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Introduction: Recognized as one of the world's greatest philanthropies, Shriners Hospital for Children is an international hospital system recognized for transforming the lives of children throughout expert care and research. And now another episode of the Shriner's Hospital for Children Chicago Podcast Series, Pediatric Specialty Care Spotlight with Melanie Cole.

Melanie Cole: Welcome, to Pediatric Specialty Care Spotlight with Shriners Hospitals for Children in Chicago. I'm Melanie Cole and today we're discussing wellness at home during COVID-19. Joining me is Dr. Kathy Zebracki. She's the Chief of Psychology at Shriners Hospitals for Children in Chicago. Dr. Zebracki, thank you for joining us today and what a great topic. It's so important at this time. Help us to understand COVID-19 and our kids. How is it affecting them emotionally and physically?

Dr. Zebracki: Well, thank you for having me. I feel like there's a wide range of emotions that the children can be feeling. Some may have an increase in anxiety, they may feel stressed, overwhelmed, lonely. There's also some children that actually may have a positive experience because they're spending more time with their parents or they're removed from outside stressors such as bullying at school or just the academic stressors. It's important to watch our children and see any signs of unhappiness, increased needs for sleep, and you're looking at physical symptoms like changes in appetite, increased irritability. Children are not, especially younger children are not able to express themselves verbally as much as adults can. So looking at their physical behaviors is going to be really important to see if they're in distress during this time.

Host: Well, thank you for that answer. And as far as also how it's affecting them physically, children, especially Shriner's Children may be used to physical therapy, occupational therapy, these therapy services and besides the kids aren't in school so they're not getting up and going to school, having recess or gym. How can parents help them at this time when they're not getting the therapy services they may be needing and they're not really getting any exercise either.

Dr. Zebracki: That's a very huge concern for us. One of the things that parents can do is establish routines, routines for bedtime, meals, but also routines for recreational activities and exercise. Whether it's five minutes in the morning, sometime in the afternoon, have time to go for a walk, play outside, do some yoga, mindfulness activities, schedule that throughout the day. Also reach out to Shriner's or to other PTs and OTs that the child is meeting with and ask for some home exercises. I know Shriner's will be starting telehealth soon too. So those physical exercises, physical therapy, and occupational therapy appointments will resume soon

Host: And children are really sad or afraid that school play dates and things are canceled and we never really realized how much our kids enjoy going to school for that social factor. How can we help them with these emotions?

Dr. Zebracki: Children are very much social individuals and they need that connection with their peers. During this time, it's important to set up social opportunities in an appropriate manner such as setting up zoom, FaceTime, scheduled time for kids to do parallel virtual play. They can play Legos together, they can do some arts and crafts, something that they're still engaging in also as possible to connect with their teachers and just some of those old familiar faces. Just to create a sense of normalcy.

Host: Well, as long as we're talking about that sense of normalcy, having a routine is so important. What are some steps parents can take to get their children out of their bedrooms and to help them cope during this time to really make sure that they do other things besides sitting in their rooms on Tic-Toc and Instagram.

Dr. Zebracki: Yes. That's a struggle that I know many families are having, including my own. It's really important to set a wake time for weekdays as well as weekends, they can sleep in a little bit longer on the weekends, but still Monday through Friday it should be considered a work day, a school day. So having regular time to wake up, try to have consistent meal times recreational activities again also just have a time to talk with their [inaudible] figure out if they have any concerns. Also remain calm during this time. Say that we're all in this together. We're trying to create the best environment we can during this challenging situation.

Host: It's so important what you just said, to make sure that they wake up and that they have that routine. Now some kids are showing signs of stress. I know my kids are, what are we looking for? And if they show those signs of stress, give us some red flags, Dr. Zebracki. And if they show those signs of emotional challenges they're going through and stress, what can we do to help them with that?

Dr. Zebracki: There will be times where you're living in the same household. You're going to be having some increased arguments that's acceptable. That's typical. You're going to have to use sibling conflict as well increase. But it's also important that there's going to be good opportunities, have time for play and positive interactions with one another. One of the signs that you are going to be looking for is this. These is anger episodes, these aggressive episodes, irritability, start outnumbering the positive experiences reach out to Shriner's or mental health care providers, pediatricians to see if it warrants an immediate medical visit. Obviously if children are starting to engage in any self harming behaviors, that needs to go straight into the emergency department. Even during this COVID time we want to keep our children safe and healthy. But if they are expressing sadness, have a discussion with them, ask them what is going on in their heads, what they understand of the situation. Children are very bright and they pick up on a lot of things and overhear news reports in the other room, so they may have questions and may not fully understand what's going on. So it's important to answer those questions for them as well.

Host: There are other things that are going along with this pandemic Dr. Zebracki, like wearing masks. Children may have a hard time with it and especially kids with sensory issues that may be a very difficult thing. How do we work with them on that?

Dr. Zebracki: In regards to masks, there's a lot of fun masks that parents can buy for their children. I'd recommend having the child pick out a few different colors, different styles, and then have some reserved just for play time. They can put the masks on their dolls, they can wear it around the house just to get used to that sensation and the feeling of wearing a mask, especially for children with sensory needs. It may need to have the child wear masks for one or two minutes at a time until the child gets used to it and slowly start increasing mask wearing time in the house. And then when they go outside of the house, there'll be a little bit more comfortable wearing one. But give the children the opportunity to pick and choose what they want to, to give them a sense of ownership and autonomy. And again, that play time is very important to just incorporate these masks into everyday play.

Host: Now we're all dealing with our own challenges at this time for adults and children. How can we help ourselves and our children handle this new normal at home? Because if we can't take care of ourselves, Dr. Zebracki, we cannot take care of our children and our loved ones give us some tips on self care and things that we can do with and without our children to help this all to move a little bit more smoothly.

Dr. Zebracki: That is very true. Parents are now required to have many more roles than they used to or more intense roles. It's very important for caregivers to take time to take care of themselves. That includes getting appropriate amounts of sleep, also incorporating exercise into their everyday activities, maintaining a good diet. Yes, I'm adding more to a person's schedule, but if you can't take care of yourself again, you're not going to be able to be as good or as able to take care of your child. So make sure that parents also set up times to socialize with their friends. Set up dates via zoom with their friends, have dinners that they can have with their friends and FaceTime during that time. So schedules are also very important for parents as well as for children.

Host: So before we wrap up with the summary, Dr. Zebracki, speak to the Shriner's parents for just a minute. They're nervous. Kids that are dealing with various orthopedic issues may have extra challenges at this time and it makes people even a little bit more nervous. Give them some reassurances. What Shriner's Hospital for Children in Chicago is doing to keep them safe?

Dr. Zebracki: Shriner's is here for our families. We're available by telephone, video conferencing, as well as in person over the next couple of weeks. We are increasing the number of patients we're able to see. Families can always call and reach one of us if they have any questions in the meantime. We have remodeled our lobby and we're also looking at other parts of our hospital to make sure that it is a safe place for all our children and the families. We are limiting the number of parents that are able to come with the child for appointments, limiting actually just to one parent per child. So we're trying to make sure we want to address the needs of our families in a very healthy and safe manner.

Host: Well, thank you for that reassurance and wrap it up for us with your best advice, the stress that we're all feeling the worldwide stress really, but for children and for parents with children that may have special needs. This can be an especially difficult time. Give us your best advice for parents on what you want us to do to really manage our wellness at home during COVID-19.

Dr. Zebracki: This is a very challenging time, but it's important to remember that it is a temporary situation and things will return to normal. What that normal will look like will be a little bit different than for COVID-19, but we're in this together. At Shriner's, we are here for you. We're available via telephone, video conferencing, and in person. We're going to be increasing our in person visits in the next couple of weeks. If families have any questions, have them reach out. We're always available to help and discuss any concerns that families may have at this challenging time.

Host: Thank you so much, Dr. Zebracki for joining us today. It's such important information for us to hear. Thank you again for more tips on wellness during COVID-19 please visit our website at Shrinerschicago.org. That concludes this episode of Pediatric Specialty Care Spotlight with Shriner's Hospitals for Children in Chicago. Please remember to subscribe, rate, and review this podcast and all the other Shriners Hospitals for Children's Chicago podcasts. Please also share this show, share it with your friends and family on social media, because that way we can get all of this good wellness at home advice from the experts at Shriner's together. I'm Melanie Cole.