Although the holidays are considered to be joyful and festive, some pediatric patients and their families are experiencing difficult times.
FROM THE REACH INSTITUTE
The December holidays this year may be more normal than those of 2020, but the psychological stressors of the pandemic are still in play. For many families, the pressure to get back to normal may itself be a stressor. For example, many parents are wrestling with whether to share a meal with unvaccinated family members or to expose vulnerable older adults, friends, and family to unvaccinated young children.
Furthermore, holidays can be difficult for children and teenagers with depression, anxiety, and other disorders, even during the best of times. Thanks to the many issues related to the pandemic, these have not been the best of times. The American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association recently declared a national emergency in child and adolescent mental health due to the skyrocketing incidence of mental illness, particularly among teenagers, during the pandemic.
Also more pronounced during this holiday season are experiences of loss and grief. According to findings from a recent study, approximately 140,000 children have lost a parent or grandparent caregiver due to the COVID-19 virus, with losses concentrated among children of color.1
All these factors may make this year’s holiday season difficult for young patients and their families. That makes this a good time to redouble efforts on behalf of pediatric patients.
A basic step is simply to use the holidays as a reason to check in with patients and caregivers as follows: “So the holiday season is coming up. How are you feeling about that?” More probing questions can follow, depending on the response.
Because family support is a strong predictor of child resilience,2 checking in with caregivers is important. Psychiatrists can listen to caregivers’ concerns about the upcoming holidays and their child’s emotional state. Sometimes being heard may be sufficient. If not, clinicians can continue to educate parents about how to deal with their child’s mental health challenges, using the holidays as a jumping-off point.
It is important to emphasize the importance of structure when talking with older children and teenagers as well as parents and/or guardians of younger children. One reason for December meltdowns or increases in depressive symptoms may simply be due to the lack of sleep as well as changes in routine when schools are not in session. Remind patients and families that keeping to normal bedtimes and mealtimes—standard advice for reducing stress during any holiday season—is more important this year than ever.
Patients and families who are mourning may need special support. In addition to monitoring patients for signs that healthy grief is sliding into depression, consider suggesting self-help steps such as joining a support group. The National Alliance for Children’s Grief offers a list of local bereavement resources by state and region, as well as its own resources. The Dougy Center also has resources for dealing with bereavement, including a grief support program finder.
Further, some patients may suffer from seasonal affective disorder (SAD). Although SAD commonly begins in young adulthood, it can affect adolescents. A diagnosis of SAD requires at least 2 instances of depression that begin in fall or winter and remit in spring. Light therapy is the gold standard treatment for SAD, often combined with cognitive behavioral therapy and medication.
Finally, clinicians should, as always, carefully monitor their own emotional health. The stressors that affect patients’ families during the holidays may also affect psychiatric professionals and their families. Self-care routines, including opportunities to share emotional burdens with close friends or trusted colleagues, take on greater importance in proportion to the distress manifested by one’s patients.
Dr Romanelli is CEO of The REACH Institute, a nonprofit organization that trains primary care providers, therapists, and health care institutions in evidence-based therapies for child and adult mental health issues. She is also a licensed psychologist with expertise in cognitive behavioral therapy in clinical practice in Princeton, New Jersey.
1. Hillis SD, Blenkinsop A, Villaveces A, et al. COVID-19-associated orphanhood and caregiver death in the United States. Pediatrics. Published online October 7, 2021.
2. Weir K. Maximizing children’s resilience. Monitor on Psychology. 2017;48(8):40. ❒