On August 17, Vicki Smetak, MD, medical director of strategy & partnerships at Yale New Haven Children’s Hospital (YNHCH), moderated a virtual town hall for parents called, “Back to School During COVID-19,” which featured experts from Yale Child Study Center and Yale Pediatrics.
This was the fourth virtual town hall geared toward families since the COVID-19 pandemic hit in the spring. Past virtual town halls focused on Yale New Haven Hospital’s new safety and disinfection protocols, new processes for patients coming in for elective surgery at the YNHCH, and – most recently – supporting children’s emotional health during COVID-19. Recordings of all town halls are available on the YNHCH Facebook page.
This town hall focused primarily on the social-emotional needs of children as they return to school this fall, with panelists answering questions that parents submitted ahead of time as well as live during the session.
Megan Goslin, PhD, clinical psychologist and associate research scientist at Yale Child Study Center, is an expert in trauma. Dr. Goslin began the session by acknowledging the important role that schools play in children’s lives, a role that has been underscored by the COVID-19 pandemic. Dr. Goslin encouraged parents to acknowledge their own feelings and reactions during this pandemic, because children look to their parents for guidance on how they themselves should react. Dr. Goslin offered a tip from her own dinner table: ask your kids what is one thing they’re excited about for returning to school, and what is one thing they’re wondering about? This could open the door to some more supportive discussions. Dr. Goslin also spoke to families whose children will be learning at home full-time. In addition to establishing and maintaining schedules to give students predictability, she recommended ongoing, open communication with educators, because they are the specialists and will have necessary solutions to problems parents may encounter. For example, for children with attentional issues, having the live or synchronous lectures available for later viewing, rewinding, and discussion with parents (if needed), might be very helpful.
Jenny Dwyer, MD, PhD, assistant professor in the Yale Child Study Center and Department of Radiology, is an expert in adolescent depression. Dr. Dwyer discussed the increase in adolescents’ stress and uncertainty during COVID-19, which are underlying conditions for the development of mental health disorders. “Some of the things that are happening during the pandemic really strike at the core developmental tasks of our teenagers,” she said. These tasks are things like needing to connect with peers, needing to explore the world and develop autonomy, and needing to develop a sense of self and meaning. All of these tasks are, at a minimum, challenged by the pandemic. Dr. Dwyer advised parents to regularly ask their teens, in a non-judgmental way, how they are feeling. She reminded adults that we assume we know what how they’re doing but this may not be true. Simply asking what’s on their minds and what their friends are talking about lately can open the door for more conversations. For both parents and teachers, Dr. Dwyer suggested, “Ask teens, ‘Are there things you need from me to support you?’ You may be surprised.” She also recommended prioritizing socialization with peers, whether it be providing space to just hang out while socially distancing outside or online. Finally, Dr. Dwyer advised parents to be on the lookout for symptoms that may signal your child’s need for professional mental health care, reminding parents that they know their children best. These symptoms include: 1) Significant changes in function (family, social, academic, overall health), 2) Persistent mood changes (chronically cranky/irritable, frequent sadness, severe mood swings), 3) No longer enjoying things they used to, 4) Increased self-isolation; loss of interest in peers or new frequent conflict with peers, and 5) Increased use of drugs or alcohol.
Parents can regularly check in with their children, and can normalize and model appropriate ways of seeking help, including therapy, said Dr. Dwyer.
Mary Gunsalus, MEd, director of the Yale Child Study Center School, works closely with school districts, educators, and parents to facilitate children’s return to school from inpatient care in less restrictive settings. Ms. Gunsalus first started by giving all parents a hearty, “Bravo! Bravo!” – honoring and acknowledging the fact that parents have been their kids’ teachers since March as well as all the work parents have done and continue to do. She spoke to the two ends of the school spectrum many families will be experiencing this fall: at one end, the much more restrictive in-person schooling with strict rules about mask-wearing and physical distancing, and at the other end, at-home virtual learning which will likely be much less formal. Ms. Gunsalus reminded parents to empower their children by keeping them informed of school plans, implementing schedules and rules about screen and device usage especially for at-home learning, maintaining regular communication with teachers, and practicing new routines at home. For example, get fun masks (your child can choose their favorite pattern) and practice reading with them on at home. Remind children that the school and their teachers will look the same, that they’ll still see their friends, but that masks and distancing are important for keeping everyone healthy. Keeping lines of communication open and setting daily goals will be especially important as the school situation may change from week to week or month to month. Ms. Gunsalus suggested that kindergarten teachers, who are welcoming new students to the school, might consider wearing masks where their faces are visible. For these students, parents can also continue managing children’s expectations by telling them what it will be like (everyone will wear masks, friends will be farther apart, teachers will show other ways they care besides high fives and hugs), that it’s OK that it’s different, and that it’s important to keep everyone healthy.
Marietta Vazquez, MD, professor of pediatrics, is an expert in pediatric infectious disease. She also runs the Yale Clinic for Hispanic Children (Y-CHiC). Dr. Vazquez addressed the most common question she has been getting in her clinic: “Will my child be safe?” Dr. Vazquez reminded attendees that it is important to remember that all human beings have the potential to become infected with COVID-19 – it is not true that children do not become infected. But what does continue to be true is that disease severity in children (infants, school-aged kids, and adolescents) is lower than in adults. Nevertheless, we all still need to be vigilant about continuing safety precautions (good hand-washing, wearing face masks, and keeping distance) and continuing medical care. “When COVID is here, other diseases do not take a break,” Dr. Vazquez said. It is safe to go to your pediatrician’s office. She reminded parents that it’s extremely important to follow up with your children’s doctors with follow up appointments, vaccinations, and preventive care. Getting the flu shot is particularly critical this year. Another question Dr. Vazquez addressed is whether children with asthma are more vulnerable to COVID-19. Dr. Vazquez notes that the available data do not indicate that there is an increased risk for children with asthma, though their asthma can be triggered when infected with a virus. Having and maintaining an asthma action plan at home and at school is important.
Julie Wolf, PhD, associate professor of clinical child psychology at Yale Child Study Center, is an expert in autism spectrum disorder (ASD), with a focus on social skills intervention and sibling support. Dr. Wolf emphasized that parents should normalize what their kids are feeling, and remind children that so many people are feeling the same way. Dr. Wolf offered advice geared toward families with children who have neurodevelopmental disabilities. She acknowledged that remote learning, where children do not have the one-on-one instruction they typically rely upon, and new in-person regulations like mask-wearing, may be particularly challenging for such children. Dr. Wolf recommended that parents maintain regular contact with their children’s educational team to determine how best to balance educational and safety needs. Perhaps there are ways children on the autism spectrum, for example, can learn to tolerate wearing a mask to be able to engage in person, and discussions need to be had to identify how schools can support parents of such children in virtual learning. Finally, Dr. Wolf reminded parents that they are not alone, that they are doing the best they can, and that they are making the best decisions they can for their children and families.
For parents and teachers alike, offering safe spaces to listen to children and adolescents and to validate their feelings is key to supporting them, as is being honest in sharing your own uncertainties. Moreover, taking small concrete steps to address children’s concerns, like telling them how you’ll work to find an answer you don’t know and when you’ll follow up with them, can ease children’s anxieties.
All panelists agreed that parents and teachers this year should focus on children’s social-emotional well-being, because academic achievement cannot occur without social-emotional health. “When kids are consumed by worry or intrusive thoughts, they can’t learn. Their brains are in survival mode,” said Dr. Goslin. Fostering relationships between children and teachers will be more important than ever.