In October 2021, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry Children’s Hospital Association declared a national emergency in children’s mental health. In an ongoing effort to help provide parents with insights on how to get their children the help they need, we interviewed A. Paul Kurkjian, M.D., a pediatric psychiatrist at Huntington Hospital in Pasadena.

What does mental well-being in children mean?

Mental well-being in children is a shared responsibility of all of us to model a safe and supportive environment for children to be able to thrive, especially in times of global crisis such as this. It is important to acknowledge children’s fears, not to overreact or tell them to “get over it,” but rather to praise them when they confront their anxiety in a constructive way and to support them in challenging these fears in a healthy way. It’s almost like having training wheels on a bike that can eventually come off.

What mental health issues are you seeing in children since the pandemic?

I am seeing unprecedented levels of psychiatric emergencies stemming from children having their cell phones taken away, as they have come to depend on this more than in-person interactions with their friends, which has been limited in the past two years due to the pandemic. Technology addiction may be detrimental by putting too much importance on social media “likes,” etc., which has exacerbated anxiety in children.

What signs should parents look for?

Anxiety in children can present in many ways, and some are not so obvious. Irritability tends to be a common presentation, but this is a non-specific symptom, so you need to put this into context. Sometimes, children have sleep or appetite difficulty or lose interest in pleasurable activities. Other times, children present with more physical symptoms that we call “psychosomatic symptoms” where they may get more headaches or stomachaches. Other times, they may have either separation anxiety or social anxiety. With more severe anxiety, you may also start to see signs of self-injurious behavior, such as children cutting themselves as a way to alleviate their anxiety.

What sets normal levels of anxiety during our current situation apart from something more?

What sets apart our current situation from pathological anxiety is an irrational fear that has a very low likelihood of happening. This can be significantly different from normal fears. As it is, developmentally, it is normal for children aged 6-12 to have fears of bodily harm, but fear of dying from COVID likely has exacerbated this. For example, being afraid to leave the house out of fear of being attacked by a bear or catching a rare disease like Ebola is an example of irrational fear. However, in this day and age of quarantining and masking, some of these once irrational fears of catching a virus are becoming more realistic, and it is more difficult for parents to determine if this [anxiety] is normal or something more.

When should parents reach out to a professional?
Parents should seek professional help when there is a persistent pattern of anxiety emerging and interfering with their child’s functionality, for example, with school work completion or interrupting sleep, appetite and/or leading to panic attacks or suicidal thoughts. But waiting until a child is suicidal is not a good idea. It is easier to intervene with behavioral therapies when the symptoms first start to become a problem, rather than waiting until it becomes a psychiatric emergency.

What can parents do to help counteract some of the collective anxiety our kids have experienced during the pandemic?

Behavioral therapy may involve helping children cope with and manage anxiety symptoms while gradually exposing them to their fears to help them learn that bad things do not always occur. Some techniques are reframing negative automatic thoughts while practicing relaxation and breathing techniques. There are various settings for these interventions, such as in groups or with individual and/or family therapy. In more severe cases, there may be a role for FDA-approved treatments for anxiety, such as with Prozac or Lexapro.

What would you say are the top 3 things that parents can do to help maintain their kid’s mental health well-being on a regular basis?

Establishing predictable routines, limiting screen time and making sure children get enough sleep/exercise are more global ways to manage anxiety, in addition to behavioral therapy.