Kids’ Transitions to Classrooms Won’t Be Easy, but We Can Help
In the U.S., increased access to vaccines for people ages 12 and older and the use of nonpharmaceutical interventions (such as physical distancing and masking) have led to progress in the fight against COVID-19. Summer brought much-needed respite for many children and families with increased opportunities for travel, outdoor playdates, and in-person gatherings. However, the spread of Delta and other variants continues to change risk assessments, and uncertainty remains constant.
Data on the pandemic’s mental health impact on children are largely focused on older children and suggest a range of increased mental health concerns. Limited available data on young children, reported by parents, suggest a negative impact on their social, emotional, and behavioral development. Given the foundational role of early childhood on longer-term health and development, early interventions and support for parents and caregivers of children is critical. Here we offer relevant programmatic considerations for healthcare professionals and suggestions for how they can support parents of young children who are adjusting to day care or school.
What Is the Role of Healthcare Systems?
Primary care teams have unique opportunities to support child and family mental health and well-being. Routine care appointments provide reliable, frequent, and non-stigmatizing environments for patient education, preventive services, and effective triage for the mental health needs of children and that of their caregivers. Pediatricians, adult primary care providers, and obstetricians are the first point of contact for children, parents or caregivers, and soon-to-be parents, respectively. Just as anticipatory guidance includes information on children’s motor or language development, resources about the critical role of parenting and relational health should also be considered.
The mental health impact of the pandemic will continue beyond the viral disease threat. We need long-term investments in mental health care. Thus, consistent with guidance from policy relevant organizations such as the American Academy of Pediatrics, integrating mental health screenings as part of routine care (e.g., “mental health vital signs“) and building collaborative care models, while scaling up tertiary mental health services more broadly, are all necessary considerations to support children and families.
How Can Healthcare Teams Help Parents Support Their Kids?
Pediatricians and other healthcare providers who have contact with patients who have children are well-positioned to prepare parents or caregivers to help their kids transition to school or day care for the first time or after a prolonged hiatus. We suggest some strategies that healthcare teams can offer their patients with children.
Parents can structure children’s daily routine, such as sleep or mealtimes at home, to be similar to the expected routine in school or day care. This helps children sync with the anticipated routine and can ease their overall adjustment.
Masking is already a way of life for many children. Given the current masking recommendations, this will continue in the coming months. For children who are new to masking, parents can practice at home, in outings to the store, in visits with friends, or in play (e.g., role play with dolls). To offset potential challenges of fewer visual cues (e.g., partial facial expressions, or inability to see smiles or lip movements), especially for younger children, having children see faces of caregivers with and without masks (with appropriate precautions), emphasizing gestures, or being aware of one’s tone of voice and ambient noise can help. Building on preschoolers’ rich fantasy life, analogies with superheroes, many of whom wear masks, is another creative opportunity to support masking. Additionally, parents can discuss safe opportunities for masking breaks with the school or day care.
If a child had limited opportunities for socializing and playdates during the pandemic, consider safe ways (e.g., outdoors and masked play dates) to build or rebuild their social muscles. A gradual process, beginning with short, structured playdates focused on a specific activity (e.g., craft project, treasure hunt), building up to more time can help prepare children for longer group-based settings. Also, consider scheduling visits to see the school or day care to meet teachers or care providers before starting a full-time schedule.
Anticipate changes in children’s behaviours. Transitions, even positives ones, can be stressful. Young children express their feelings through their behaviours. So, during the initial days of transition, children might be fussier, have difficulty with sleep or setbacks in toileting skill, or experience separation anxiety from caregivers.
Balance routines with flexibility. As children adapt to transitions, they may need more soothing and reassurance, or more support in daily activities. Parents can try to build in extra time in the initial days when children are adjusting to unfamiliar environments and people, and prolonged separation from their parents. Additionally, taking the time to talk to children about the changes, their feelings, and to clarify confusion or questions is important. Also, changes in the pandemic situation and emerging data may bring updated guidelines. Local changes in the prevalence of infections, and unique family specific considerations (e.g., medical conditions) means that plans might change. Having flexibility and alternate childcare plans, if possible, is valuable in these uncertain times.
Plan goodbye rituals. Be transparent with children about drop off and pickup routines. Consider a comforting goodbye ritual. Rituals are different than routines. While routines provide a structure for the day, rituals are specific actions created with intent, often to build a sense of connection or belonging, and may be culturally informed. Rituals can help navigate emotional periods. They should be age appropriate and consistent. For instance, parents can incorporate a special song or series of actions (e.g., cuddles, high fives), or incorporate a comforting object (e.g., blanket, stuffed toy) as part of the ritual. Additionally, rehearsing drop-off and pick-up routines through a child’s favorite action figure or doll can help. Parents can also consider animated characters to reinforce the idea that parents will be back.
Some families report that pandemic stressors have come with silver linings. For instance, families may have enjoyed extra walks, learned new games, or started new hobbies together, such as baking or gardening. While the time together may change with transition to school, day care, or a change to parents’ work routine, consider ways to retain these new points of family connection. Highlight what will change, what will stay the same, and if possible, maintain a treasured family ritual developed in the pandemic.
Most importantly, parents and caregivers can actively invest in their own health. Even prior to the pandemic, the paucity of supports such as paid parental leave and affordable childcare were significant stressors for parents of young children. Recently, isolation, losses, and economic uncertainty have demanded extraordinary efforts of parents and caregivers. Burnout is ubiquitous. Longer-term policy and systemic changes are necessary to address many issues. But for now, parents’ investments in their own well-being is critical for them and their children.
Overall, short-term interventions including developmentally sensitive psychoeducation and long-term approaches, such as integrated care models across the life course and scaling up tertiary mental healthcare, are needed to support the mental health needs of children and their parents or caregivers.
Archana Basu, PhD, is a research scientist in epidemiology at Harvard T. H. Chan School of Public Health, psychologist at Massachusetts General Hospital, and an instructor at Harvard Medical School. Nancy Rotter, PhD, is a pediatric psychologist at Massachusetts General Hospital and an assistant professor of psychology in the department of psychiatry at Harvard Medical School.
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