During the pandemic, challenges around separation and peer relationships have become more common in children
“When the pandemic first hit, nobody knew it would last this long,” says Dr. Egger. Many families have been able to manage the stress of having kids at home, the disruption to school, and juggling childcare while working, but as we set into year two of the pandemic, “it really is showing an impact on the mental health of children and the mental health of parents.” As children are returning to school and some parents are returning to offices, “we’re seeing issues around separation. We’re seeing peer relationship issues for children who haven’t had the opportunity to be social with peers. We’re seeing some behavior challenges in school or group settings.” Common challenges like chronic stress, depression, and anxiety have only increased.
Any symptoms lasting over two weeks might indicate your child needs more mental health support
A common question many parents ask is: “When do I worry? When is what you’re seeing some variation of normal development, and when is it something that might be clinically significant?” Dr. Egger emphasizes the importance of prevention. She focuses on the very early signs so “that we can really get support and help before [the issue has] a negative impact on the kid or on the family.” (She also notes that even if the issue you’re facing isn’t a mental health challenge, you might still need support.)
“As parents, we want to protect our children from feeling this fear and upset. But we know that accommodating anxiety only makes it worse.”
“When we’re thinking about mental health challenges, we look at patterns of behavior that are lasting two weeks to a month,” says Dr. Egger. If your child is anxious, you can ask questions like:
- How frequently is that happening?
- How much distress is it causing your child?
- Is it impacting your child’s ability to play or go to school?
- How is it impacting your family?
If the issue is separation, you may be able to arrange your life around that by allowing the child to sleep in your bed, keeping her home and never sending her to daycare or leaving her with a babysitter. In this situation, “even though you’ve protected your child from experiencing that suffering, [it can have a] really bad impact on your family,” notes Dr. Egger. “As parents, we want to protect our children from feeling this fear and upset. But we know that accommodating anxiety only makes it worse because you’re giving the message, ‘Yes, this is a really scary, bad situation, and I’m going to protect you from this situation by taking you away from it.’ So we really are just reinforcing the anxiety.”
Instead, it’s important to give children the skills to be able to manage difficult emotions that are part of life. “Our job as parents is not to protect our children from feeling negative emotions or facing emotional challenges.”
“Our job as parents is not to protect our children from feeling negative emotions or facing emotional challenges.”
Other common signs to look for are changes in eating, sleeping, and other behaviors. In children, physical complaints like stomach aches, headaches, or other aches and pains can indicate that they’re feeling distressed.
Digital services could help solve the lack of evidence-based care in the pediatric mental health space
“Child mental health was a public health crisis before the pandemic,” says Dr. Egger. And it’s only gotten worse. Twenty percent of children have an impairing mental health or developmental challenge, and 80 percent of children do not get the mental health care they need. One key issue is that “it’s very hard to find evidence-based care – care that’s based on science delivered by practitioners who you can trust.” Seventy-two percent of the counties in the United States do not have even one child psychiatrist.
By co-founding Little Otter, Dr. Egger hopes to solve some of these issues by offering digital mental health services. “I think we have promise right now in how we bring digital innovation and telemedicine and data science… [to] make care more efficient, more effective, find ways to intervene as early as possible so that we can prevent challenges downstream.” Dr. Egger’s hope is that technology will create transformative change to child mental health.
Parents’ mental health is also a factor of child mental health
“Whenever we’re thinking about child mental health, we want to be thinking about parent mental health,” says Dr. Egger. There are genetic risks that run in families, like anxiety and ADHD, “but a huge part [of supporting our children] is also taking care of our own mental health.” Finding support for parents is, in turn, going to help the child regulate their anxiety.
“A huge part [of supporting our children] is also taking care of our own mental health.”
“Parents who have sought treatment and gotten effective care often can be fantastic advocates for their kids,” says Dr. Egger, but it’s also important to note that just because a parent faced challenges, doesn’t automatically mean the child will face challenges.
Prevention should start sooner rather than later
“When I started doing this work, people would make jokes: ‘Oh, you’re putting babies on couches,’ ” says Dr. Egger. People thought the challenges of young children were just risks. “But what my work and the work of other amazing people in the early childhood mental health field have shown is that the rate of these impairing mental health challenges is similar to the rate at older ages.”
Taking the example of ADHD, which can be diagnosed from age three but on average is diagnosed at age nine, most parents look back and say, “We knew that there was something going on when our child was little.” Early childhood ADHD includes a lot of the same behaviors of preschoolers: inattentive, hyperactive, impulsive. Diagnosing it at a young age can seem tricky, “but what’s important to realize – and it’s true about ADHD or any of these disorders – is it’s a pretty high bar to get to the point of meeting diagnostic criteria. If you take ADHD, you have to have seven or more symptoms.”
According to Dr. Egger’s studies of preschoolers with ADHD, 45 percent had been suspended from school at least once, 15 percent had been expelled at least once, and 80 percent were having significant problems in their relationships with their parents, other adults, siblings, and peers. “This is just an example [of how], across the board, we are not recognizing that young children suffer from these same challenges [as older children],” she says. There are treatments to help early on to prevent these challenges from impacting their development over time. “That’s why I love early childhood mental health – because it’s really hopeful.”
“Children from a very young age face a lot of challenges. The earlier we can identify them, the earlier that we can help get a child back on track in terms of their development.”
It’s very common to see a parent have an “aha” moment when their child is diagnosed with something like ADHD. They’ll say, “‘Oh my gosh. That’s what I had. I thought I was a bad kid, a bad student.’ It can be very powerful for parents to help their children and rethink their own childhood and challenges,” says Dr. Egger.
We want to think of childhood as a magical time, “but the truth is, children from a very young age face a lot of challenges,” says Dr. Egger. “The earlier we can identify them, the earlier that we can help get a child back on track in terms of their development.”