Transcription:
Managing Back-To-School Anxiety During COVID-19

Melanie Cole (Host):  There's no handbook for your child's health, but we do have a podcast, featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole, and today we're discussing managing your children's feelings and anxiety about going back to school in person. Joining me is Dr. Sherry Huang. She's the Site Medical Director for Pediatrics, Lower Manhattan and an Assistant Professor of Clinical Pediatrics at Weill Cornell Medicine. Dr. Huang, it's a pleasure to have you join us again today. This is such an interesting topic, and I know as someone who has two children now in college, that my youngest is really nervous about going back. So, this is a common thing, and we're going to try and kind of hit all the age groups. So, as we start to think about this new normal in the coming months, and families may be feeling anxious about going back in person to school or even camp. What are children experiencing right now? What have you been seeing?

Sherry Huang, MD (Guest): Thank you, Melanie. It's great to be back. And I agree, this is such an interesting and important topic. It's been more than a year since many children have gone fully or partially remote for school. As the pandemic is better controlled in the US, and schools are opening up, many children and parents or caretakers, and even those who are very excited about schools reopening, will feel some anxiety about returning to in-person learning in the fall. Even though we know that there are many benefits to in-person learning, the prospect of this presents new challenges for families. Some feelings that children may be experiencing, children may have separation anxiety. So, after being home every day with the family for so long, children may have difficulty separating from their parents or caretakers.

They may worry about leaving a newly adopted family pet at home. They may be scared of getting sick, or bringing the virus home to medically fragile family members. They may be concerned about racially targeted violence when they go outside or travel to school. For those transitioning to a new school in first grade, middle school or high school, they may not know exactly where to go on the first day, what the school would be like and where the classroom is and if they will have any friends. If the child was a victim of bullying, they may worry this will continue when school starts. If a child has learning disabilities, social anxiety, or depression, and did well at their own pace during remote learning, they might be concerned about what will be required of them in the classroom.

Older children and teens may be self-conscious about changes in their bodies in the past year. Maybe they have grown taller or started showing signs of puberty, developed acne or gained weight. They may worry about how their friends will react to the changes after not seeing them for so long. For young adults starting high school or who are just starting college, they may feel sad or disappointed about missing many milestones, such as prom, graduation, or senior trips. They may be very anxious about starting college. There are many unknowns about how dorm life, classes and socialization will work because of the pandemic. They may not know if their roommates or classmates will be vaccinated.

Host: Wow. That is a lot to process for these kids, Dr. Huang. So, how do we know, how can we tell if our child is anxious about going back to in-person activities or school? I know myself and other parents like me, when our children are going to college for the first time you hit the nail on the head with that, they don't know about the dorms and the protocol, and there's no orientation. They don't know who's vaccinated. Who's not. So, how do we know what's going on in their heads?

Dr. Huang: So, for teens, and older young adults, they may be more withdrawn than usual. They may be spending more time in their rooms or sleeping. They may be less communicative with you. For younger children who are not yet verbal, you may see increased defiance or irritability or clinginess. They may just flat out refuse to go to school or have meltdowns. They might require frequent reassurance by asking am I going to get sick? Are we going to be all right? There may be disturbances in sleep, loss of appetite, loss of concentration. They may also have less energy. They may show physical symptoms like nausea, muscle tension, or dizziness, headaches, or stomach aches. And then some of them may have persistent sadness or crying.

Host: Wow. Again, it's a lot for a child, so what can we do as parents first of all? You know, obviously you're going to talk to us about when it's time to contact our pediatricians, but what should we do as parents to help our children if we recognize some of these red flags that you've just mentioned?

Dr. Huang: I would encourage parents to ask their child what is going on in their minds and listen intently. Start with open-ended questions. And then probe a little deeper. Examples are how are they feeling about the past year and what are they feeling about going back to school? What are they most excited about? Parents should avoid asking leading questions such as, are you feeling nervous or scared about going back to school? They should make these conversations casual, like during dinner time, during a calm moment, while on a walk or a drive, but these conversations should be ongoing and regular so that the child has time to process their thoughts. For teens, it may help to schedule time to talk every week. Parents should observe how their child has been acting when discussing going back to school.

For children who are not yet verbal, using a feelings chart or faces or asking them to draw might help them express themselves better. Now, it's really important for parents to validate these feelings and not dismiss them or minimize them, or even make fun of them. I encourage parents to keep an open mind and not jump right away to reassuring their child. Use affirming statements, such as so you were excited about school, but I understand that you were worried about this issue. Can you tell me more about this? Let's work together as a family to see what can be done. If your child says they are scared or will miss mom or dad or the family pet, you can say, I know you are scared or we will miss you too, but we are so proud of you for going to school and I will be at your school to pick you up as soon as you are finished.

For a teenager, whose body has gone through changes, ask them what would make them feel more comfortable. Do they need different clothes, different underclothing. Do they want to see their doctor about newly developed acne. And now is at the time to discuss and have a plan, for typical teen and young adult hygiene issues like showering, deodorant use, shaving that perhaps the teens do not have to deal with while learning remotely. This is particularly important for college students, also.

If a child asks questions that you cannot answer, tell them you will ask the teacher or the doctor and get back to them. Perhaps it would help allay their anxiety if you make a list together of the questions to tackle. If a child will be starting a brand new school, or even if the child has not been to the school physically in many months, I suggest parents and their children to travel together to the school a few times, so the child knows exactly where they will go on the first day. And a few weeks prior to starting school or college, it's a good idea to review their sleep schedule and think about gradually shifting to sleeping earlier so that they can wake up in time for classes.

Host: Wow. That was great advice. Absolutely great advice, especially about the hygiene and the getting them back into a routine so that they're ready to wake up because really with the way it's been, school online, some of them don't even roll out of bed. They just open their computer and start their class, you know? So, this is really excellent advice. Now, red flags, you mentioned tantrums. You mentioned feeling anxious. When do we involve our pediatrician or a mental health professional Dr. Huang? What if the parents are nervous about sending their child back to school, can we see this therapist together? Is it something the child needs to do on their own? Tell us a little bit about when it's time to bring in the help.

Dr. Huang: It's definitely a good idea to involve your pediatrician or your child's school and or mental health professional. If your child has persistent crying beyond a few weeks after school starts, or they're unable to attend school independently after two to three weeks without having meltdowns, if they have persistent physical symptoms, such as headaches or stomachaches, especially if they only occur on school days and that has been medically worked up. These could be somatic symptoms that indicate anxiety or depression. If the child or teen has poor sleep or reversed sleep schedules and unexplained weight changes. If there are reports of bullying or drop in grades for older teens and college students, and of course, thoughts or expressions of self-harm or suicide. Now, some other things that a parent can do if their child is fearful of returning to in-person school is, considering incremental social exposure. So, inviting a few children from their class to an outdoor gathering prior to the start of classes so that the children will be excited to see their friends again.

It might be very helpful for teens to gather and hear that they're not alone in their feelings of frustration and disappointment about the past year. If the teen is very anxious, try not to mention starting school too far ahead. Perhaps just a few weeks prior and make it an exciting time. For a child consider getting a new book bag or small reward for completing the first day of school, consider preparing a routine or a visual schedule so your child knows what to expect. For a child who is fearful of separation, it might help to let them know what you will be doing while they're in school and when you will be there to pick them up. It's also a good idea to discuss and practice with your child things that they can control such as keeping the mask on at school, not touching their face, social distancing, and hand hygiene. And what the plans are for meal times.

Also, children should practice what to say or do if they see other students or friends not following the safety guidelines. You can use authority figures that your child trusts by saying, I have spoken to the pediatrician or to the principal, and they have assured me that the child will take measures to make sure all children are safe.

Host: So, before we wrap up then, and really what an informative segment for parents to listen to and share with their friends and family, because we are learning this, this expert advice from the specialists at Weill Cornell Medicine. So, as we wrap up Dr. Huang, what should the parents do if they themselves are nervous, if they are nervous about sending their child, maybe their child's nervous, maybe their child's not, but if they themselves are feeling this anxiety, give us some of your best advice about helping our children when we may be feeling it ourselves.

Dr. Huang: That's such a great point. It is very normal for parents to be anxious about sending their child back to school. And it's important for parents to manage these feelings before discussing with their children because children will definitely sense this anxiety. I suggest parents tried to build resilience by speaking to other parents or friends or their support systems.

They can speak to their healthcare providers. They should also consider self-care measures such as deep breathing, meditation, or exercise anxiety, or the stress becomes too overwhelming, seeking a mental health professional may be important to help parents cope. Parents should be honest and empathize with their children using age appropriate terms, of course, but should try to model resilient behavior.

Parents can use statements like sometimes I get anxious or emotional at work, and this is how I manage my feelings. Parents can consider practicing deep breathing or stress reduction methods with your child. And also parents really should keep in mind that with proper precautions in schools, such as having all the children above age two years old, wear masks, hand-washing appropriate distancing and ventilation and symptom screening and testing protocols; it has been shown that COVID-19 transmissions in schools are actually rare. So, I would suggest that parents become familiar with the recent guidelines by the CDC and the American Academy of Pediatrics on the safe reopening of schools and ask what the school's mitigation measures are.

Host: Wow. That was such an excellent episode, Dr. Huang, and to reassure parents, when you said that it is rare, this kind of transmission, is really encouraging and heartening for those parents of us that are sending our kids back to school in person. I thank you so very much for me and for our listeners. Thank you again for joining us. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download subscribe, rate, and review Kids Health Cast on Apple podcast, Spotify and Google podcast. For more health tips, please visit weillcornell.org and search podcasts. And don't forget to check out our Back to Health. I'm Melanie Cole