When COVID shut down life as usual in the spring of 2020, most physicians in the U.S. focused on the immediate physical dangers from the novel coronavirus. But soon pediatrician Nadine Burke Harris began thinking of COVID’s longer-term emotional damage and those who would be especially vulnerable: children. “The pandemic is a massive stressor,” explains Burke Harris, who is California’s surgeon general. “Then you have kids at home from school, economic hardship, and folks not being able to socialize.” These stresses could be particularly toxic for children, she and another state health official wrote to health providers in April 2020. Last week U.S. Surgeon General Vivek Murthy issued a similar warning about children for the entire country.
The toxicity has become all too real after 20 months, driven by not just disarray but death as well. As of this past June, more than 140,000 children lost a close caregiver—such as a parent—to COVID, according to research published in the journal Pediatrics. Since 2019 there has been a rise in suicide attempts among people younger than age 18, researchers at the Centers for Disease Control and Prevention found when they examined mental-health-related emergency room visits during the past three years. And a study of pediatric insurance claims filed between January and November 2020, conducted by the nonprofit FAIR Health, found a sharp increase in mental-health-related problems, especially generalized anxiety disorder, major depressive disorder and intentional self-harm. These and other distressing trends recently led the American Academy of Pediatrics and two other health organizations to declare that children’s mental health is currently a national emergency.
Burke Harris says those patterns arise from what pediatric health specialists term adverse childhood experiences (ACEs). These events include 10 types of specific traumas that range from direct abuse and neglect to overall household dysfunction. The adverse experiences activate the brain’s fight-or-flight system—a normal response to an immediate physical danger such as a bear rushing at you. But “what happens when the bear comes every night?” Burke Harris asks. Because adverse events put children in prolonged and repeated danger, it extends their stress response and creates damage.
When COVID disrupted the routine and resources that school and after-school care ordinarily provide, many children were left to face ongoing hazards at home, including parental issues such as intimate partner violence and substance misuse. Both of these problems significantly rose during the pandemic, according to researchers.
As the pandemic wore on, California, guided by Burke Harris’s warnings, took some action to protect its children. This October the state legislature passed the ACEs Equity Act, a first-in-the-nation law requiring insurance that covers preventive care and pediatric services to also cover in-depth screenings for adverse events. And, since January 2020, California’s ACES Aware initiative has been educating clinicians about nonmedical interventions available to patients facing adverse events, and the state’s Medicaid program has paid eligible providers $29 per screening. Such regular screenings—which involve asking intimate questions in a nonthreatening and supportive manner—are linked to a variety of positive health outcomes. A recent literature review found patients associate these screenings with greater trust in their doctors. And clinicians say the screenings help them identify social factors that influence health, which allows them to offer more effective care.