Coronavirus in Context: The Complex Impact of COVID on Children

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You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. We're clearly seeing the impact of COVID on children physical and mental. And the different policies relating to schools are-- are making parents frustrated, are-- are making kids frustrated, and how do we make sense of all of this and keep everyone sane while keeping them safe?

So to help provide insight, I've invited back two of our most popular guests. Dr. Nathaniel Beers. He is a Fellow of the American Academy of Pediatrics, and he's a pediatrician at Children's National Hospital in Washington, DC. And Dr. Phil McGraw, host of the Dr. Phil Show, now in its 19th season. Gentlemen, thanks for joining me today.

Thanks for having us.

Thank you so much for having us.

I know you are both passionate about children's health, and I wanted to start off with, what has been the impact of COVID on children, especially their mental health? Dr. Phil, what are you seeing?

One of the things I'm seeing is the impact of what the children are not doing. I'm so concerned about the developmental aspects of what's being lost out with the children not having the interactive experiences interpersonally, competitively, whether it's in sports or debates at school, playing with the other children, and the academics that are being lost in the classroom. Parents are not trained teachers, and particularly with the younger children, the primary grades that just don't do as well with remote learning.

And we know that the number one predictor of graduation is whether or not a child is reading on grade in the third grade. And children that fall behind in the third grade are four times less likely to graduate, and if they're in a lower income, lower socioeconomic group, it's-- they're six times less likely to graduate if they fall behind reading level in the third grade. So I'm very concerned that these children are falling behind now because they don't do as well with remote learning.

And Dr. Beers, you know, some experts are saying the longer that this drags on, the worse it's going to be on-- on children's health. Well-- just partly based on the uncertainty of it all, too. What-- what are you seeing in-- in your practice?

Well, I think as Dr. Phil noted, right? There's a huge emotional impact on children as well as the educational impact on children. And we're also seeing that it is, as many things, not necessarily an equitable distribution of impact. And so certainly we know that when you talk about access to the educational services, as students were, uh, starting school virtually this, uh, spring, that that, uh, access was not, uh, necessarily equitable across the-- the communities, and certainly, uh, the ability to access was much more difficult for black and Latinx communities.

And so certainly that, uh, as Dr. Phil noted, has grave implications around educational attainment, as well as around greater health. We also know, uh, as it relates to health, uh, that reading is as important to someone's general health as it is to our educational attainment. And so, uh, certainly early literacy and health literacy are inextricably linked, and we need to make sure that we are addressing those issues as we think about how to address, uh, the wide array of challenges that families and children have been experiencing during this pandemic.

Yeah. Are we taking the wrong approach? In many ways, it's been a one-size-fits-all-- either the school's completely closed and it's all virtual, or there's some hybrid. And there's not a differentiation, uh, Dr. Phil, to your point about the age of students or the grades of students. In Canada, they've been talking about having either quadmesters or their cohorts where perhaps elementary school students are in class for some limited time, but older students are not. Here, it tends to be one size fits all. Is-- is that the right approach or it's, you know, it's the best that we can do right now?

Well, I don't think you can take the one size fits all in terms of the age of the children. And, you know, Dr. Beers couldn't be more correct with the intertwinement between educational literacy and-- and health literacy, because parents in different parts of the country have different priorities, uh, based on their experiences growing up.

And I know that if you-- if you look at what's happened, there was no real plan for remote learning, and I think we failed the children in that. We shut the-- we shut the schools down. The day they shut down, there should have been a place for remote learning and immediate planning for reopening the schools, and that just didn't seem to be a priority.

And I don't think you have the same plan in Wyoming where the density of population and-- and the frequency of the virus is much different than it is in an urban area like New York or LA or Chicago. You can't have the same plan on for those two situations. So it can't be the same for all ages and it can't be the same for geographical areas that are so different in density of population and frequency of the disease. And I do think there are more buffalo in Wyoming than there are people, but I'm going to check on that, which is a good point about what's happening--

--you're right.

What's happening in the local area is going to impact what's happening at the school. But Dr. Beers, what about this one size fits all where some people would argue-- you and I are both in the DC Metro area, that-- are the schools doing the right thing when we're saying, you know, can first graders, kindergartners really do virtual learning?

Yeah, I think certainly. Anybody who has, uh, young children, uh, this spring experienced the challenges of thinking that a-- a child could independently sit at a video screen and effectively learn by themselves without an adult in the household or another member of the household engaging with them, uh, to make sure that they were accessing the information and understanding the information and participating in that program.

And so, you know, certainly what you saw is, uh, from the American Academy of Pediatrics is a regional recommendation, recognizing that you need to understand what the thread is in your community to know what your plan should be. But what you also saw from other organizations like the National Academy of Sciences is an understanding that-- a really focusing on early childhood and elementary school is really critical as we think about how to effectively open, and make sure that we acknowledge that the ability of about five or six-year-old, uh, to engage in virtual education is very different than a 16 or 17-year-old.

Um, and so thinking that the same plan is going to be effective across ages, across geographies, um, is a naive, uh, way to approach the issues that we have in front of us today.

Dr. Phil, you did a-- a survey on Facebook where you polled parents-- and we're going to put some of the results up on screen. You found children are bored, they're not sleeping well, they're lonely, and they're sad-- none of the things that we want to see in children. How concerned are you about these survey results?

Well, Dr. Whyte, I am concerned about it. We-- we found that, um, in terms of sadness, 52.1% of the parents report that their children are quite or much sadder than they were before the pandemic; 68% are much or quite more, um, lonely; and 79.08% are much or quite more bored.

And the problem with this, of course, is, we took these measures-- uh, we took this poll, uh, about 60 days in. And now they're talking about so many of the schools not opening, which means this is going into-- it's going to be like 120 days into the fall, 180 days in. So this is just going to get deeper and deeper of these children being in isolation. And as Dr. Beers can address, loneliness in human beings is just something that doesn't bode well for their health. You start to see depression and anxiety, which is-- was also significant in our findings, and these are things that just simply don't do well.

And additionally, we also know that there's a certain savings that are lost. Math skills, for example, even over regular summer, erode. And what's going to happen as these times stretch out when you don't have the academic rigor with some of the poorly-planned remote learning? So I'm concerned that these children are going to, uh, experience failure when they get back into the classroom. And we've seen-- Oxford did a study, uh, after the '05 quake in Pakistan that those children came back after that a year and a half to two years behind their peers, and that this lasted for a lifetime, which has now been like 15 years where they were 15% behind in earnings over the-- over the life of the-- of the study. So they just don't ever catch up.

So this has long-term impacts on them emotionally, financially, and in a lot of ways. So this is something that we're looking at short-term that has long-term impact.

Dr. Beers, you know, sometimes we like to say that, you know, kids are amazingly resilient. Um, so what is your concern about the long-term impact, especially-- let's be honest, we're not sure where the end is, you know, here.

Yeah. I mean, I think that is, uh, one of the things that is certainly unknown, and I think that one of the things that, uh, we have to be, uh, thoughtful about, uh, figuring out how we move forward meaningful solutions. I think that, uh, we know that, uh, as Dr. Phil noted, every summer there are these slide in academics that occurs, uh, while students are out of school.

And yet we're now talking about, uh, an additional three months already as well as whatever this extends to in the fall, and beyond those social-emotional states that our kids are in that is critical, uh, in their capacity to be able to learn, you also are not providing the quality of instruction, uh, that students need to be able to a-- achieve the academic potential that they have, and that that has long-term consequences in their capacity to be effective in a workforce in the future, as well as their future earnings potential.

And so certainly as we think about these solutions, thinking about how we are providing effective solutions that allow students to get high-quality instruction, access to the social-emotional supports that they need, as well as the nutritional supports and other supports that they receive for school are part of what we have to be thinking creatively about, uh, to ensure that we maximize the potential of every child and that we support families during this challenging period.

Dr. Beers, what do you say to people that say, we are in a pandemic that occurs once a century? You know what? If we lose an academic year, does it really matter? We need to keep kids safe, we need to keep teachers safe. i want to get both of your response to that, but let's start with you, Dr. Beers.

Yeah. I mean, I think there's no doubt we're in a once-in-a-lifetime, uh, pandemic, and that, uh, we all hope that that is the case. Um, and yet we know that, uh, that type of experience can have long-term consequences for children, uh, and their families. Uh, and so it is important for us not to use that as an excuse for not figuring out high-quality solutions, uh, that are going to allow, uh, us to ensure that, uh, children and adolescents, um, are getting the education that they need, as well as all of the other support services that schools provide for children and adolescents, uh, to ensure that they are healthy and able and ready to learn.

Doc-- Dr. Phil, what's your reaction to that? People who come to you and say, doctor-- keep them safe until we figure out what's going on. What's wrong with that?

Well, first off, I-- I have to say, Dr. Beers just articulated it as well as I've ever heard it said in saying, this cannot be an excuse that we have to come up with high-quality solutions. It's not just a gap year. We have to come up with high-quality solutions to maintain good academic training, and I'm so glad that-- that Dr. Beers, you said that the way you did, because that's what has to happen.

But another thing, in terms of keeping children safe, one thing that I'm very concerned about is-- I was speaking with the medical director of the Department of Child and Family Services here in LA just recently, and he tells me that their referrals are down 40% to 50%. Thousands of calls per month because so many of the mandated reporters that make observations about psychological and physical abuse are in the school systems. Through the counselors, the teachers, the-- the people that work in administration. We don't have those eyes on children now to observe these things and report them.

So I understand that we have to keep the children safe, and I-- I don't know that it's safe to put them back in the classroom right now. But I also know that they're not safe if we don't have mandated reporters watching over these children that could be subjected to domestic violence, molestation, and issues in some of these homes, and now it-- it isn't that that's dropped off-- just the reports have dropped off, and I'm very concerned about that.

Let's be practical and talk solutions for our viewers. So Dr. Phil, how-- how do parents communicate with kids? Wh-- where do we go from here? What's the roadmap?

I-- I think as corny as it sounds, it really does get down to communicating with your children. And the advice that I give is to meet the children where they are in their understanding. You know, we always talk about talking to children in age-appropriate ways, but nobody ever defines what that really means--

Well what does that mean? I don't know-- [LAUGHS]

And the-- and the way to define what that really means is to ask questions and listen-- what terms are they using? If you're talking to them about coronavirus, instead of talking to them about it, ask them what do you understand about this? Listen to what terms they use, listen to what concepts they have, and they will tell you the level of understanding they have, and that's where you need to meet them. Don't be talking to them about RNA molecules if what they're saying is, this is a severe flu. Meet them where they are and listen, listen, listen.

And I always say, talk to children about things that don't matter, because it's great practice for talking to them about things that do matter. If the first time you ever try to talk to your child is in crisis and that seems foreign, talk to them about things that don't matter. Talk to them about their video games, their music. Do things where you get that channel open so when it comes time to talk about things that are really important, it's not the first time you've ever sat down and had a dialogue with them.

Well, sometimes it is pulling teeth. You say, how's your day? Good. What'd you do at school? It was fine. You have to sometimes, you know, use some tactics, Dr. Phil, that get more, you know, information. Everyone's not a-- a talker. And to-- but to your point, is we need to meet them where they are.

Dr. Beers, what advice do you have for-- for parents and-- and viewers to, you know, guide those conversations with children to-- to have a roadmap that-- that tries to, you know, make kids more resilient?

Certainly to build on what Dr., uh, Phil noted, I think that's certainly, uh, one of the things that we often do as adults, uh, is project our own anxiety about situations onto our children. And so it's important, as Dr. Phil said, to listen and hear what they are worrying about, um, and be responsive to those issues. They may be worrying about whether or not their teacher is going to get sick or their friend is going to get sick, or they may be worrying about the fact that they can't play soccer right now, right?

And so meeting them where they are and helping them process their own anxiety and their own understanding of what's going on in the world, um, is a really important first component. Um, in addition, making sure that we, um, are encouraging increased dialogue, um, together, and certainly those strategies that Dr. Phil noted around not always having to talk about the pandemic, um, is an important space to-- to create a space where that dialogue starts to, um, come more free withly and hear about what your children care about is important.

We also need to make sure that we are asking questions about how their friends are doing. Sometimes, uh, kids will share more about what their children are-- or their friends are doing than, uh, what they are doing with other people, uh, and-- and what they are willing to share with you as an individual about their own feelings. And so that can be another good strategy to hear, uh, what is going on in their lives.

Um, and finally, if your child's behaviors are really shifting or if they are, uh, starting to act differently or spend more time in their room and not engage with you, um, it's important to recognize those are signs of potential depression or anxiety, um, and make sure that we push and challenge ourselves, uh, to really engage a little more deeply, uh, to make sure that that child is not, uh, getting themselves into a situation, um, that could put them at high risk for-- or, uh, more significant complications of mental health issues.

And with kids, it can look a little differently, correct? Depression and anxiety.

Sure.

So how-- how could it look, perhaps? Um, so certainly that child who might just, uh, um, uh, retract into their room, that child who might have, um, been really engaged around a certain topic or certain issue or certain, uh, thing that they were passionate about who all of a sudden is not, um, uh, really engaging in that.,

Um, it could be, again, where you start to see sleep disturbances, uh, that child who's more difficult to get up in the morning is getting up multiple times during the night. Uh, that child who you're fighting to get to bed at-- on time or is really combative with you, all of those are things that may suggest, um, that there is a larger mental health or behavioral health issue at play, uh, that we should be attending to and making sure that we are getting our children support, and that may in reaching out, um, and getting some counseling even if that is a virtual space. Um, could still be really valuable to our children, as well as us as parents as we work through this pandemic.

I want to end with asking both of you, what are you hopeful for? Dr. Beers?

I mean, I think that there are some really great, uh, things that are happening in communities where they are-- are really thinking creatively about how they are supporting children, and specifically children with disabilities. Uh, there have been some really great conversations about making sure that children with disabilities are not being left behind as well, and that they are, um, being included in, uh, some of the smaller group pods that families are creating as well as, uh, in activities where they may have, uh, sometimes been left out because of their disability. And so I think there is certainly some space, uh, for us to have some of those conversations.

I think together with what is going on in the country around natural equity, uh, this pandemic has forced us to acknowledge the racial inequities in health care as well, as well as in our education systems. Um, and I'm hopeful that that is going to push this dialogue forward, and-- and force us to really come up with meaningful solutions that will create an equitable society that allow every child to achieve, uh, what they can and to be healthy and ready to learn.

Dr. Phil, we'll give you the last word.

Oh wow, I'll take that. Uh, you know, for me, um, you know, it's-- it's always been said, um, the hours are long and the ears-- the years are short. Uh, years fly by, even though sometimes it seems like those hours drag by when you're standing on the side of a soccer field freezing, uh, but parents sometimes miss the opportunities. And we talk about the pressure of being jammed into the house, but this is also a great opportunity to do those things with your children, uh, that you wish you had had the time to do before.

And I know all parents really want the best for their children, love their children, want to nurture their children. And I hope that this is a time that they seize that opportunity, and instead of just, you know, staring at the television or whatever, that they take this time to talk to them, get outside with them, as you say, play games, take walks, whatever.

Use this time where you look back on it and say, you know, that was a time that we grew closer together than any other year, uh, during our lifetime. We seized that opportunity and made the most of it. Sorry that it happened, but there was a silver lining, and it was that we grew closer together during that time.

No, it's a great point. I'm having dinner every night with my, uh, wife and children kind of last six months, which normally, you know, I have not done that in-- in a long time, so that's a great opportunity, it's a great point, uh, to remember. I want to thank you both for all that you're doing to raise awareness of the issues impacting children, about all that you're doing and trying to help parents and others keep kids resilient as-- as best as we can. And I look forward to checking in with you, uh, to-- to see how we're doing in-- in terms of addressing many of the issues that you brought up in your survey, Dr. Phil. So thank you both.

I'm looking forward to that. Dr. John Chirban from Harvard Medical School, a psychologist, we've worked on it very hard. We're going to be, uh, putting it out in its entirety very, very soon. And it's my honor to be here with you, Dr. Whyte and with Dr. Beers. Thank you guys so much.

Yes, thank you for having me, and it's been great, uh, being together here with you, Dr. Phil, as well.

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