Helping Kids and Teens through the School Year – PediaCast 499
- Dr Parker Huston visits the studio as we consider the new school year’s impact on mental health. In a normal year, anxiety is common when classes resume. Add in a pandemic, and things are tougher still. We explore what students and parents can do to ease the transition.
- School-Related Anxiety
- Big Lots Behavioral Health Services at Nationwide Children’s
- On Our Sleeves
- The Million Classroom Project
- How to Prepare Kids for Back-to-School
- How to Help Kids Manage Anxiety
- Boosting Resilience in Healthcare Workers – PediaCast CME 55
- National Suicide Prevention Lifeline: 1-800-273-8255 (TALK)
- Crisis Text Line: Text “START” to 741-741
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.
It's Episode 499 for August 19th, 2021. We're calling this one "Helping Kids and Teens through The School Year". I want to welcome all of you to the program.
So it is that time of year once again. Summer is winding down. Schools are opening up. And what has become common in these days of the continued COVID-19 pandemic, there is lots of uncertainty in the air.
We're not certain what impact the school have on community transmission of the virus. We're not sure if the Delta variant, which represents the overwhelming majority of new cases in the United States, will make difference for schools compared to last year's experience. We're not sure when COVID vaccines will be available for those under the age of 12 years.
And while the American Academy of Pediatrics and the Centers for Disease Control and Prevention strongly recommend universal masking for everyone in the classroom this year, including students and teachers of all grade levels, despite these recommendations, many school districts and local governments and state governments are uncertain about their masking guidelines and enforcement. There are lots of debate, which create further uncertainty for kids, teens, parents, and families. And all of these uncertainty presents itself at a time that traditionally causes high levels of anxiety in a normal year, the beginning of school.
So today, we're going to tackle the anxiety of a new school year during a pandemic head-on. We'll talk about what's normal and how to manage those normal anxious feelings. We'll identify when anxiety becomes unhealthy and what kids, teens, parents can do about it.
We'll also consider things that go along with anxiety like difficulty sleeping, trouble concentrating in school, depression, and even suicidal thoughts. Important topics, also difficult ones.
And so, we invited a friend of the podcast back to the studio as we consider helping kids and teens to the school year. That friend is Dr. Parker Huston. You'll recall he is a pediatric psychologist at Nationwide Children's Hospital and a calming presence during any anxious and difficult time. He has lots of tips and tricks up his sleeves, which he will share with us shortly.
Before we get to him, let's cover our usual quick reminders. Don't forget, you can find PediaCast wherever podcasts are found. We are in the Apple and Google Podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music and most other podcast apps for iOS and Android. If you like what you hear, please remember to subscribe to our show so you don't miss an episode.
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So, let's take a quick break. We'll get Dr. Parker Huston connected to the studio. And then, we will be back to explore helping kids and teens through the school year. It's coming up right after this.
Dr. Mike Patrick: Dr. Parker Huston is a pediatric psychologist at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University College of Medicine.
He's here to talk about mental health in kids and teenagers as we approach the new school year at a time of continued uncertainty, thanks to the COVID-19 pandemic. We'll explore helping kids and teens through this new school year. But first, a warm PediaCast welcome to our good friend, Dr. Parker Huston. Thanks so much for stopping by again.
Dr. Parker Huston: It's great to be here, Mike, as always. And thanks for talking about all these timely topics with us.
Dr. Mike Patrick: Yeah, we really appreciate when you come and share your expertise with all of us.
So back-to-school time is sort of a stressful time at baseline, like even when there's not a pandemic. So, this year in particular, how is back to school going to impact mental health in kids, teenagers, and their parents?
Dr. Parker Huston: Well, you're exactly right that it's almost every year a stressful time. And the reasons for that are the transitions that kids go through, they're having to change their routine back to a more stable school time routine. There's a new social situation, new teachers, new people, sometimes, new places. So, there's a lot of new things that they have to contend with.
And during the pandemic, what we've realized is that we pile on many many other new things and new decisions and choices and procedures that they're having to come to terms with and figure out. And it's not consistent. So that lack of consistency is something that is really throwing a lot of families off and has for the past 18 months now.
And it's because usually school is one of those things that is a consistency once you get started. It's the same every day. We know what to expect.
But these days, we don't really know what to expect because people still think different thoughts about what should be going on in schools, and when kids should be there, and when they shouldn't, and what they should be doing and where they should be. So, there's just a lot of unanswered questions and inconsistent things about school right now that make it more stressful than it would be typically be.
Dr. Mike Patrick: Yeah, absolutely. And really anxiety-provoking because of those unknowns and the changes.
Dr. Parker Huston: For sure.
Dr. Mike Patrick: One thing that often happens at the beginning of the school year is that there could be some kids who have some difficult concentrating. And again, because of all these changes, they don't know what to expect. Maybe they're not sleeping very well either, which can play into it.
And so, a parent may think, "Oh, does my child have attention-deficit hyperactivity disorder, ADHD?" But really, that may still just be transition. You might want to wait a bit before you jump into that diagnosis, right?
Dr. Parker Huston: Yeah, certainly. Symptoms of attention-deficit hyperactivity disorder can mimic symptoms of anxiety a lot of times because kids seem distracted. They seem like they're not able to concentrate as you were mentioning.
But really, ADHD has to do with a more long-term pattern and a more consistent and stable inability to focus and concentrate and it's not related to mood or emotion. Whereas, the difficulty concentrating or focusing with anxiety is really brought on by situational variables, what's going on in my life right now? What thoughts are going through my head right that make it difficult for me to get them on track with what I'm supposed to be doing in math class or homeroom or whatever it might be?
So especially at the beginning of the school year, you have to give kids time even in their best year, which we all know is it's not everybody's best year right now. But you got to give them time to settle in. You got to give them time to sort of find their way into the school year before you start thinking about is this a chronic issue that we need to address?
Dr. Mike Patrick: Yeah, absolutely. So then what can parents do during this transition time, as we're really changing up and such, what can we do to help ease that transition for our kids?
Dr. Parker Huston: Oh, I think there are several things that parents can do. And depending on where your kids are in their school year as you're listening to us today, some of these might be already past, but you can think about for what can I do today and what can I think for other transitions for the kids?
First of all, practicing what you can before the actual first day is great. So, I'll take my kids, I'd love to use my kids as an example. They're my psychosocial guinea pigs in a good way. So, we have a third grader and a fifth grader this year. Oh, sorry, a third grader and a kindergartener.
And so, for our kindergartener, we practice what it's like to get up in the morning and get ready for school? Where are we going to hang your backpack? How are you going to remember to grab a couple of masks on the way out? Because that's a mandate in our school this year.
And what time do we have to leave? And all of those things. We kind of did dry run a couple of time before the day. And so, when the first day came, that part of it was a little bit less of an unknown. So, practicing ahead of time is great.
Roleplaying can be really great as well. So, there are a lot of kids who might think, "Oh, how do I meet a new teacher?" "How do I meet a new kid?" Especially now when kids are wearing masks and some of them haven't really been in a classroom much in the past year.
Roleplay those things at home, what would you say to your new friend who's sitting at your table at school? What would you say to a new teacher? How do you introduce yourself?
And getting them to roleplay it with people that they know, and trust can reduce some of the anxiety and the unknown. And then, of course, coordinating with teachers and support staff is really crucial if you've got one who's a little bit more on the anxious side.
And again, I'll use my third grader as an example. When she started first grade, she had really high level of anxiety about starting school. Any my wife and I thought that it's beyond just kind of her being a little nervous about the first day.
So, we really coordinated and came up with a great plan of how we were going to do a separation at school every morning and some things to help her feel a little bit more comfortable. And so, after a couple of weeks of stress with her, she did really great for the rest of the year.
And so then, the final thing I would say in this area is to review the first few days with your kids when they get home and problem solve anything that comes up. There's going to be an anticipated, "This part of the day was difficult," or "This kid in my class is giving me a hard time," or whatever it might be. And then, you can problem-solve those things to help them figure out a solution as the school year gets going.
Dr. Mike Patrick: You mentioned routines before and even starting that routine a little bit before school starts, what parts of the routine are particularly important? I imagined sleep is going to be one pretty important part of it, but there must be others.
Dr. Parker Huston: Exactly. Sleep is probably the number one thing because many of us get a bit lax with our sleep schedules over the summer. It's fun to stay up a little bit later and sleep in a little bit, especially if your kids have changed kind of drastically over the summer. I have some friends who eight o'clock is their normal bedtime, and their kids were edging towards like 10 or 10:30 during the summer a lot.
And so, trying to go from let's say 10:00 to 8:00 within a day or two is really going to be a challenge for your kids. Same thing with the wake-up time. If they're used to sleeping until 9 and all of a sudden, they got to get up at 6:30 to be ready for school, that's going to be a real challenge.
So, trying to work it back by no more than about half an hour every two to three days is best way to try and do it. But other things, even like what's your routine in the morning? A lot of kids during the summer, they wake up, they stay in their pajamas for a little while. They may be watching TV.
They don't have a lot going on in the morning as they're getting up. Versus on a school day, you have a pretty strict routine probably to get everyone out the door and leaving with all the things that they need.
So all of those routines, and then for older kids, especially homework routines, they're not used to having as many demands on their during the summer when it comes to going to school and then coming home and having a dedicated time to complete work in the evening or in the afternoon. So, reestablishing those patterns so that it's not a battle and it's not something that they're leaving to the last minute will help reduce the stress. Even though it's a little bit frustrating to them to have to make those changes in the moment, it reduces stress over time for sure.
Dr. Mike Patrick: Absolutely. As a pediatrician, I'm going to add a couple more. One is going to be breakfast. I'm going to be an advocate for breakfast. Getting some fuel in to feed your brain is going to be important. And we know that breakfast eaters tend to snack less later on during the day as you're getting some calories in in the morning. So, eating breakfast is important.
That family dinner is also important. It's a great opportunity to sit around the table and kind of rehash the day and support one another and have those conversations over a meal. And then when you're eating that meal, half your plates should be fruits and vegetables. We kind of get into the routine of healthy eating during the school year as well.
And then, it's easy for kids to not get enough exercise during the school year. Like in the summer, you're up, you're running around, you're playing and active and it's sometimes harder to fit in that exercise during the school year. But getting 30 minutes of good exercise over the course of the day is going to be important for kids as well.
Dr. Parker Huston: Certainly.
Dr. Mike Patrick: So that's my breakfast spiel. So, as we think about anxiety at the start of the new school year, and we're saying, "Well, even under normal circumstances, there is some anxiety present." What level of anxiety would you consider normal? What does normal anxiety look like? So that then parents can be cued in to "Hey, maybe, the anxiety level that my child is experiencing is not quite normal. Maybe they need some help."
Dr. Parker Huston: Yeah, it's a great question. And it’s a difficult question for a lot of parent to answer. I get a lot of conversation with friends and family and people standing in line at the kindergarten line in the morning about a similar topic. Really, the distinction whether they can still function and do what they need to do.
So, a lot of kids, they have anticipatory anxiety. They have hesitation about the beginning of school. They have hesitation about certain things. They might have a little bit of sleep difficulty where they're up in the middle of the night saying, "I'm worried about my day of school tomorrow." That's personal experience for me with my kids.
But what should happen is a couple of things. First of all, it shouldn't actually prevent them from going and from being able to be present. So if their level of anxiety is making it so that they are not physically able to be present in school, or you're getting a lot of phone calls home that "Hey, they're not really able to participate in the day at school," that's a little bit beyond what we would expect and might warrant some additional attention.
But also, it should return to normal. They should get back to their normal functioning. Normal for them. They might be a little bit on the anxious side typically which is okay, but they should return to their normal functioning within a couple of weeks after the start of the year.
Once they settle in, they get the new routine down and they realized how everything is going to go for the year. So if you notice after those first couple of weeks that they still are really struggling with daily anxiety and not at their best at school, it's really time to talk with the teachers and maybe pediatrician and some other folks that we can get into.
We should also say that it should be something that they can respond to some suggestions that you make. So if they're not just able to take any advice that you have or work on any strategies with you because they're so anxious that they can't even really stop think about what's going on, then that's also a concern that it might be a little bit higher than your average kid.
Dr. Mike Patrick: When you say it impacts their functioning, so then parents maybe want to look for specific cues that would relate to poor functioning. And I would imagine as we think about school, some of those things could be that the quality of their schoolwork. If they're normally a good student, and suddenly, their grades are not that great, there may be something else that's going on there. And anxiety could be one of those.
And then the relationships with friends too, right?
Dr. Parker Huston: Yeah, certainly. Social relationships if they're wanting to pull back from their social relationships. Or extracurricular activities is another one where you'll hear them say, "Oh, I don't really want to do that this year." "I don't really want to be in art club this year," or "I don't really want to play soccer this year," or things like that.
But also, just in their other daily functioning, you mentioned a couple of really important ones, sleep and eating. If they're unwilling to eat breakfast in the morning because they got too many butterflies in their stomach, that's typical maybe for a couple of days. But that shouldn't be the way that they're waking up every single day is really dreading going to school. Because there can be a little bit more going on when it comes to that.
So, you just have to watch for those important daily functions of living, sleeping, eating, toileting. Some younger kids actually regress with toilet training at the beginning of a school year or when there's a really stressful time. So again, look for that to rebound pretty quickly if that happens in your kindergartener or first-grader.
And so, any of those things, you just want to keep an eye on and hopefully, they return to normal pretty soon.
Dr. Mike Patrick: Again, with my pediatrician hat on, physical symptoms of anxiety can mimic other problems, in particular, bellyache, headache.
Dr. Parker Huston: Right.
Dr. Mike Patrick: Of course, those can be other things too and you don't want to miss real diseases. But other things to think about at the beginning of a new school year if, all of a sudden, they have new belly problems they didn't have before that aren't severe, and headaches and such.
Dr. Parker Huston: Especially if it’s the five-day-a-week. We have the kids who come in and I see in my clinical work. And they'll say, "Yeah, they've just been having so many headaches lately," or "They've been having a lot of body aches and stomachaches." And it's like, "Oh, when are those happening?"
And then they stop and thing. Sometimes, they'll say, "Well, you know what, it happens the usually the night before they're going to school." It doesn’t happen on Friday or Saturday typically when we're having fun. And there's nothing to anticipate the next day.
And so then, you start to maybe form a hypothesis that you can work from. But you're right, Mike, you never wanted to discount those purely as just, "Oh, it's all something related to anxiety or something related to mental health." But you can certainly use that as hypothesis to try and understand why they might experience those symptoms.
Dr. Mike Patrick: And then, there's so many variables that are also important. And this is why I think once you get to the point as a parent where you're like, "I don't really know how to help my kid," that it is time to get help.
So, some of those things to think about, as we mentioned, maybe they really do have ADHD. And so, as anxiety, and it progresses and goes out, stretches out past those two weeks, now maybe they are having relationship issues. They're not doing well with their schoolwork. They probably do need to be screened for ADHD.
We know vision and hearing problems can be an issue and affect those things. And bullying, as we get kids back together, there may be those questions as well. And so, so many things to think about and if things aren't going well, you definitely want to give your pediatrician or whoever takes care of your child, your primary care provider.
And then, if they're already set up with the counselor, connected with them, definitely touch base with them. And if they don't have a psychologist or counselor, maybe it's time to do that when things are really stretched out and lasting farther into the school year, right?
Dr. Parker Huston: Yeah, absolutely. And I say the two best places to start for most any kid out there are, as you said, the primary care provider because they not only know child development and they hopefully have a good sense of your child's developmental history and what's been typical for them. But they also know how to connect people with resources. That's what primary care physicians are there to help with as well.
That's one place. And then, the school is a great resource. And I know not every kid and every family has a great relationship with all the folks in their school system. But there's always support staff in the school who they're experts in child development and they know the local resources and the local things that are available for kids. So, don't hesitate to reach out to them too and just say, "I have a concern. Can I talk about it with you?"
And they have another set of eyes or multiple eyes that can keep track of things at the school and sort of confirm or sometimes allay some of your fears. Yes, they're really nervous getting out of your car in the morning and they are very tearful. But you know what, by the time they're five steps into the school, they have found a friend and they're on their way to their classroom. And they're actually doing pretty well.
So just keep the faith and keep doing what you're doing, and things will get better. Sometimes, it's just really great to hear from someone who can keep an extra eye on them at the school.
Dr. Mike Patrick: Absolutely. I have said that so many times to parents. Like, if you come in and I say, "No, this is normal," that reassurance is worth the visit because you're going to sleep better at night knowing, "Okay, things are okay. This is what we can expect."
Dr. Parker Huston: For sure.
Dr. Mike Patrick: As the school year progresses, maybe now we have concerns for depression. Sort of when we think about kids and mental health, anxiety is one phase, but the other phase is depression. And how do we screen for it if that could be affecting our kids? What does depression look like, especially in the younger kids?
Dr. Parker Huston: Depression can take many forms. It's a slippery thing to try and keep a handle on. First of all, symptoms of depression aren't necessarily as outward as we might think. Sometimes, kids are sort of folding in on themselves a little bit where they're staying quiet. They're not really making a fuss. They're not really being a problem at school or at home.
So, it might be that the squeaky wheel gets the grease in your house when really the silent wheel is the one who's suffering a little bit and just not wanting to talk about it.
So, I think the first and most important thing to do is just to keep the lines of communication open with your kids. And that's always a good idea but especially now, all the stress that everybody is going through, as a parent myself, sometimes I do get lost in my own stressors in life. And it's easy for me to lose track of checking in with my kids frequently and making sure that I'm attending to them and really listening to them.
And so, if you show that you're willing to talk about it both by asking them more detailed questions but also just sharing appropriately for their developmental level you're doing. "I had a really stressful day today. It was really difficult. And so, now that I'm home, here's what I need to do for myself tonight to relax because I'm feeling this." Or, "These are the emotions that I'm having."
If you show that you're willing to talk about that, and then ask questions of them, then they'll be more likely to come to you spontaneously in the future.
And then, also try and do more listening than talking when they're sharing. Because that's a really difficult thing for most parents to do, myself included, as soon as there's emotion shared, we want to go into solve-it mode, right? "Oh, you're feeling anxious? Let me tell what to do about that and why you shouldn't feel anxious because isn't third-grade fun? Isn't your teacher so great? Let's find all the ways that you shouldn't be anxious." But what I am telling you is that I am anxious.
And so, from a kid's perspective, they just want to be heard out sometimes and then say, "Well, how can we solve this?" When it comes to depression, it's the same. Seems like you're feeling really down lately, what do you think we should do? How often is this happening? Thanks for telling me. Tell me more about it. What's been going on?
And so, you can really ask directly, too. That's the thing that a lot of parents don't realize is we don't have to tiptoe around it and try and come at it from these secret angles. We can just say, "Tell me how you've been feeling? Have you been feeling really sad lately?
I'm a little worried about the fact that you haven't been interacting with your friends. Or you haven't been really talkative at dinner with the family. So, share with me what's going on lately." And so, when you come at it like that, they might be more likely to talk with you about it.
Dr. Mike Patrick: And when you say, "You seem like you've been sad lately," they may not even be able to pinpoint why they feel that way, right?
Dr. Parker Huston: Right. And that's okay, that's part of what depressive symptoms mean. We can run through the criteria. There are lots of different symptoms of depression. But in essence, it's a persistent low mood and sadness and feelings of hopelessness and helplessness that don't always have a cause. If we're sad about our dog dying that's understandable grief. That's something the we can process and it will probably will come and go.
Depression is more just an overall sense of sadness and low mood that persist for a long period of time. And so, they are not likely to say, "This one thing happened and that's why I'm depressed." They’re likely to say, "I don't know why I feel like this." And that's okay. You don't have to figure it out. You just have to know that it's time to get them some support.
And in young kids, it can present as irritability and even sometimes some aggression. So, a lot of time when kids are acting out like that, parents are quick to put behavioral plans in place and to start doing punishments and taking away things. When really, after we manage the incident that's going on, having a deeper conversation about, "Hey, this isn't like you. This has been happening a lot lately. Tell me what's going on. Tell me how you're feeling lately," and it might just be that they're processing a lot of negative moods lately.
Dr. Mike Patrick: And really, that underscores the importance of getting help once you've gone past your comfort level. And not only with what you think might be anxiety or depression, really even with behavioral problems because those may be root causes that are causing the behavior changes.
And so, just getting some professional mental health help for your child and your family can really be helpful. And not only it helps your child, it helps you as a parent too, right? Because we aren't all born knowing how to parent with best practices. And so, it's a learning process and part of that is sometimes getting some professional help.
Dr. Parker Huston: Sure, yeah, the plug for connecting yourself with a mental health expert out there is that, at minimum, as a parent, you should expect to learn a lot of information about child development and child mental health. And that's one of the things that our profession and similar professions really want to do. We want to give parents information to be helpful in raising and parenting healthy kids.
And so, I've had many, many parents come in who think, "My kid is a behavioral nightmare and all of this," and they might leave understanding it very differently. Understanding it as a mental health concern that's presenting and we need to take a different tactic about it. And so, it can actually be really helpful.
As you said, sometimes, it's nice to come into the office and be told that it's normal. Sometimes, it's nice to come into the office and be told it's a different direction than what you've been struggling with and working on and trying to understand before you sought some care for your child. So, it can be really helpful conversation to have.
Dr. Mike Patrick: Yeah, and then that provides hope. Hope that it doesn't have to continue to be this way, that things can change which is what parents and kids really want.
As we talk about depression, sort of the next step in are thought of self-harm, thoughts of suicide. Is that something that parents should also be asking openly if there's that concern?
Dr. Parker Huston: Absolutely. It's the probably the single scariest conversation that many of us would have with our kids. There are a lot of things that are hard to discuss and that's at the top of the list for most of us. So, we have to first get over our own emotions and feelings about that topic and about those words that we might use.
But time and time again, research tells us that coming at it directly and talking about it directly from an early age does nothing to increase risk and does a lot to decrease risk.
So again, I'll use myself as an example because I wouldn't recommend anything that I wouldn't do myself. I've got an eight and a five-year-old and both of them know what those words mean. Both of them have been asked by me in the past about, "Have you ever thought of hurting yourself when you're really upset?" And, "If you have had those thoughts, what have you thought about doing?"
And I think many kids at some time in their life will blurt out things like, "I wish I was dead." Or, "I wish I wasn't here," or things like that. And in the moment, again, our parent radar goes off and there's a little bit of a frustration or a panic moment where you try and say, "Don't ever say that."
But I see as a teachable moment and a time to have a discussion and to say, "Tell me what you mean by that. I take that really seriously when you say things like that. And I really care about you, so I want to learn more about what you mean."
And it's a really great opportunity to talk through how serious those thoughts are and let them know that they can come to you and talk about that. You can say, "It's okay for you to tell me that. I'd rather you tell me that if you're thinking something versus hiding it because I'm here to help you. And there are ways that we can help when you have those thoughts."
Unfortunately, suicide rates are going up in lots of childhood age groups. So, it's the second leading cause in, I think the group is 15- to 25-year-olds. And unfortunately, it's the third leading cause of deaths in 10- to 14-year-olds. So, it starts younger than many of us would like to admit. And we should have those conversations.
Dr. Mike Patrick: And when there is a concern and your child does say, "Yes, I have had those thoughts," this is something that you want to get them help sooner rather than later. I mean, this is really an emergency at that point.
And so, some resources for you, we'll have in the show notes, the National Suicide Prevention Lifeline, 1-800-273-TALK or 8255. We'll put that number in the show notes for folks because that's staffed 24/7. Regardless of where you are in the country, they can direct you to the right place in your location.
There's also a Crisis Text Line. You can text Start to 741-741. Again, we'll put that in the show notes as well. And then, of course, if you have nowhere else to go, your local emergency department. Here, in Central Ohio, we have a Psychiatric Crisis Department that's inside our Behavioral Health Pavilion here at Nationwide Children's Hospital that's open 24 hours a day, seven days a week. So, if there are those kinds of emergencies, you can definitely stop then and get help there.
Let's change things up here a little bit. Since we are in the midst still of a COVID-19 pandemic, and you had mentioned that the school where your kids are going, the school has universal mask guidelines. And there are lots of interesting scenarios that this presents from a family dynamic and mental health aspect. And I just wanted to throw out some examples of things that families may have to deal with this year.
And just from a mental health professional, what is your advice on dealing with these particular situations. So, the first one that I would have for you is when school mask guidelines differ from what a family is doing at home and in public.
So, of course, in the house, you're in your bubble, you're not necessarily wearing a mask then, unless someone actively has COVID. But if your family is not wearing mask when you go to the mall, but now school wants you to wear a mask, that can create some tension. How can families best handle that?
Dr. Parker Huston: Well, I think in that scenario, parents have a decision to make because on one hand, you could explain that there are different contexts and different rules in different contexts. And you can leave it at that and continue doing something different within your family than what they're doing at school. And that's acceptable. There are lots of ways in which school is different than home. There are lots of rules at school that you might not have at home about technology and about talking out of turn and all kinds of different things.
So, you could underscore for them that this is one other rule that they have at school for safety reasons that we don't necessarily have at home. I think the younger the kids are, the less easily they will understand that. But still the rule governed kids and so they will comprehend that.
The tactic that I think a lot of families have taken and that we took is that we were a little bit laxer over the summer, especially playing outside with other kids in the neighborhood. Or we even got to the point where there were few times, we would go to the store without wearing mask for a little while. But when we realize how the direction things were going and that a lot of schools were likely going to have mask, we decided to change our family policy.
And it wasn't that we necessarily changed our own minds in that exact moment, but we realized for consistency’s sake. And even I started wearing a mask when I was with the kids and going into a store just as a good model for them.
And so, I think that's just a personal choice that parents have to make about, do you want to have a unification of just this is what we're doing all day every day or a bit of separation between school and home.
Dr. Mike Patrick: What about when parents have really strong feelings about masking versus not masking? So, some of us, we listen to our public health guidelines. And we do what the experts are telling us to do and just sort of trusting that they know what they're talking about. But then there are others who really have strong feelings for one reason or another, that no, masks are not needed. Or I think everybody should be wearing masks. I can't believe that all schools aren't having universal masking guidelines.
When sort of the internal conversation within your family is not matched well with the conversation that's happening in the school system, that can really bring about confusion and anxiety in our kids. Like how can we temper ourselves when we strongly feel one way or another? Does that make sense?
Dr. Parker Huston: Oh, absolutely. I have certainly met people on all sides of the spectrum on all levels in the past couple of years and had these exact conversations.
Again, I think considering the children's wellbeing in this, having more of the dialogue in adult context about "Here's what we think. Here is the decisions that we agree with, don't agree with. Here's our perspective on things." Sorting all of that out as parental unit or as a caregiving unit first is really important because you don't want to have that dialogue with the kids involved. Because what they need is to understand that there is a unification of this protocols, whether you agree with them or not.
And so, I've had parents who I know who have said, "I personally don't agree with this that's going on in your school. But I do agree that school is really important for you. And so, we're going to follow these guidelines because I believe that it's really important for you to be school and get an education."
And so, you can express the fact that you may be discontent with some rule that they have on regulation. But to me, it's no different than many of the other regulations. There are certain vaccines that are required to enter school as a kindergartener. You have to provide a lot of medical information to a school when you start kindergarten.
There are certain dress codes at other schools where they limit the type of outfit that you can wear. So, there are lots of examples where any individual parent might say "Oh, I don't really agree with that." But we don't necessarily have a big argument in front of kids.
So, deciding on those things and deciding on messaging beforehand and then having a clear and direct conversation with the kids I think is the best way to go.
What about in situations where masks are optional, and you want your child to wear masks, but their friends perhaps are not wearing masks? That also create some tension.
Dr. Parker Huston: Yeah, it's a bit of our kids living out the awkwardness that we, as adults, are facing right now as well with… In any friend group, you probably have, even if you're united on a lot of things, there are going to be things that you might not agree with amongst your group of friends.
And so, for the kids, I feel like giving them responses to questions that they might get are really helpful. So, the biggest concerns that I've heard from parents is "What if my kid is not wearing a mask and everybody asked them why?" Or, conversely, "What if my kid is wearing a mask and everyone asked them why?"
So again, back to some of our original discussion about role-playing and coming up with kind of canned responses to those things. So, I've said things like "Well, I got to change with the times," and then just sort of walk away, right?
Or, "My parents told me that this is what I need to do." Or, "I like to keep my germs to myself." You could even go with humor. Like I had one kid who said, "I always wanted to dress up as Darth Vader in school," and that was his response to a bunch of friends.
So, trying to relieve kids of that awkwardness of that conversation. And then, of course, from the parent perspective, I have really tried, and a lot of our friends have really tried to impart on our kids, this is not a thing to judge people on. This isn't another reason to bully someone or pick on them or evaluate their choices.
Families make choices, kids don't really have full hand in those choice. And so, we try and encourage them to give other kids a break and to not take it personally.
Dr. Mike Patrick: Really, really great observation. In terms of, when there's a difference within the same family, so maybe the teenagers and the family are not required to wear mask in school. But the elementary-aged kids are required, that can then create some tension in the family, where one kid envies the older kids that don't have to wear the mask.
Dr. Parker Huston: Yeah, if you've got an 11- and a 13-year-old now, you are struggling. They are really close in age to each other and have very different options for health care right now when it comes to COVID. Again, I think you got to know your family and know your kids. But two directions that I think you could go pretty easily, one is "Hey, if one of us has to do it, we all have to do it." I know a lot of families who do that with food allergies for instance, right, where one kid can't eat berry. And so, hey, the whole family is going to be berry-free because we're united family, and we're all just going to live this together."
So, it might be that the teenager doesn't necessarily wear the mask 100% of the time but maybe they would more than they normally would have to if they weren't vaccinated. On the other hand, you can talk about concepts of health equity. And a lot of that has come up lately where not everybody needs the same thing to be healthy and happy and productive.
So right now, that’s an option that your older brother and sister has that you don't have, but it's because that's what you need to be able to attend school and stay healthy. And they need something different. And when things change, we'll adapt.
It's the same reason why they're going to get a driver's license before you and the same reason why they'll be able to vote before you. It's just something that happens where it's not all equal at all ages. So, either one of those discussions I think can be really helpful in that situation.
Dr. Mike Patrick: Putting my pediatrician hat back on, I'm going to advocate for COVID vaccine for everyone who's 12 and older who can get the shot.
And so, I guess that's one way that you can explain it, too, like "Well, you're not eligible for the shot. Once you get the shot, you don't have to wear mask, when it's optional." And so, that maybe a helpful way to explain it to some of your older kids have been vaccinated.
So, as we think about all of these stressors with the new school year, whether it be masking, related to routines and changes in our daily schedule, one concept that gets brought up is resilience. How can we help our kids be resilient and bounce back when they're faced with stresses during this school year?
Dr. Parker Huston: Well, there are two things I want to highlight. The first is resilience has a lot to do and one of the best predictors is the strength of social connections with trusted and reliable adults. And so, of course, as parents out there and caregivers, we want to be that for our kids, right?
We also know that we don't have to be the only trusted adults. So anyway that we can facilitate those good close relationships, whether it's with the teacher, a guidance counselor, a coach, another family member, a mentor, whatever it might be, the strength of those consistent relationships really helps with resilience because kids go to them. They look to them for guidance. They emulate their good behavior and their good strategies for managing stress. So that's one.
And the second one is developing their emotional skills. Because when we think about resilience, it's not about kids who don't experience negative things in their life, or who don't experience sadness or anxiety or worry or sadness. It's about managing those emotions when they come up and being able to still function and overcome those periods of adversity.
So, the program that I work for is called On Our Sleeves. And we have an emotional empowerment curriculum which is our take on emotional intelligence. And so, there's sort of five steps, five skills that will lead kids through, whether it's recognizing and identifying emotions that you're feeling. Whether it's being able to use those skills to recognize and understand other's emotions. And then being able to express yourself and being able to regulate those strong emotions when necessary.
And we never want to discourage kids from feeling sad or feeling angry or feeling frustrated. We just wanted to teach them how to express it, how to identify it, and explain it to other people. And then, when it becomes something that interferes with their life, how to manage that little bit better, so that it doesn't prevent them from doing things that they want to do or need to do.
And so, if every kid got a little bit better at all of those skills, that would certainly improve their resilience and their ability to deal with whatever life brings.
Dr. Mike Patrick: I would imagine that the same sets of principles are not only applicable to kids, but to us as parents too, right?
Dr. Parker Huston: Absolutely.
Dr. Mike Patrick: It's going to be important for us to manage our emotions. How can we best learn to do that?
Dr. Parker Huston: Well, I think first of all, stopping to take stock of how you're managing your own stress. Parents get wrapped up pretty easily in what's best for the kids, what do the kids need. Got to take him here, got to take them there, got to make dinner and do all the things around the house.
You got to stop and take stock of, "Boy, how am I managing right now? And if I'm not managing well, what do I need to do differently?"
Rely on people in your social circle. Because we're all having shared experiences right now of all of these struggles. And so, sometimes, it can be really liberating to talk with another parent who, "Hey, man, I'm going through the same thing you are right now. What could we do together? Could we combine forces to do something where we take each other's kids for an hour once week so that the other one can get out there and do something?"
And then, the third thing would be to don't lose track of your own wellbeing. Meaning, all of the things that you have to do to keep yourself feeling well, it's easy for those to get swallowed up in the day. But you have to maintain your exercise routine and your healthy eating habits and your healthy sleep habits and things like that, that help you stay mentally well. So that you can transmit that into the rest of your family as well.
Dr. Mike Patrick: Yeah, really important tips.
Another segment of our audience consist of healthcare workers. So, we have a lot of primary care providers and medical learners who are all listening to this podcast. I just wanted to point out that you and I did a podcast together last year called Boosting Resilience in Healthcare Workers. It was on our Continuing Medical Education podcast, PediaCast CME Episode 55.
And I'm going to put a link in the show notes to that episode as well. Because I think if you are a healthcare worker in the midst of the COVID-19 pandemic here, and now the Delta variant being on the rise, boosting our resilience is really important for us. And so please do check that out.
You mentioned On Our Sleeves. What exactly is On Our Sleeves? And what sort of additional resources do you guys have to help kids through this school year?
Dr. Parker Huston: Yeah, On Our Sleeves, it's a national movement for children's mental health. And what our focus on is we're trying to reach kids as early as possible and in the places that they already are.
And so, it's different than focusing on mental illness. We're really focusing on mental wellness promotion and mental health promotion. So we have all kinds of different resources for parents, teachers, businesses, after-school programs, all kinds of things that help educate kids about mental health and wellness, give them activities to do to help build those skills that we've been talking about today.
It gives parents and teachers and other people who work with kids language to talk about some of these difficult topics. And it's all free and open to access. So, anybody who wants to can go to onoursleeves.org and you can look through all the resources we have and all the information on different mental health concerns you might have.
But then, as I said, we're kind of an action-oriented group. So, what do I do about it? What could I do today with my family? What kind of conversations could I have with my kids? What kind of activities can we do together to help build these skills that are related to resilience and mental wellbeing?
Dr. Mike Patrick: We'll put a link to onoursleeves.org in the show notes so folks can find it easily. And then, there are some particular resources on that website that I really wanted to highlight, one is How to Prepare Kids for Back to School. So, we'll put a link to that one.
And then How to Help Kids Manage Anxiety, and that include activities to help your kids manage their anxiety. There's anxiety game plan. There's a thought chart that really helps you track negative thoughts and difficult emotions, maybe help identify triggers of those things. So really, some advance tools that families can use.
Even anxiety in my body, where you can draw your feelings on a human body, which may be helpful especially for those young kids that can't quite express how they're feeling and where they're feeling it. So really some cool tools and again, we'll put links to all of those in the show notes.
And then, there's this Million Classroom Project I've been hearing about. What exactly is that?
Dr. Parker Huston: Well, apropos to the topic we're talking about today, we were thinking to ourselves, even at the beginning of 2021, where the back-to-school time this year that we're going through right as we're recording is going to be a doozy. It's going to be a year of preparation to have as many kids back in school as possible. And teachers have really gone through a lot with having to adapt pretty much everything that they do in education on the fly to meet the needs of kids out there.
And so, our mission is to give On Our Sleeves material, free lesson plans for teachers that we've developed, free information for parents and counselors and whoever needs it into a million elementary and middle school classrooms in 2021. And so, we know that that's about one-fourth of all of those classrooms in the country.
And we're focusing on that age group because there's a lot out there for high school. There's are lot of programs for high school kids and adolescents and young adults. There are not nearly as many for the younger populations.
And so, a lot of what we developed is definitely applicable to high school-aged students and very easy to use in that age population, too. But people can go to onoursleeves.org/million. That's the direct link to get there.
You can nominate a teacher. Or if you are a teacher, you can download things directly from there and help us reach our goal of getting into those million classrooms. We're a fair bit of our way through it. So, we're excited about the response we've gotten but it's really our way of trying to support teachers and students especially as they're getting back into school this year.
Dr. Mike Patrick: And we'll put a link in the show notes to The Million Classroom Project there too, also, to On Our Sleeves website so folks can find it very easily.
Speaking of On Our Sleeves and The Million Classroom Project, these are all efforts of Nationwide Children's Hospital here in Columbus, Ohio. Tell us about the Big Lots Behavioral Health Services and Nationwide Children's. You guys have just grown so much in recent years.
Dr. Parker Huston: Yeah, we're really fortunate here in Central Ohio. I consider myself not only a professional who works here but a parent. And I love living in a place that has these types of services for kids available. So, the Big Lots Behavioral Health Pavilion is this beautiful building that was opened the week before the pandemic shut most of everything down in Ohio last year.
But it's really a tangible manifestation of a larger hospital mission to make children's behavioral and mental health a focus of what we do here as a hospital system. We have so much topnotch medical programs here that we're really proud of and that are nationally and internationally recognized. Behavioral Health is actually one of those that's there's about 1400 employees just in Behavioral Health here at the hospital.
And despite the fact that we have this gigantic building, only about 10% of our Behavioral Health services are at this building. We are out in the community. We're in primary care centers. We're in Close to Home centers. We're in main campus.
And so, it's our way of trying to be a model for what an ideal scenario is working towards. We're not the ideal scenario but we're sure working towards this model and mental health being really integrated into medical care and child developmental care as a routine service that people have access to.
We're really proud of it. We're really happy to be trying to lead the national conversation and the national movement towards taking better care of our kids' mental health and doing lots of research on different treatment outcomes and treatment strategies, and prevention strategies as well. So, it's a big wholesale effort here in Columbus that we're trying to do.
Dr. Mike Patrick: It's really fantastic work. And we'll put a link in the show notes to the Big Lots Behavioral Health Services at Nationwide Children's Hospital, along with all those other links that we have been mentioning as we've gone along. Lots of great and helpful information there for parents and families.
All right, well, Dr. Parker Huston, pediatric psychologist at Nationwide Children's Hospital, we always love it when you stop by and we have to plan our next visit with you.
Dr. Parker Huston: Yes, please. I always love being a guest and I'm an avid listener as well. So, love this podcast.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks to our guests this week, Dr. Parker Huston, pediatric psychologist at Nationwide Children's Hospital.
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Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.
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