Diana Grimaldos keeps getting the same questions from her kids.
“Is the virus gone? Has the virus gone away?”
Her seven-year-old daughter, Katalina, has always been an anxious child — but it got much worse during the pandemic.
“She worries,” said Grimaldos, who lives in Toronto.
Katalina’s anxiety was especially high during lockdown. Although seeing her parents get their COVID-19 vaccines helped, along with going back to school in person, “she’s still very fearful,” said her mother.
The meteoric rise in mental health issues among children throughout the pandemic is all too familiar for many parents — backed up by study after study and reflected in the practices of health-care providers across Canada.
The best medicine for many children, pediatric experts say, is to restore normalcy in their lives, while staying safe from COVID-19 infection.
Now that Health Canada has approved Canada’s first coronavirus vaccine for kids aged five to 11, many parents and children’s health-care providers see light at the end of the tunnel.
‘Vaccine is the way that we can get there’
The pandemic’s effect on kids extends beyond the threat of COVID-19 making them sick, said Dr. Eddsel Martinez, a pediatrician in Winnipeg and member of the Canadian Paediatric Society’s public advisory committee.
The public health measures that had to be taken to save lives have led to isolation, economic insecurity and parental stress, which are all “terrible for mental health,” he said.
“We’ve seen an increase in all sorts of mental health issues, including anxiety, depression, eating disorders, substance use and abuse.”
Children, in general, are resilient, Martinez said. For many, a return to regular activities, including school, birthday parties, sleepovers and visits with grandparents will do wonders.
“All those things are extremely important for mental health,” he said. “The vaccine is the way that we can get there.”
Many kids are also acutely aware of the fact that they can carry the COVID-19 infection and make someone they love ill, both parents and doctors say.
Grimaldos’s husband is immunocompromised and Katalina worries about making her dad sick, especially when there’s a COVID outbreak at her school.
Her mother tries to reassure her and “remove that guilt.”
But even at outdoor family gatherings where all the adults are vaccinated, “she feels more comfortable with the mask than without it,” Grimaldos said.
That’s a big emotional burden for a child to carry, said Dr. Anna Banerji, a pediatric infectious disease specialist with the Dalla Lana School of Public Health at the University of Toronto.
The children’s vaccine can not only reduce the risk of kids getting really sick, but also address “the worry about COVID and what’s going to happen next,” Banerji said.
“‘Am I going to get sick? Am I going to transmit this to my family members?’ That’s a huge stress,” she said.
When Health Canada and the National Advisory Committee on Immunization (NACI) decide whether or not to approve a vaccine, the key questions they must answer are whether the vaccine is safe and effective and whether the benefits outweigh any risks.
In the case of COVID-19, mental health has to be part of that discussion, said Dr. Caroline Quach-Thanh, a pediatric infectious diseases specialist and medical microbiologist at Chu Ste. Justine in Montreal.
“What you have to look at is the burden of illness. And the burden of illness includes not only the medical complications but also all the cross-collateral damages that occur,” said Quach-Thanh, who is also a former chair of NACI.
The recommendations released by NACI on Friday concluded that Pfizer-BioNTech’s vaccine was not only safe and effective in protecting children from illness, but also said that children are “at risk of collateral harms of the COVID-19 pandemic. Prolonged schooling disruptions, social isolation, and reduced access to academic and extra-curricular resources have had profound impact on the mental and physical well-being of children and their families.”
The U.S. Food and Drug Adminstration (FDA) and the Centers for Disease Control and Prevention (CDC) came to similar conclusions when they approved Pfizer’s vaccine for American children — a move that was applauded by the American Academy of Pediatrics (AAP).
“The numbers are trickling in now that [show] the COVID pandemic has really resulted in significant psychosocial stressors on children and families,” said Dr. Arwa Nasir, professor of pediatrics at University of Nebraska Medical Center and member of the AAP.
“We have numbers now to indicate an increase in the number of emergency room visits for mental health issues, suicide attempts,” she said.
That data backs up what pediatricians feared, Nasir said.
“We knew that the stressors associated with the pandemic, all the way from, you know, the illness itself, the death of family members, the quarantine, the interruption of school … we knew that this is not going to be good.”
Surge in ER visits
The alarming rise in mental health issues so severe that they require a trip to the hospital is also happening on this side of the border, said Dr. Michael Cheng, a child psychiatrist at CHEO in Ottawa (formerly the Children’s Hospital of Eastern Ontario).
“We are overloaded in terms of mental health issues,” Cheng said. “Kids have gotten more stressed, anxious, depressed, suicidal during the pandemic and now they’re just to the point they’re presenting to emerg,” Cheng said.
Part of that is due to the interruption of health-care services during the pandemic, so people delayed getting treatment for both physical and mental health problems and they got worse, he said. The other part is an increase in children experiencing psychological distress.
“Our wait lists have exploded,” Cheng said.
The good news, he said, is that if kids can get back to normal life, many will recover and be OK.
“Whenever you have a stress on a population … most people will recover from that stress,” he said. “Hopefully 80, 90 per cent of people will manage to move on.”
In the U.S., children have been getting COVID-19 vaccinations for a couple of weeks. While Nasir has been providing information to many families who are hesitant to get the vaccine, she’s also families with kids who are “just so happy” to get the shot.
“This is a happy, empowering, good adjustment feeling that … can be very helpful to their mental health,” Nasir said.
“[Kids feel like] ‘I’m not like a victim to this. I’m doing something about it … and I’m participating not only in my wellness but also in the community’s wellness.'”
That’s how Diana Grimaldos hopes her daughter will feel when she gets her vaccine soon.
“I think it will give her a sense of security, for sure.”