Why does UNICEF support return to face-to-face classes?
3:16
(CNN) -
With the return of children to schools, a massive effort is underway in many districts of the country to keep Covid-19 at bay.
But there are other problems, like stress and anxiety, that are making their way.
Doctors and psychiatrists want parents to take note: Children may be bringing the stress of last year's pandemic into the classroom.
Anxiety, along with depression and isolation, contributed to more parents reporting mental health problems in their children last year compared to the previous year and 31% more ER visits for mental health problems in adolescents, according to the US Centers for Disease Control and Prevention (CDC).
Children need your help to deal with anxiety right now
Behavioral developmental pediatrician Dr. Carol Weitzman said mental health problems related to the pandemic will not go away now that children are back in school and hanging out with friends.
"There is a large part of the children who will be ready to go (to school), but we have to pay attention to the children who are not and think about what it takes to go back to school safely and confidently," he said. Weitzman, co-director of the Autism Spectrum Center at Children's Hospital Boston and a physician in the hospital's division of developmental medicine.
Your child's silence doesn't always mean "stay away," said Weitzman, who also sees patients in Connecticut at CT's Center for Developmental Pediatrics and is president of the Society for Developmental Behavioral Pediatrics.
As someone who spent the year talking to children with all kinds of mental health issues, she sees this moment as an opportunity for families to strengthen their relationships and for caregivers to better recognize when children need help.
These are their tips.
advertising
This interview has been edited and condensed for clarity.
CNN: Children and parents are eager to go back to school, but you say that there are many things that we have lost. What do we still have to tackle with our children?
Dr. Carol Weitzman:
I think we've had a year and a half of unusual and atypical experiences and a lot of loss: loss of normal daily routine, loss of social relationships, loss of learning, loss of new experiences, loss of important events.
Now we are getting back ... there is an adjustment that has to happen to get back on track.
There are also a lot of really disturbing, annoying and tragic things that have happened in this period, and we could go back to school with enthusiasm, but those things keep happening.
We have to figure out how to make sense of that and we can have simultaneous and even contradictory feelings.
You can be excited.
You may feel like doing new things again and continue to carry the loss, pain, and anxiety of things that happened.
You can feel both.
It is not one or the other.
CNN: The National Institutes of Health says 1.5 million children have lost a close caregiver, and are grieving. How can that show up in your behavior?
Weitzman:
When it looks like a duel, we are familiar with it.
We are better able to recognize it.
Sometimes we are not even good at it, but we are better at acknowledging it when children are sad, tearful, or talk about their loss.
Grief can also look like many other things.
It can resemble loss of pleasure in things.
It can resemble changes in our daily habits, in our eating and in our sleeping habits.
It can resemble anger.
It can resemble irritability.
It can look like inattention.
It can look like poor school performance.
Children have to recover that emotional loss and learning lost by the pandemic, says the representative of Unicef in Mexico
When we see significant changes in functioning, it is essential to obtain a history of trauma, because the trauma may be there.
We don't always think about it when we see angry, argumentative, oppositional, or disobedient children.
But when we see a change in the function, we have to ask about it.
If we do not ask, we make the mistake of thinking that it is one thing, when in reality it can be another.
CNN: What can parents say to start a conversation when they see a change in their children?
Weitzman:
The most important thing is our way of thinking and approaching children.
We have to maintain a curious, interested and non-judgmental posture towards children, so that we convey that we are interested in learning, not in fixing or judging.
Ask the children: "Why do you fight so much with everyone?", "What happened to you?"
or "Why are you doing so badly at school?"
they are not invitations to speak.
Children and teens tend to shut down when asked questions that sound like accusations.
Negative language focuses on undesirable behavior rather than understanding the problem underlying the behavior.
Curiosity and interest must be accompanied by concern and empathy.
Better test with this: "It seems that it is more difficult for you to start doing your homework, and before it was not like that. I am worried that something has changed and I would like to understand it a little better."
Other examples of good conversation starters include the following: "This pandemic has been tough in many ways and everyone has experienced it differently. It seems that you are not completely behaving like yourself, and I am here to listen to you. We can get through all of this together. "
You can also be direct: "I am worried that you might be thinking about hurting yourself. Would you be willing to talk about it and what worries you?"
These types of questions invite further dialogue and give the child or adolescent the opportunity to open up.
CNN: Sometimes adults think children don't want to talk when that isn't necessarily true. Can you explain it?
Weitzman:
In fact, children often want us to ask them.
They want to know that people care about them.
They don't want to feel, like no human being, feelings of shame or that there is something wrong with them for having certain kinds of feelings.
When we ask questions, we need to reach out to them in a way that doesn't provoke feelings of shame or discomfort.
The other day I saw a young teenager who, over the past year, had a surprising number of absences that no one at school had drawn attention to.
When I asked him about it, he said, "I just hate asking for help. I'd like to be left alone."
It turned out that he felt that if he asked for help, it made him look weak or incompetent, as if he were not good at anything.
Unicef: the opening of schools can reduce the increase in gender violence in minors and mental health problems
CNN: Is a certain level of stress and anxiety normal in children?
Weitzman:
Not only is a certain level of stress and anxiety normal, it can even be healthy and promote development, and we call this positive stress.
When we study for exams, if we didn't have stress or anxiety, we would feel like, "Uh ... I really don't need to study."
And small increases in our heart rate and rises in our stress hormones can motivate us to necessary action.
The time it becomes problematic is when children experience "toxic stress."
It is when stress is chronic and incessant.
And, most importantly for a child, when there is no adult to help provide a protective bubble around them through supportive relationships, stress can become toxic and not be cushioned.
How to help teenagers manage their emotions?
0:53
CNN: When should a parent realize they need to ask a mental health professional for help?
Weitzman:
When children are not functioning well, when moods are extreme and incessant, when children are not going to school, when they are not enjoying things, when they are not eating, when they are not sleeping, when they are not participating in activities they enjoyed in the past. Or when the child says to his parents, "I am overwhelmed. I can't handle this."
The father can be a support person in your life, but he does not have to be a therapist.
When symptoms are severe, or the parent or child is overwhelmed and distressed, it is time to turn to the professionals.
It is better to ask for help soon.
You don't have to go down a third time to ask for help.
And we need to continue to remove any stigma about getting help and convey that seeking mental health treatment is not a sign of weakness.
CNN: Many parents are stressed by covid-19. Should they hide that from their children?
How to talk about the coronavirus with children?
3:29
Weitzman:
You don't want your kids to take over your stress.
So if you talk to your kids about these things as a way to relieve stress, it probably isn't helpful.
On the other hand, talking to children and adolescents at their level about school safety and sharing opinions and information is important.
It's important to be able to say, "You know, this is what concerns me. This is the information that I think you should know. This is why I ask you to keep your mask on all the time."
It also helps children deal with the tons of misinformation out there that can lead to distorted ideas and create unnecessary fear.
--With additional reporting by CNN's Natalia V. Osipova.
Well-being childrenstressPandemic