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Military Health System

Military kids are resilient, but far from immune to pandemic effects

Image of Military personnel wearing face mask holding up posters for Month of the Military Child. Soldiers with the 1st Theater Sustainment Command showed their support for the children attending Kingsolver Elementary School at Fort Knox, Kentucky, April 23. The soldiers created posters and cheered on the families of the Fort Knox community in observance of the Month of the Military Child (Photo by: Army Pfc. Kaylee Harris, 1st Theater Sustainment Command).

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Children have had an especially rough time since March 2020.

COVID-19 largely took away their schooling, in-person relationships with friends and fellow students, their teachers, extracurricular activities, and any semblance of a normal life. It gave them worried parents and iffy internet connections for school - and for game playing or other 'fun' uses.

And for the almost 2 million kids of activity-duty families, already saddled with the burden of frequent moves, it gave them more emotional instability.

"There has been more of a demand for mental health services as military kids are coping with the pandemic," said Kelly Blasko, a research psychologist and lead for the mHealth Clinical Integration Connected Health Branch with the Defense Health Agency (DHA). "Depending on the age, military kids are experiencing anxiety, depression and behavioral concerns."

Between March 2020 and June 2020, 27% of parents reported worsening mental health for themselves and 14% reported worsening behavioral health among their children, according to DHA data presented during a "Clinical Communities Speakers Series" on April 22 that addressed the effects of COVID-19 on military families with children. Among the accompanying challenges have been a lack of childcare or supervision, a modified educational structure, a loss of social experiences, a loss of normal services and support, and limitations on recreational activity.

Even at 3 months of age, babies can pick up on their parents' moods and become more irritable and clingier when the adults exhibit stress, anxiety, anger or depression. But the pandemic is affecting kids in a variety of ways.

"We're getting now over a year into this pandemic, and we're starting to talk about how fast do we re-open, but as we continue to prolong, children are at risk of worse mental health outcomes," said Air Force Capt. (Dr.) Matthew Scott, a developmental-behavioral pediatrics fellow at Madigan Army Medical Center, Joint Base Lewis-McChord in Washington state.

Scott noted during a DHA webinar on April 22 on the impacts of the COVID-19 pandemic on children and youth, and the emotional, behavioral and educational changes that have come with it.

Scott cited pre-COVID-19 studies on isolation and loneliness with children that resulted in depression issues for close to a decade. The effects of this pandemic won't be able to be measured for a good while, but he said there is plenty of anecdotal evidence.

"Reading through newspaper articles, talking to other providers, there's been a very significant increase in mental health problems during the pandemic," Scott said. "Some hospitals have noted almost double the rate ... for suicide attempts, and what we’ve noticed here in our local area is that access to mental health providers has been limited."

Blasko sees a similar trend.

"There has been more of a demand for mental health services in specialty care, primary care and emergency services," she said. "The demand has varied depending on the shelter or quarantine restrictions, which can be more socially isolating."

Additionally, "child care has been very challenging," Scott said. "It's not always certain. Sometimes facilities are closed without notice, or someone tests positive, and there's uncertainty related to that. Children are experiencing loss of social experiences, stress, change. And families are experiencing significant financial stressors, loss of jobs."

Scott noted there has been evidence of 'regression' with many children, from worsening behavior to the loss of milestones - annual events like sports seasons, graduations, proms. For children in early development stages, even the use of masks is having a negative side effect because social cues from the faces of adults and other children are being missed.

Children writing on the sidewalk with chalk
To celebrate Month of the Military Child, children at the Fort Drum School Age Center and Chapel Child Development Center, New York, participated in a sidewalk chalk art project April 20 (Photo by: Mike Strasser, Fort Drum Garrison Public Affairs).

Children ages 7 to 11 have had different problems with the pandemic than older kids, noted Army Lt. Col. (Dr.) Bonnie Jordan, program director of Madigan's developmental-behavioral pediatrics fellowship, who also took part in the webinar.

"In our elementary (school) age group, we start to see increased rates of anxiety and depression," said Jordan. "You can see that they are still rather low, but significantly increased from our preschool age group. In this age, children are expecting to go to school, they are expecting to be physically active during the day at the playground, at recess, running around with friends. The pandemic caused this sudden shut-down of that, where not only did they lose their social interaction and school ... but kids at this age are not really developmentally able to fully understand what's going on, so there's probably a lot of fear associated with that as well."

The result is often more frequent emotional outbursts, Jordan added, as well as increased boredom and lack of interest. For kids in the 'transitional' age group of 11 to 14, this is even more pronounced, and increased episodes of 'acting out' can be a sign of depression or anxiety.

"For teens and young adults, we see a dramatic increase in mood disorders," Jordan said. Even pre-pandemic, some 10% to 20% of those aged 14 to 21 experienced depression, and 32% were listed as having anxiety. Mood disorders in girls are twice as common as those in boys and are seen at adult rates.

"Anhedonia, or loss of interest, is one of the biggest red flags, but also sometimes a lot more difficult to recognize, especially during the pandemic," she said. That's because going to the park for a ball game, participating in a club, or just socializing after school with friends are all things that have been mostly off the table for a year now.

Most alarming is the rate of suicide among teens. It is the second leading cause of death in that age group, Jordan said, and has increased over the past 10 years.

The news is not all bad for military kids, who are generally considered resourceful and resilient to constant change, due to the many permanent change of stations (PCS) that a career military parent goes through. The average military family moves about 10 times while their kids are growing up. For some, it is more frequent.

"It is hard to compare parents and kids in terms of adaptability and the level of responsibility for a PCS," Blasko said. "That said, kids take cues from their parents, so if the parent is overwhelmed or anxious, the child may pick up on that and experience similar feelings."

In a recent article that Blasko wrote for Sesame Street for Military Families (in partnership with the DHA), she suggests creating a 'COVID-19 family rules' cheat sheet, because there is so much variability in COVID-19 restrictions based on location.

"It can get confusing for both parents and children," Blasko wrote. "Establishing a visual checklist of the precautions can help everyone remember what needs to happen. It could include ideas for different situations such as leaving home to go to the store, going to daycare, visiting with friends and family, or even at-home quarantine."

So, what can parents and caregivers do, especially for 'tweens' and teens? Jordan explained that they must be models of resourcefulness and mindfulness. From a planning perspective, she said a 'flexible routine,' one that fits with school schedules, would be valuable, along with planning ahead for transition and down time.

She also said to encourage kids to talk - about everything, from their emotions, to the pandemic itself, and risky behaviors. Staying busy is also key, with activities such as exercise, reading, volunteering where possible, engaging in family projects, or just watching TV together. Taking an active role in a child's education is important, and giving positive feedback that might be absent because of closed schools.

Of course, getting kids needed behavioral health care as soon as possible is paramount, Jordan said.

"Regardless of age, we want parents to stay positive," she said. "We want parents to stay active, stay scheduled ... stay connected, stay informed, and stay safe."

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