Children's Hospital Colorado

Supporting Kids and Teens During the Youth Mental Health Crisis

A teenage girl lies in bed while looking at her phone

After having their lives disrupted by uncertainty, isolation, school closures and, for some, illness or loss throughout the pandemic, kids and teens have in many ways returned to normal life. But that doesn’t mean they feel – or that life is – “normal.”

Children of all ages are still struggling to readjust to in-person school and social events after interacting virtually for long periods of time and enduring more than two years of constant change. These struggles reveal themselves in ways adults might not expect.

You may have observed this in your own family: Many younger children are having separation anxiety when leaving their parents or experiencing aggressive outbursts at school. Many adolescents are anxious, avoidant or even moodier than usual. Still others feel disconnected, lonely and depressed.

We reached out to Children’s Hospital Colorado school nurses and child and adolescent psychologists to understand the challenges children are confronting and learn ways parents can help kids navigate them.

What our experts are seeing in schools and clinics

“Most parents were understandably relieved when school reopened and kids could go back,” said Stephanie Turner, RN, BSN, a pediatric nurse and Children’s Colorado school nurse consultant in Englewood Schools. “Returning to in-person school was crucial for kids on so many levels, but at the same time, it was a huge transition that has brought challenges of its own – challenges that parents may not have expected.”

Children’s Colorado pediatric psychologist Jacob Holzman, PhD, said that transitions bring uncertainty, which can be difficult for children. “It can be stressful to figure out how to shift from technological communications to in-person communications,” he said. “A lot of kids are worried about fitting in the same way as before and whether they’ll have the same kind of relationships that they do online.”

Fitting back in

As kids have reintegrated into in-person school and adjusted to additional changes such as shifting mask requirements, many have felt anxious about making friends and fitting in.

“There have been times that I notice lots of kids are inside at recess, and when I ask why, they say, ‘I don’t have anyone to play with. It’s hard to make friends,’” Turner, the nurse consultant, said. “Some kids in middle and high school kept going to the bathroom at lunch and when I asked why, they told me they’d rather eat lunch or hide in the bathroom because it’s so hard to make friends.”

Self-esteem

Wendy Moore, RN, MSN, a nationally certified school nurse who also consults with local schools, said that she has talked with adolescents who didn’t want to come to school without a mask on because they didn’t want people to see their acne. Others feel embarrassed about their looks, whether due to bodily changes or lack of self-confidence about their appearance, so returning to learn in person and removing their masks has led to anxiety.

“A lot of kids experienced physical changes while they were away from school, so now they look different and they’re anxious to come back and present themselves,” Moore said.

Bullying after isolation

To make matters worse, such changes have in some cases become a flashpoint for bullying. Children have told school nurses that they prefer to wear masks because they get bullied about their acne or appearance, often online. One recent example of cyberbullying is posting photos of girls with and without masks on, Turner said, using the #MaskPretty hashtag to insinuate that these young women are so unattractive without their masks that they should continue to cover themselves up.

“Kids will often be nice to each other’s face,” Moore said, “But then they’ll turn around and use something the other child has said against them online.”

Why this time is especially tough for kids and teens

The ongoing challenges of the pandemic and social reintegration have led to separation anxiety, social anxiety, behavioral issues, and even depression, pediatric psychologists say. Watch this video with pediatric psychologist Jessica Hawks, PhD, to dig into why kids are struggling, and how to help.

“A lot of kids got used to not socializing as much during isolation and it has been very hard to transition back,” said Children’s Colorado pediatric psychologist Amanda Trovato, PsyD. “If there was social anxiety before, once they went away and returned it was amplified.”

While psychologists like Dr. Trovato are working with patients and their families on strategies and practices that can help kids adjust socially and manage their anxiety or low moods, there are things that you as a parent can do if you notice your child having a hard time reintegrating into school or other settings. And even though the school year is nearly over, it isn't too late to help them adjust for the end of school, summer and beyond.

What to do if your child is struggling

So, what’s a parent to do? First: Listen.

We’ll dive into specific categories of difficulties and how you can help with each below, but one overall theme that our experts emphasized for any challenging circumstance was the importance of listening. Dr. Holzman says that no matter what your child is dealing with, listening to them is the first most important thing you can do to help.

“Most of us want to immediately launch into fix-it mode and offer solutions,” he says, “But the way to create a safe space for them to share and for you to provide support is to begin with active listening: really hearing what they say and then repeating it back to them so they know you heard.”

Once you’ve shown that you’ve heard them, it’s important to validate their experience and show empathy, said Dr. Trovato. “You can never go wrong with validation and empathy,” she said. “If all you do is provide validation and empathy, there will be an improvement – that's what the research shows.”

Kids are not little adults, and this goes for their mental health, too. Mental health challenges in children and adolescents often show up differently than in adults. Open the windows below to review common signals that a child is struggling (and why), with tips for supporting them through challenging times.

Challenges with social anxiety or making friends

Outbursts and behavioral problems

Bullying

Languishing

Depression

Finding support

Parents, caregivers or friends who are worried about young adults, adolescents or even younger children should check in on them and ask how they’re doing. Asking about depression, mental health or suicide does not create or intensify the problem.

If you or someone you know is having thoughts of suicide or is in crisis, do not delay. Contact the following organizations for immediate support and counseling for yourself or a loved one.

If you think someone is at risk of suicide or harming themselves or others, call 911, call a crisis line or head to the nearest emergency room, where medical professionals are ready to help.

Resources for kids and families in crisis

Calls and texts are free, confidential and available 24/7.

In Colorado

Contact the Colorado Crisis Line by calling 1-844-493-8255 or texting "TALK" to 382-55.

Nationwide

If you are having thoughts of suicide, call the National Suicide Prevention LifeLine at 1-800-273-8255 (TALK).

If you need help with drugs, alcohol or addiction, call the Substance Abuse and Mental Health Services Administration helpline at 1-800-662-4357 (HELP).


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