Kids' Mental Health During Covid

Pediatrician Jody Ullom offers advice to better understand how the experience of living through a pandemic is affecting kids, how parents can spot potential issues, and what they can do to make things better.
Kids' Mental Health During Covid
Featured Speaker:
Jody Ullom, MD
Jody Ullom, MD, attended the University of Oregon as an undergraduate, Oregon Health & Science University for medical school, and completed her pediatric residency at the Stanford University School of Medicine. Her medical interests include anxiety, depression, digestive issues, asthma control, and complex medical problems and their management. On a personal level, she practices daily meditation and enjoys gardening and regular exercise by walking or hiking. Dr. Ullom has two children, who keep her both busy and humble. 

Learn more about Jody Ullom, MD,
Kids' Mental Health During Covid

Scott Webb (Host): The pandemic has affected all of us physically, of course, but it's also affected us mentally as well. And that's especially true for our kids who have endured distance learning, separation from their friends and teammates, maybe spending way too much time with their parents and so much more. And joining me today to help us understand what our kids have been through mentally and how we can best support them as life slowly starts to get back to normal, is Dr. Jody Ullom. She's a Pediatrician with Stanford Children's Health. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Doctor, thanks so much for your time today. We've all been living with and dealing with the pandemic and we're going to primarily focus on that. And as we get rolling here, what are the most significant ways the pandemic has disrupted kids' lives both directly and indirectly?

Jody Ullom, M.D. (Guest): I think the kids that I've seen most impacted are the middle schoolers and high schoolers, the tweens and the teens. And I think the year that they were off of school, and actually at home and not with their peers was really detrimental to their psychological wellbeing. As I like to say to people, we kind of did that experiment and we maybe protected their health, but we really impacted their mental health in a very profound and negative way. So, I've seen a very big impact in the middle schoolers and the high schoolers.

Host: Yeah. I've seen that myself. As I mentioned, I have kids, so I have a tween, but I also have a son who just graduated from high school last year. And so, for him going from high school now being in-person in his first year of college is amazing and interesting. And I guess the follow-up is what changes have you noticed in patient's mental states since the pandemic began?

Dr. Ullom: As we saw across the world, there's been this big surge in eating disorders in kids. It's sort of like the pandemic came and they were stuck at home. And so what else did they have to do? So, they really focused on, you know, good things. Well, let's exercise and let's eat healthy, but kind of took it to an extreme. I've had, I can't tell you the number of kids. I would have two new kids, two teens a week with new really profound weight drops. So, they really kind of took over that, you know, finding a way to have control in an uncontrollable situation.

And it's interesting now that they're back in school, there really has been a lot of improvement in that I've actually heard of teens who have been so motivated by their own struggles with eating disorders, that they've started clubs in their high school, and the interest has just unbelievable. I've heard of hundreds of kids joining these clubs to find out about eating disorders, their own eating disorders, or their friends' eating disorders or people within their homes.

So, it's been really an incredible service for those kids to be able to pay that forward and help other people. Another thing is that their world really becomes defined as they become teenagers with their peers. And so peer interactions are really important. And when they were at home and in the pandemic, they were really just in their family's realm and that's just not a normal place for teens to be. They're supposed to be out and about. I keep thinking that no matter what, even with the technology that we have, there should be times at a parent's life where we have no idea where our kid is or our teenager is, and we should be like, why aren't they answering their texts?

Why aren't they responding? I can guarantee you the vast majority of parents knew exactly where their kids were and their right under their thumbs. And that's just not a normal sort of situation. They're supposed to be branching out. They're supposed to be individuating. They're supposed to be identifying with their peers.

So, not only did it present as eating disorders. We were already seeing huge numbers of mental illnesses with kids in terms of anxiety and depression, well this just put gasoline on that. And it was just really profound, the numbers of kids with really significant depression and anxiety, through the pandemic and they're still coping with those issues as well.

Host: So, you gave us some things as parents to be on the lookout for. So, naturally then what can we do? What adjustments can we make to account for the things that we're seeing and experiencing with our children?

Dr. Ullom: I think it's really important to have dialogue with your kids and that can be a very high bar with a teenager. I tell parents when they're talking with their kids about sex and you know, that sort of thing, you know, they seem like they don't want to get the information from us, but they do. And so we just keep offering and then every so often you get the hand and then you give them a little break and you start again. So, I think checking in with them and just saying, you know, hey, I noticed that you seem to be spending even more time in your room than you did. Are you touching base with your friends?

Just kind of talking to them. I think that as parents, we cannot be the complete solution for our kids. We need a community, they need their friends, they need their teachers, they need their counselors, therapists, whoever, they need a team of people to help them. I mean, I was just thinking about, I'm not homeschooling my kids. And the reason they're going to other people is because other people have a lot of good things to offer them. So, I think the pandemic was even harder because these kids were isolated. So, the counselors didn't really see them. And their friends didn't really get direct contact with them. So, I think as parents, we need to be aware, keep the dialogue alive and engage others to help us in a team kind of mode to help kids get better.

And then I'm just going to segue right into being a pediatrician. I can be part of that process. I can't tell you the number of times I get back channeled by parents prior to their kids coming in for the physical. And they'll be like, I'm worried about this, this and this. I have one coming in today. It's a new patient and the mom's concerned because the kid has some significant anxiety and is very resistant to taking medications that he's taken in the past that helped him. So, it's really helpful for me to have that framework of what's going on. And then I can gently explore that with the kid and see what's happening.

So, I can be part of that process of talking to them about what's going on. And if they're not already plugged in with therapy, helping them get plugged in with therapy. So, it's a team approach, you know, talking to the school, sometimes talking to their friends. I mean, it's just really kind of engaging a group of people to help your kids get through this.

Host: Yeah, what's that old saying, it takes a village, you know, and I know that's kind of old school, but it really does. It takes a village. It takes a community. We have to work together. We have to do this as a team and speaking for myself and maybe you've experienced this as well. And so great to have an expert on to ask this question.

You know, life got a lot easier for us, for my wife and I dealing with our daughter and her wanting to be social and wanting to be with her friends and play sports and all that after she was vaccinated. Have you found that as well? That there's just this sort of giant sigh of relief. And now that the younger kids five through 11 are also eligible, do you feel like this is going to help us all sort of get back to some sense of normalacy?

Dr. Ullom: Yeah, absolutely. I mean, the vaccines are really key. It's really important that the kids get vaccinated. We do know there are some breakthrough cases, but we know that the kids who have any, anybody who has a breakthrough case is far less likely to become ill with it, far less likely to be hospitalized. I mean, the numbers are profound.

So, being vaccinated does provide a huge degree of protection. And I do see the kids feeling more relieved when they're vaccinated, because another concern that they all have is about bringing it back to their family or bringing it back to their homes. So, I do definitely see an improvement that kids are now getting vaccinated. And frankly, I think we've reached a point where, you know, the Delta surge in the summer was very scary, with the Delta and then the travel all at the same time. Now the Delta surge seems to be abating. And I really think we have to find sort of a way of coexisting with this virus.

There's going to be outbreaks. There's a little tiny outbreak at my high school here. You know, it's like isolation, identify, we're just going to have to deal with this. But I think the most important thing is that going back into quarantine and isolating our teens from one another is not the solution.

I mean, clearly it's not the solution. It will further erode their mental health. So, I do definitely see a light at the end of the tunnel in terms of back to some normalacy. And so, yes, the vaccines will definitely help in that process.

Host: Do you think what we're seeing and experiencing with our kids, what they're experiencing, do you think this is going to be a long-term thing? Is this isolated to the pandemic, or if we don't get a handle on some of the, you know, mental aspects that we've discussed here, could this persist beyond, well beyond the pandemic?

Dr. Ullom: This is collective trauma for our entire society and the world. And so definitely trauma is going to be part of their story because of this. The vast majority of kids are going to be somewhat informed by this experience. I tell kids this all the time, you know, what's the difference between your brain and my brain? Well, you're far more neuroplastic than I am. So, they have this incredible ability to adapt and change for the positive. So, if they recognize that they've been traumatized and they recognize that gee, I'm a lot more anxious than I used to be, or I'm feeling really down and depressed.

If they come to an awareness about it and they get help, they literally can retrain those tracks in their brains and really create a positive adulthood with this. Minor anxiety, depression things might pop up from time to time as their lives go on, but by dealing with it and having an awareness at a young age, they really have a chance to have a pretty good life with this.

So, I like to really quote that they have until around 26 to figure this out. So, it's not like you're 13 and you have to know next year how my brain works. These situations make me anxious, but some sort of awareness and some sort of tools to deal with it when it comes up as opposed to using drugs or alcohol or overexercising, or restricting your food to really deal with those feelings as they come up. So, I do think it's going to inform them going forward, but I hope that they can use this by having some insight into how they work in the world and using that in a positive way going forward.

Host: I think our hope is that this will just be a distant memory for them. And we've talked about the anxiety, emotions, what can we do, if our kids have anxiety or stress, whether it's about going back to school or just the pandemic or life in general, where do we start to? Do we mention it to the pediatrician and we move on from there? What's your best recommendations?

Dr. Ullom: You know, I think that it's a multi-pronged approach. And so I think talking to your pediatrician is a really good beginning, a very good start. We have the advantage of most times knowing the families, you know, kind of having an idea of this kid was a little anxious in the past, so we know to check in with them. So, I think starting with your pediatrician, we're very accessible. You know, you can come to us for a physical, a lot of kids are overdue for their physicals, so there's a good excuse to come in. Or you can actually schedule a visit, you know, that you're concerned about and so just scheduling a visit to talk with a pediatrician, I think is a really good first step.

Sometimes for kids too, if there's anxiety, there's a few labs that I do to kind of make sure that there's nothing you know, underlying medical going on, so that can be reassuring to the family and the teen as well. So, that's one thing. And then utilizing school counselors is terrific. Utilizing outside therapists is great. I mean, we're very fortunate were I am. There's actually a lot of therapists for kids and adults, but even with having a relatively high population of therapists, they are still really booked. And so it's very hard to get in.

I literally have a living list of therapists that's probably 20 or 30 long, that I can give to parents and they can go through and kind of see who's a good fit. And if anybody has openings. So, I think, again, starting with your pediatrician is a great start, talking to the school counselor and seeing if you can get outside help, if you feel like your teen is having any kind of issues or struggling, just offering them those resources.

Host: Yeah. And I'm sure that a lot of this is age appropriate and that's what I love about pediatricians is you all just have a knack. I don't know if you're just born this way, or you learned this in school, but you just all seem to have a way of having that age appropriate sort of way of dealing, not only with the adults, but also with the kids, because dealing with a five-year-old versus a 15 year old and the range of patients and children that you see is a challenge, but you all seem to be up to it.

Dr. Ullom: Thank you for the compliment to all of pediatricians. I do think all, we're a dedicated group and they're just like, there's so many great pediatricians. And so I know so many great pediatricians. It's really lovely to have so many wonderful colleagues. Part of our jobs in these physicals is asking about these things. I mean, we really are pushed by the American Academy of Pediatrics, their lead to really look at mental health issues and do screening questionnaires and ask kids how they're doing. And also for the vast majority of us, for the teen physicals, we take some time alone with the kids and give them an opportunity to talk to us in a confidential way of anything that they're worried about.

And every so often you'll have a kid who's not very forthcoming, but a lot of times you can tell there's something up because there's a delay in their response. Like, are you feeling down or depressed? And they're like, No. You know, some big delay. But anyway, we are a ready, available resource and largely it's covered by your insurance and we're really good place to start, I think.

Host: Yeah, you really are. And I've just appreciated this conversation so much today Doctor and as we get wrapping up here, we've talked a lot about the sort of the parents' perspective and our role in all of this. And I'm sure many of us feel anxiety and have felt it during this time. So, you know, I know I'm pushing the limits of your age range here, but what coping strategies do you have for parents to make sure that we can manage our own stress, and that we don't make things worse for our children in the process, especially as some of us go back to work in the workplace? As I mentioned before we got rolling, a lot to unpack there, but maybe you can help us all.

Dr. Ullom: You're absolutely correct. I was just talking with a therapist and I, you know, I was just talking about families and struggling and that sort of thing. And I have a 21 year, and an almost 18 year old at my house. I certainly feel this, the collective stress we're all experiencing.

So, I think everybody's still is a little bit on edge and a little tense and we're probably not functioning at our absolute best. So, I think we need to be forgiving to ourselves. My joke is I make a lot of mistakes with my kids, so they know what a true amends and apology looks like. If we're short with them if we're kind of crabby or whatever it is, acknowledging that and admitting that to them. I think really it's important that we model self-care. You know, so if we're not doing the exercising and we're not kind of starting to have our social contacts as well, if we're not doing things to promote our own emotional wellbeing, whether it's like exercising, meditating, you know, eating better, whatever it is. If we're not modeling those things, we're not going to be able to be there for them. So, we have to be able to parent from you know, the overflow, we can't deplete ourselves by trying to make everything okay for them. And the other thing is, boy they're individuals and we cannot just go you're depressed. I want you to be better. Let me give you this, this and this, and it'll make you better. They have to be willing participants in this and some kids are not there. And so you can't beat yourself up as a parent if you have a kid who's just not receptive to getting help.

What you need to do is keep checking in with them. Make sure you have a safe environment, no guns in the house. If you have a gun in the house, it ought to be secure. We'd have to make sure that we keep our kids safe, keep checking in. And hopefully at some point they will be ready to access care. So, you have to take care of yourself in the process of trying to take care of them.

Host: That's a perfect way to finish. And I think you're so right, we have to take care of ourselves mentally, physically, look out for our kids. Talk to them when they'll talk to us, my daughter this morning, didn't want to eat breakfast. She didn't want to talk to me. And we just drove to school in silence and I'm like, I'm going to have to be okay with that. She's almost 14 years old. She knows when she wants to talk to her dad. And when she doesn't and this has just been really great. Your compassion, your expertise, makes me feel better and I hope that it has the same reaction in parents and maybe they even let their kids listen to these. So, Doctor, thanks so much for your time today. And you stay well.

Dr. Ullom: Okay, thank you so much for interviewing me. I really appreciate this, and I really appreciate you getting this information out to everyone.

Host: For more information on this topic, visit Stanfordchildren' And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.