, underscoring the need for attention to these and related concerns. Depression, along with anxiety, can get in the way of forming healthy self-esteem, learning coping skills to handle stress and developing healthy forms of communica- tion. Depression and anxiety may disrupt sleep, appetite and good, adaptive habits of healthy living. Some individuals may struggle to maintain social relationships and academic goals. Emotional and be- havioral issues also can affect family rela- tionships and functioning within the home. Signs of depression in youth may in- clude sad mood, excessive or uncharac- teristic tearfulness, irritability, angry out- bursts, sudden and inconsistent changes in behavior, and withdrawal or isolation from friends and family. They may not enjoy fa- vorite activities or pastimes they typically do. They may have sleep and appetite dis- turbances that lead to weight loss, weight gain or not achieving expected gains as they should for typical, healthy growth and development. Younger children, espe- cially, may be prone to developmental re- gression or more immature behaviors and emotional outbursts. Of greatest concern are thoughts of wanting to be dead, espe- cially when accompanied by actual plans to harm or kill themselves. As more people receive the COVID-19 vaccine, we are hopeful that the “begin- ning of the end” of COVID-19 is here. The many difficulties of the past year, howev- er, may continue to affect families into the near future. forting during the most stressful of times. Adults should encourage youth to focus on the positives in all situations, including what a child can look forward to in both the immediate and long-term futures. Don’t be afraid to ask for help: Final- ly, seek help if you think that your child or adolescent is struggling to cope with the effects of the COVID-19 pandemic, whether in their personal and family lives or more generally in the community and world around them. If you are concerned that the youth is anxious or depressed, a parent, guardian or other concerned adult assisting the parent should seek help for the child. Speak with a school counselor, schedule an appointment with a thera- pist or psychiatrist, or ask a pediatrician or primary care provider for help with referral options. If the situation is serious or life-threatening, especially if anyone has concerns that a child or adolescent is potentially suicidal or harmful to self or others in any way, it is imperative to seek emergency medical care immediately. It is more important than ever for our medical communities to collaborate re- garding the mental and physical health of our children. We will continue to get through this challenging time — caring about one another, together. n Mary Lynn Dell, MD, DMin, is the service line chief for behavioral health at Children’s Hos- pital New Orleans. Dell is board certified in general, child and adolescent, consultation liaison, and forensic psychiatry. Her aca- demic interests include psychiatric needs in chronic illness; ethical issues in psychiatry and pediatrics; end-of-life care; culture and psychiatry; and the interfaces of medicine, psychiatry, and religion/ spirituality. She is co-chair of the American Academy of Child and Adolescent Psychiatry Ethics Commit- tee, a member of the American Academy of Pediatrics Committee on Bioethics and has served on several hospital ethics committees and institutional review boards. She also is the founding chair of the AACAP Religion and Spirituality Committee and President of the American Psychiatric Association Cau- cus on Religion, Spirituality and Psychiatry.