Background: Compared to adults most children don’t get as sick from SARS-CoV-2 (Covid-19), are hospitalized and/or have complications less often, and rarely die. Minimizing the impact of Covid-19 on children, though, serves to divert attention from our collective obligation to protect children from harm. It also risks ignoring another Covid-19 related crisis: children’s mental health. Kids need safe spaces to gather in. They need to interact with their friends, grandparents, and teachers. Covid-19 has changed the most basic rules of childhood and it is hurting our children.
Objective: To describe how this pandemic is harming children’s mental health.
1) Go to work.
2) Take care of hospitalized pediatric patients.
3) Remember that the author, who is an internist and pediatrician, is trained to take care of the bodies of adults and children with some thought to how the mind impacts the body.
4) Remember that the author, who is not a psychiatrist, is not trained to take care of serious mental illness in any age group.
5) Find that on any given day the author has several patients with mental health crises such as: suicide attempts, aggressive outbursts, and eating disorders.
Excluded from analysis are the days the author spent on the adult hospital units.
Results: One day the author assembled a list of representative patients. The list was long and reported in this study are only typical examples of patients with identifying details changed to protect their identities. Here is her qualitative analysis.
Patient #1: An adolescent who bounced from foster home to foster home. They took a handful of their antidepressants mixed with Tylenol in an attempt to kill themselves and were then admitted to the hospital to clear the drugs from their body and wait for an inpatient psychiatric bed.
Every day when I stepped into their room the blinds were drawn, intricately shaded coloring book pages hung on the wall and the TV was off. I never thought I made much of an impression on them and truthfully I didn’t try. I didn’t have anything to offer them except words, the same words I used for all the other kids:
We’re still waiting for a bed at a psychiatric facility, I’ll let you know when I know but I bet you’ll hear before I do.
Over and over, day after day.
That day they told me they wrote poems and wanted to read them to me. I sat down and heard about freedom, self-love, rising above others. There was hope in their words and their shy smile. This was the first chance I had to see them as a person with a life outside of the hospital; I couldn’t thank them enough for sharing their work with me. I wanted to pluck them out of their tragic circumstances and find them a calm pocket of air to breathe, but I could only encourage them to keep writing.
Patient #2: A little boy, younger than my own children. Sometimes when he didn’t have the right words he expressed his feelings with a monstrous violence too big for his parents to handle. Every day I crouched on the floor with him and we played with his toys or he told me about his drawings. It was calm enough.
But inside my sadness paralyzed me. We could offer him medication changes and a safe place to stay until a spot in a treatment program opened up. The few options were limited by social distancing rules and they had waiting lists. Every day he spent with us was a day away from normal childhood.
A few times a week I saw him running through the halls, making a circle around the pediatric unit, sometimes yelling. His behavioral health companion, in her light tan scrubs, struggled to keep up with him and return him to his room.
Patient #3: Another teenager, with an anxiety disorder being treated with medications by her pediatrician. There were no therapists available anywhere to help her. Slowly while in remote school she began hating her body. No one was there to tell her otherwise. No one saw her meals become smaller and smaller. No one put together that her running, her incredible fitness, was a desperate attempt to erase her meager calories from her body.
She came to us, her heart beating slowly like a bear in hibernation, her bones prominent, her eyes wide. We made her eat vast quantities of food to gain back the weight. But I didn’t know how to help her to heal her thoughts, to love her food again. All I could do was offer hot packs and anti-nausea medication to soothe her intestines’ protest at the reintroduction of food.
The Covid-19 pandemic is affecting children in a multitude of ways. The author has cared for kids with respiratory illness and with mysterious post-Covid symptoms causing months of weakness and chest pain. The author has also cared for kids with floridly inflamed bodies and failing hearts in the aftermath of even previously undetected Covid-19 infections. The illness of each one of these children causes suffering—for the children themselves, and for their families struggling to navigate the world of sickness.
But what the author has seen more of is an unprecedented mental health crisis in children. Kids, perhaps more so than adults, have been traumatized by this pandemic. The cases presented here are merely examples of the scores of patients who have passed through the author’s hospital. The mental health system in the author’s state and all neighboring states is completely inundated. These patients have nowhere to go but the local Children’s Hospital. Here, as they wait for transfer to a psychiatric treatment program, they are cared for by pediatricians with some assistance from a very overwhelmed psychiatry team. Some, after waiting days or even weeks may be sent to a facility a hundred miles or more from their home.
Children who are depressed, anxious, suicidal, violent or not eating need help and there is little help available. The author has never felt so helpless. The author has never had so little to offer to so many children.
Conclusion: Please wear a mask. Please get vaccinated. Please help us end this pandemic. Please. Just do it for the children.