Kids are in their second summer with pandemic restrictions. We asked Jenny Radesky, M.D., assistant professor of pediatrics, to tell us how summer this year is different from last summer, as well as how to deal with the long-term social and emotional impacts of the pandemic.
What have we learned in the last year about COVID-19 and kids?
What we've learned in the past year is that children are very impacted by social isolation, lack of access to in person schooling, insufficient special educational support, and feeding off of the stress their families are under. Certainly some children — especially those with developmental delays or mental health difficulties — are more sensitive to these changes, experiencing more regression, emotion dysregulation, or behavioral or sleep difficulties, while some children have fared pretty well. Therefore, in addition to addressing the practical issues of children's summer camp and recreational experiences, it's crucial to address their emotional and psychological adjustment to the past year and a half. (I'll discuss more of that below.)
If you mean medically, my general understanding is that children are at far lower risk of severe disease from COVID-19 compared to adults, but a small proportion develop the multisystem inflammatory syndrome (MIS-C) several weeks later. Children from Black, Latinx, and indigenous communities are more likely to die from COVID-19, develop MIS-C, and have been more likely to lose a parent to COVID-19, so the risks are not distributed equitably in our communities, and this will certainly influence families' psychological adjustment to reopening.
The more recent variants are more transmissible in children than other variants but don't seem to cause more severe disease or cause MIS-C more often — but variant-fueled surges are still under study, so it's possible that will change. However, as we saw in the spring surge in Michigan, the variants did spread more readily in children's group sports, birthday parties, and other indoor gatherings of children.
How does the second pandemic summer look different for kids than the first? Are there any activities available for this summer that weren't recommended last summer (pre-vaccine)?
Well, things keep changing in this regard. The CDC has lifted mask mandates for some outdoor summer activities for children, and it's important for parents to continue to follow any changes in recommendations as COVID numbers either rise or fall in their county.
I think the most important change for children is that they will hopefully get to see more family members that they have missed over the past year, which will allow some time to retell the stories of what this year has felt like, process it together, and reduce children's sense that their family has been coping with this pandemic in their own isolated bubble. That shared sense of experience and meaning-making is really important for children to understand their sources of resilience during traumatic or sad periods of their life. There will likely be more access to community opportunities like beaches and swimming pools, but it's important for children to expect that not everything is going to go back to "normal."
Does having vaccinated parents (and grandparents) open up any new activities for kids that would be considered unsafe if their adults were unvaccinated?
Having vaccinated parents and grandparents helps in several ways. First, kids can safely see their grandparents and do more of the activities that help kids feel connected to their families' histories — including snuggling, sharing meals, or close conversation. Grandparents can chip in more and help take some of the load off of parents, who have been juggling way too much this year. Overall, this helps reduce everyone's stress, and having less stressed parents is really helpful for children's emotional development.
Has the transmissibility of B.1.1.7 and Delta variants changed your advice to parents?
Somewhat. During the Michigan surge in March and April, which was thought to be fueled by the B.1.1.7 variant, I kept my own 11-year-old out of his soccer team for a few weeks until cases settled down. I gave similar advice to families wondering if they should be starting new indoor sports such as gymnastics, or attending any group activities with children. Now that the surge is thankfully waning, I don't give any different advice compared to earlier in the pandemic, and continue to advise masking for unvaccinated children according to the CDC recommendations. When in-person schooling options have been made available, I have continued to encourage families to take advantage of it, even during the spring surge. My patients tell me that learning is so much easier in person, and I've seen dramatic improvements in child behaviors and parent stress when kids have returned to in-person classes.
What do kids have to look forward to?
That's an interesting question. Children and families have been living with such uncertainty — with COVID-19 cases and recommendations frequently changing, and families adapting on a sometimes weekly basis — so it has been difficult to turn our outlook forward and plan for the future. I mostly have heard children say how excited they are to see family members they haven't seen in over a year, travel to their favorite summer destinations, or get back in the local swimming pool! As with any challenging time, it's crucial to enjoy the small victories. Kids and their parents shouldn't expect things to bounce back to normal, but to be grateful for the small changes in opportunities they will have this summer.
Some parents say their kids have lost all their social skills during the pandemic. What can they do this summer to start regaining those skills?
There are a few reasons why children's social and emotional skills may have regressed during the pandemic. Children pick up on adults' stress, so it's natural that children's emotions can be a bit more disorganized when parents have more on their plates and in their heads. Children also rely on school as a social skills practice space, where they learn to follow the group routine (rather than their own agenda), resolve conflicts without blowing up, and learn the language skills to express themselves.
Learning at home, with only parents, siblings, and a few neighbors to interact with regularly, children simply haven't gotten as much practice — but most typically developing kids can pick these skills back up quickly. I've been recommending that parents enroll children in a few summer camps, so that kids get the hang of following a group routine before going back to school in the fall. Lots of kids have developed heavy tech habits during the pandemic, so I recommend that families peel back some of those hours and replace them with socially reciprocal (meaning "back-and-forth") activities like sports (even throwing a ball back and forth gets us attuned to the other person), dancing, singing together, or cooking together — anything where kids have to interact and adapt to other people in real time.
Listening skills are also an important part of social relationships, and kids have been "stuck in their own heads" more this year. A few activities that can help with listening include finding kid-friendly podcasts or audiobooks, Skyping or calling with relatives and asking them to tell your kids stories from their pandemic experience or their own childhood, and language games like "I Spy" or MadLibs.
For kids with autism, ADHD, or other social skills challenges, I recommend that they sign up for social skills groups at local therapy centers – these groups were on hold for a while during the pandemic, but I'm thrilled to see them open back up.
How do things look different for teens vs. younger kids?
Teens rely more on peer input for their sense of self and identity formation. Therefore, the isolation of the pandemic has been even harder on them — however, teens have leveraged social media much more to stay involved in their social groups and to support their mental health. One advantage teens will have in coping is that they can think abstractly about what this pandemic has meant to them, and how they would like to grow from it. Older students have already "learned how to learn" so were able to manage online learning more easily than young children, but I've heard lots of concerns about teens losing motivation for remote schooling. Like for younger kids, connecting with family, nature, physical activity, and volunteering to help others are natural ways to improve teens' motivation and joy.
