A new school year always prompts some butterflies, but as children and parents prepare to begin a third school year amid the COVID-19 pandemic, it’s understandable that kids and grown-ups alike may be feeling more anxiety than usual.
After all, as all schools in Orange County will proceed with in-person instruction for the 2021-22 school year, some children may be setting foot on their school campus for the first time in about 18 months and beginning entirely new routines.
In this Q & A, Dr. Sheila Modir, a CHOC pediatric psychologist, discusses what parents might expect from their children, tips to support them, and when to know if a child needs professional mental health support.
Could returning to on-campus instruction after so long away prompt anxiety in children?
There are mixed emotions about returning back to school. We know that there are many benefits to an in-person learning environment, including academically, socially and emotionally. But being away from something for so long can bring a natural form of anxiety related to new beginnings and adjustments.
A child might feel fear or anxiety about further disruptions or reclosures. The pandemic has been so fluid and ever-changing, so it’s natural for them to worry if their school will close again or they’ll return to distance learning. For a child, these constant changes can be difficult – especially since we know children tend to thrive in structure and routine.
Finally, there is also separation anxiety. This is the anxiety that children may feel about leaving home or a place they have considered safe and have become very used to during a chaotic time, as well as the people who have been there with them.
The COVID-19 pandemic has been traumatic for many. What are signs and symptoms of trauma that might show in children?
The U.S. Substance Abuse and Mental Health Services Administration defines trauma as an experience of a real or perceived threat to life or safety – or the life or safety of a loved one – that has lasting negative effects on the individual’s functioning and mental, physical, social and emotional, and spiritual well-being.
For younger children, we may see more crying, tantrums, heightened separation anxiety, poor sleep, and regressive behaviors in their eating or toileting.
For children in elementary school, they may be more anxious or scared, easily startled or clingy; they might have impaired concentration; and they might experience somatic complaints like headaches or stomachaches.
Teens might show more complex emotions like feelings of depression, guilt or shame. They may also engage in risky behaviors, act out more, skip school or use substances.
What can parents do to help reduce anxiety in children as they return to school?
There’s a lot parents can do before school starts and throughout the school year to help ease these transitions and reassure anxious children:
It is OK and very normal for children to feel anxious about returning to school. Tell your child this and validate their feelings. And for parents, it’s OK and normal to feel anxious about a child returning to in-person instruction and for their own return to the office after working from home. You’re doing a great job!
Talk to children about what is happening and what they can expect. Keep conversations age-appropriate, being careful not to share unnecessary information.
Parents should stay calm and stay positive, and remind children that grown-ups are all working together to keep kids safe as they return to school. Parents can use examples of what the different school staff are all doing on this front. While we can’t promise children they won’t get sick, we can show them that we are confident in the measures and precautions schools are taking. Parents can also review with their child ways the family has practiced being safe at home and in public, such as wearing masks, washing hands frequently, and maintaining social distance.
At this time, all Orange County schools will require children to wear face coverings while at school. If a child needs extra support, a CHOC psychologist has advice about helping kids get comfortable with masks.
Establish routine and structure
Parents can remind children of their daily schedule especially since many have experienced school since March 2020 with a different type of schedule. For example, a parent might walk a child through the process: “Mommy will hug and kiss you at drop-off right next to the tall tree by the front doors…”
While routine and structure is important, flexibility is also key. Given the pandemic’s fluid nature, it’s prudent to have conversations about how conditions, routines and environments may change in the future.
Rehearse return to school
If a child is having a really difficult time and talking isn’t helping enough, consider visiting the campus together when it’s empty. This can help the child get reacquainted with the environment. A parent can have a child show them their old classroom, where they ate lunch, where they liked to play, and other landmarks that might help rekindle positive feelings.
Work on emotional identification
Work together with children to help them communicate and understand their feelings. This is called emotional literacy. A tool like a “feelings chart” where different faces illustrate feelings can help children identify what they might be experiencing. Movies like “Inside Out” also do a great job teaching emotional literacy.
Explain and model emotion regulation
Children take cues from their parents about how to respond to situations. Those nerves may be mutual, parents should model their emotions appropriately. Use this as an opportunity to model coping skills. For example, a parent might say, “When Dad is feeling worried, he takes three deep breaths.”
Children respond well to praise. Parents should be sure to call out behaviors they want to reinforce. For example, “I loved how you put on your shoes so quickly when we needed to leave for school.”
Here is a tip sheet that can be printed or screen captured showing 9 tips for parents to help reduce their children’s back-to-school anxiety:
What can parents do to build resilience in their child as they return to school?
Resilience is our ability to bounce back from stress and adversity. Being resilient also means being flexible during challenging times; being validating and supportive; making meaning out of difficult situations; and coming together as a family and using social support. It is important for parents to model these elements.
We also know that when we are in a stressful situation, our sympathetic nervous system is activated. There are skills we can teach our child to help access our parasympathetic nervous system to reduce stress. These are things like practicing deep breathing, going on a mindful walk, reading emotionally validating books, or spending just five minutes of one-on-one time with a child each day.
This toolkit can help parents build resilience in children during COVID-19.
What can kids do if they start to feel anxious at school?
If children feel anxious at school, they can rely on “pocket” coping skills. These are skills that kids can pull out of their literal or figurative pockets and employ in the moment:
Diaphragmatic or belly breathing lowers the heart rate and blood pressure and helps the body relax.
Watch this video to learn from a CHOC psychologist how to do this.
Grounding with five senses
This technique helps a child calm down by focusing on their senses. For example, a child can focus on five things they see, four things they hear, three things they feel, two things they smell, and one thing they taste.
Watch this video to learn from a CHOC psychologist how to do this.
To bring themselves into the present moment, a younger child can try counting backward from 100 or an older child might count backward by seven from 100. They can try naming as many animals as they can in one minute or naming all the colors they see in the room.
Small sensory tools like a stress ball or fidget tool can help. Parents should work with teachers to see what would be appropriate to make available for their child.
Ask a child to pretend they are squeezing a lemon in their hand. They should squeeze it hard like they are getting all the juice out, noting the tightness and pressure. Then have them “drop” them lemon and note how relaxed they feel. They can try it again with their other hand.
In this video, a CHOC psychologist illustrates progressive muscle relaxation.
Use positive mantras or self-affirmation
Kind, reassuring words can help a lot. A child and parent may work together to come up with some phrases a child can say to themselves when they feel anxious.
If a child has a smart phone, tablet or other device, a parent can help a child create a folder of cute, funny, silly or comforting images or quotes that they may look at when they are feeling anxious. Be sure to be mindful of any rules about using smart phones in a child’s classroom.
Watch this video of Dr. Modir demonstrating coping mechanisms for anxiety:
What are signs that a child might need professional mental health support?
The experience of a pandemic has been traumatic for many children. Being aware of a child’s emotional cues can help parents know when they are experiencing distress.
Some signs and symptoms of distress are a normal part of adjusting to a transition — such as changes in a child’s sleep or appetite — and will subside as the child adapts. However, when these signs and symptoms begin to interfere with a child’s ability to function or last longer than two weeks or so, a parent might consider contacting a mental health professional.
There also might be other reasons why a child isn’t wanting to return back to school. Perhaps is it social anxiety? Are they being bullied? Do they have an undiagnosed learning disability and enjoyed moving at their own pace? A parent might not know the reason but connecting with a therapist could help gain a better understanding what is going on.
Here is a tip sheet to help parents navigate when to seek professional help for a child.
For more health and wellness resources from the pediatric experts at CHOC, sign up for the Kids Health newsletter.
How to prevent and treat respiratory illnesses this season
Unfortunately, many kids get infected with respiratory illnesses in the fall and winter seasons. CHOC experts highly encourage all eligible members of households to receive their annual flu shots. Other preventative measures like good hygiene and staying home when sick can help protect families from illness. The following articles and guides provide more information.
Get answers to your frequently asked questions – and some peace of mind – with this complete guide to COVID-19 vaccines from CHOC pediatric experts.