According to the Unicef data hub, children are not the face of this pandemic. But they risk being among its biggest victims’. During the onset of COVID-19, many schools shifted to remote learning as cases rose among young patients. After a prolonged period of online learning, schools are reopening in the UAE, however, going back to school is causing anxiety in students. For paediatricians, the dawn of a new school season in midst of the pandemic means lending more support to parents and caretakers. There is a newfound resilience but also a continuous struggle in maintaining it due to several contributing factors. In an interview, Dr. Bariah Dardari, Head of Department and Consultant Pediatrician, and Dr. Sanjay Perkar, Specialist Pediatrician from Fakeeh University Hospital, share their insights and discuss solutions to promote better mental and physical health.
What were the psychological implications of COVID-19 on children?
Dr. Bariah: The scale of COVID-19’s impact has been staggering affecting both physical and mental wellbeing. The healthcare industry has recognised that there is a parallel between the two as we face a psychological epidemic amid the pandemic. A study published recently in the UAE indicated that up to 67 per cent of children between the age of seven to 16 were suffering from mental health implications caused by COVID-19. Anxiety, depression, fear, and phobias related to returning back to school, were the reoccurring issues faced by children and many female adolescent patients. International studies show the same in Europe, Spain, and Italy during the lockdown.
Dr. Sanjay: In many ways, there has been a profound effect on children. Some of the most common causes for psychological disorders, which have been identified during COVID-19 are a result of exposure to media or challenging family life. This surge in anxiety, stress, and overall implications of the pandemic have heightened awareness surrounding mental health and understanding how various age groups react. Younger children may not consciously understand the severity of their surroundings, in comparison to pre-adolescent and adolescents who are more sensitive to social media, news, or challenges at home.
As many students return to school, how are safety measures working in tandem with supporting guardians in reassuring children about the ‘new normal'?
Dr. Sanjay: The pandemic has been a learning curve. We are already in the second year of living through a life-altering contagion and as time progresses, research is helping us sift through findings to identify models which work. Schools have integrated hybrid learning, and the acceleration of digital solutions has paved the way for funding of diversified curriculum formats, enabling the flow of education. With a new approach to learning, safety regulations were heightened to ensure transmission was kept at bay through social distancing, wearing of masks, installation of sanitiser stations, frequent disinfection of the campus and temperature checks across transportation as well. In addition, the vaccine rollout has built the confidence of parents and guardians in sending their children back to school.
What has been the physical impact on young patients experiencing mental health issues?
Dr.Bariah: One of the prevalent issues of staying at home and the pandemic has been an unhealthy diet. A coping mechanism for many parents and children, the ‘feel good’ aftereffect of foods with low nutritional value is a growing concern. Coupled with low physical activity and the connection between gut health and the brain, children in many circumstances have become reliant on a poor diet which creates a momentary satisfaction. Parents give in to the demands of snacks as it helps create a buffer against underlying issues. For adolescents, a poor diet not only negatively impacts their mood but can cause irritable bowel syndrome and abdominal pain. It’s a vicious cycle of being physically unhealthy, which affects your mental health and vice versa.
Circling back to social media’s role, why are there many female patients specifically?
Dr. Bariah: A common denominator in all our patients was extended exposure to screen time, with a prominent risk factor being social media. There is a prevalence among female patients who use social media and experience low self-esteem and self-image. In general, online regulation is extremely vital as users can be exposed to cyberbullying and female users can be vulnerable to predators. A family history of anxiety or depression are compounded factors as well, and other contributing issues such as lack of support in the family or parents undergoing stress. Globally we are undergoing economic uncertainty and uncertainty on a whole when we address the future of the pandemic, which can be overwhelming for young patients.
How are young patients recovering from the effects of the pandemic?
Dr. Sanjay: In comparison to influenza and SARS, the rate of recovery for younger patients is higher, and the symptoms less severe. However, prolonged symptoms, diagnosed as Long Covid, can cause fatigue, loss of interest, and malaise. At Fakeeh University Hospital, we have always adopted a multi-disciplinary approach, which has supported successful recovery for patients.
Dr. Bariah: We witnessed a sub-population of young high-risk patients with type two diabetes and obesity, although we haven’t had cases of severe disease. Nevertheless, practising diligence is of the utmost importance as new variants target the younger population. We are still in the early stages of fully comprehending the fourth wave and its outcomes on young patients.
Has there been a rise in cases of young children and adolescents seeking mental health support or therapy since the pandemic?
Dr. Bariah: Children who stayed home lacked a support system that tends to their development. A healthy support system consists of family, teachers, and peers, especially for teenagers who are at the cusp of internalising key social and behavioural patterns. The consequence of social isolation from activities, especially for the younger population, was development milestones delayed in contrast to mental health impact. Nurseries were closed during the lockdown, and when they could reopen, many parents were still reluctant to send their young children in fear of exposure. This gave rise to many two- and five-year-olds experiencing challenges in learning key motor skills, which are usually acquired through preschool activities.
For older children, there was more of an impact on mental health before hybrid learning was introduced. The several reasons include busy working parents who were unable to dedicate time to their children, online learning with no access to school facilities, lack of mental health support services and providers. The high expense of these services needs to be addressed. The economic impact of COVID has been devastating, many parents have lost their jobs and healthcare coverage and, therefore, are unable to provide these services for their children. Our role as primary care pediatric physicians is crucial now because we can bridge that gap and provide support to the parents and their children.
As we globally recover and adapt to the new normal, what will be the impact on children, and what methods will ease the transition period for them?
Dr. Sanjay: Moving around benefits physical and mental health. Therefore, activity from an early age should be encouraged as it also enhances the development of motor skills. Our advice to parents is to teach mindful thinking to their children, this includes helping them observe and address their thoughts in a conducive way. As a parent, if you notice any concerns, consult your physician for the appropriate guidance to ensure your children are supported from an early stage. During regular checkups, we always speak to parents and children to ensure that they have not been suffering silently, in many instances by asking leading questions such as ‘how the kids are doing in school and at home?’ we receive observations from their parents and can help navigate the course of action.
Dr. Bariah: Parents play a tremendous role in supporting their children, therefore, self-care is crucial. Many parents neglect themselves, but do not realise that for them to better care for their children, they should take care of themselves first. As physicians, we foster relationships with families to ensure they are always supported.