Dr. Bunting: If I had a penny for every time I have said, “It really comes down to your individual risk tolerance.” How do you feel about risk — both the risk of getting COVID and what that would look like for you, and the risk of this activity and exposing yourself? Ultimately you have to decide, and a lot of those discussions are around your own comfort level, and the comfort of those you’re spending time with.
“It manifests differently depending on the child’s age, but the youngest kids are more likely to show, rather than tell, when they’re feeling anxious.”
Dr. Greene: I had a family that was always asking, “Is this safe?” I would start off the conversation with, “How much do you want to do this?” I had families whose kids were thriving at home in virtual school and they didn’t go back right away. As soon as they called and said, “The five-year-old’s acting out, the seven-year-old feels left out because he’s the only kid not back in the classroom. Is it safe to go back?” It sounds like the benefit is worth the very small risk. So I always talk about risk-benefit. It’s just a constant balancing of that equation.
Dr. Fradin: It’s also important to take what you can get. So if we have a summer with really low cases and variants circulating that are well covered by vaccines — if there are meaningful experiences you want to have for yourself or your children, go get those experiences in, at least domestically in the U.S., when it’s a good time.
Recognizing and managing anxiety
Dr. Fradin: For children, with all the changes to their schedules and the restrictions on their body with masking and spacing, they have experienced anxiety in this pandemic. It manifests differently depending on the child’s age, but the youngest kids are more likely to show, rather than tell, when they’re feeling anxious. They may withdraw from their normal activities or say they have a headache or tummy ache. Older children are more vocal when they’re unhappy, but it also can show with changes in appetite, changes in sleep.
I think it’s important for us to realize that the anxiety that has begun during the pandemic doesn’t necessarily turn off like a light switch after vaccination, that it’s a process of re-acclimating to life post-pandemic too. And it’s going to be a longer-term issue for many people.
Dr. Glinder: The anxiety centers in your brain react first, and then our critical brain rationalizes what we’re reacting to. That works really well in an emergency, like, “Oh, there’s a lion right there.” But in our modern day, with COVID, the anxiety is in response to so many different inputs. That anxiety builds up, but people don’t recognize the buildup, and they likewise don’t recognize how to chip away at it as we come out of this.
We’re getting new stimuli as we return to normal activities, but we’re way above pre-pandemic levels of anxiety. And so we want to look at all the stressors in somebody’s life because they’re additive, even if they don’t feel like they’re causative.
Dr. Greene: Unwinding is something that we’ve talked about a lot in our practice, but I think with kids, we sometimes leave them out of those conversations. We may have told them, “Stay six feet away from your friends, wear masks, everyone’s dangerous. You could kill grandma.” And now we know why we’re safe, but we may have forgotten to tell the kids. As it’s age appropriate, involve them in those conversations and explain to them about vaccines and why we’re going to do things that we weren’t doing before.
You want to recognize the collective trauma that we’ve all been through, but also recognize that for some kids, it was a great year. You don’t want to be constantly talking about, “This has been so terrible and generation-defining. You’ve been through such a terrible time.” It’s a fine line.
“With kids, never assume—ask, how are they doing? How did it feel to be back in school? How did that weekend feel? That was a lot. Do you feel tired?”
With kids, never assume — ask, how are they doing? How did it feel to be back in school? How did that weekend feel? That was a lot. Do you feel tired? Just checking in with older kids. With younger kids, check in with your family. How did that go? Wow, we had an epic meltdown and we were all screaming at each other. Maybe that was too much too soon.
Tracking lifestyle changes
Dr. Fradin: At a population level, there’s a pretty good suggestion that people have gained weight, that maybe as many as eight or 10 percent of children who were not overweight before the pandemic are now overweight because they didn’t have the same opportunities to exercise. Children’s commute to school and their sports activities were a huge opportunity for them to move their bodies, and there’s been a lot of stress and changes in food insecurity.
On the other end of the spectrum, sometimes when people are grasping to control their environment, they restrict their food intake. And so some people have experienced weight loss and eating patterns that border on disordered coming out during the pandemic. But weight is only one aspect of health. It’s just a number, so I think it’s important to keep the context of, what is your lifestyle? Where are you in your wellness and how does movement and sleep and mental health play into your family’s weight journey?
Dr. Bunting: I actually have a group of adults — mostly single, younger adults — who have gotten much healthier during the pandemic. Before, they were out at bars, partying at night, drinking too much, eating too much, not sleeping very well, overworking. And they’ve all been like, “Wow, I feel so good now.” They’ve lost weight. So we’ve been having these conversations about: How do you not fall back into that unhealthier lifestyle pattern when it’s available to you again? How do you remember how this feels on the other side of the pandemic?
I’m talking to them about writing down or dictating into their phone about how it feels to live a healthier lifestyle. Everything from sleep and exercise, to just how they feel in the course of the day.
“But weight is only one aspect of health. It’s just a number, so I think it’s important to keep the context of, what is your lifestyle? Where are you in your wellness and how does movement and sleep and mental health play into your family’s weight journey?”
Dr. Fradin: There may be pandemic changes that kids and families want to hold on to. Some parents have traveled less and been around for more meals, or some kids have been less over-scheduled and they find more space for free play. As we reopen, we should be cognizant of what we want to hold on to, what has been the good, because for a lot of families there is something that’s been good.
Weaning off of screen time
Dr. Glinder: I think that it’s important to have activities that replace the screen time, because screen time replaced a lot of activities coming into the pandemic. Be strategic about what is going to go in those blocks of time. One of the easiest ways to deal with that is scheduling something that, while you’re doing it, you can’t be on the screen too — even better, leave your devices behind. It’s a lot easier than just turning off the WiFi and having a battle.
Dr. Greene: Screens were a lifeline for teens. Recognize that and empathize — don’t tear the XBox out of the wall and say, “You’re done.” That’s where their friends are. That’s what they’ve adapted to. Instead say, “Hey, why don’t you and your friends all do X, Y, or Z” — something that they can’t replace with screens. At some point there may need to be limits, but right now, it’s so much easier to have something scheduled that’s social with friends, serving that same purpose as screens have this past year.
Dr. Glinder: Kids are much better at their own mitigation measures than we are because they’re back in school doing it every day. If they’re going to have a playdate, they should mask and distance like they do at school.
Dr. Fradin: I think while you’re part of a school or daycare, it’s really important to understand the expectations of the community you’re part of, and to prioritize keeping those places going. Because it’s so important to everyone that we don’t have risk. But if you’re in an area where the rates are low and the families are highly vaccinated, I think that doing outdoor activities is pretty safe for children. And you can incorporate masking to further reduce the risk.
Dr. Greene: And small groups — going back to that pod mentality. Every family is going to have to do their own risk assessment, but maybe do what baseball teams are doing: masks on, jump on top of each other, play, and get to be kids.
Making summer plans
Dr. Fradin: Making summer plans goes back to the benefit. For example, we have our cousins who can come to visit us this summer. For the purposes of two very cautious families whose parents are vaccinated, allowing the kids to mingle in a very selective way makes sense for us. And it is responsible in that the kids won’t be returning immediately to school after, and the adults understand the risks that we’re taking to make that decision.
Dr. Greene: With younger kids, or even older kids, role-playing or having a conversation before an activity can be helpful. There’s going to be new rules, so go over what the rules are going to be. For Kelly, she might say: “When we’re with the cousins, we don’t have to wear masks and we get to do a slumber party. But when we go out to restaurants we’re still going to wear a mask.” If you’re going to fly, tell the kids what they’re going to be doing, what the adults are going to be doing, what everyone’s jobs are.