How coronavirus and civil unrest put children’s health at risk

Between the pandemic and civil unrest borne of racial inequality and uncertainty, children are absorbing more stress and trauma than usual. Whether it’s the disruption of positive relationships or a pervasive fear created by reports of death and turmoil, children’s emotional and physical health is at greater risk.

“A lot of what has happened recently pushes harder on children because they don’t always have the outlet, space or even the language to have the conversations about social or racial justice,” said Tawanna Jones-Morrison, executive director of We.Reign Inc. and a psychologist with the School District of Philadelphia.

Children "have a mixed bag of feelings. They talk about being frustrated, scared, and hopeful — looking to the future and what can come next with them.”

Pervasive fear and toxic stress have long been known to be harmful to children’s long-term health. For years, scientists have studied the short- and long-term effects of early childhood trauma, finding links to depression, heart disease, high-risk sexual activity and substance use, among other consequences. Now, a recently published study in Nature Communications found that women who experienced childhood trauma, specifically due to war, were more likely to become mothers earlier than those who had not been traumatized.

“The evolutionary logic is if you’re in an unpredictable environment where the risk of dying is high, the prediction is that the reproductive schedule gets accelerated,” said Robert Lynch, a postdoctoral researcher at the University of Turku and lead author of the study.

The behavioral response is not as simple as "have kids now,” as Lynch points out. It’s a more complex combination of factors that could include a higher tolerance of risk or a psychological alteration that places immediate rewards over future benefits.

Decades of research show that the period from childhood to early adulthood is a sensitive developmental window. Children exposed to toxic stressors then are overall less likely to be healthy.

Lynch and his colleagues compared 37,613 women before and after their trauma and against their sisters who didn’t go through the same trauma. That unique comparison let them dispel potential alternative explanations, adding to the body of research on the many ways that unresolved trauma can shape health.

There are potential solutions. A decades-long study just published in the Journal of the American Medical Association (JAMA) Pediatrics showed that youth intervention programs designed to support healthy development provide multiple benefits — social, cognitive, and behavioral — for children and their future offspring. But in the real world, proven programs are not used often enough.

“In my experience, the public as well as legislators don’t know about the successes of investment in child and adolescent prevention programs,” said Karl Hill, director of the Problem Behavior and Positive Youth Development Program at the University of Colorado Boulder and lead author of the JAMA Pediatrics study.

Well-funded programs such as Project D.A.R.E. (Drug Abuse Resistance Education) have not been supported by strong evidence. But there are many model programs that have been tested, with strong evidence that they can improve the lives of children and can be used on a large scale.

“Cost-benefit analyses of effective programs show that for every dollar spent, there is a large payoff in reduced policing, courts, incarceration, and mental health treatment costs,” Hill said. “But that reduction takes time, and people are sometimes shortsighted. Reasonable investments now will have big payoffs later, but we have to be patient.”

» READ MORE: One in five children in China showed depressive symptoms after coronavirus quarantine. Here’s how parents can help.

A trial from 2012 examined 24 communities that were randomly assigned to either do science-based prevention planning or conduct business as usual. The former showed large reductions in substance use and delinquency at a community wide level — paying off five times the cost of the program.

But in the United States, health care, education, public health, and social services mostly function independently, and schools rarely get time for more programs like intervention.

“My fear is we haven’t carved out enough time in schools to focus on the social and emotional development of kids, and we don’t do a lot of community work with parents about the same.” Jones-Morrison said. “Some of the interventions that will be helpful will be creating opportunities for kids to have a safe space to talk with people about the very real issues that are happening in their lives right now.”

The challenge extends beyond schools.

“It’s the same situation for a lot of our community-based mental health services. There aren’t enough of them. There are a lot of drive-by diagnoses, and there’s a lot of nuances preventing open space for conversation,” Jones-Morrison said.

Crises will always occur; the key is investing in ways to better prepare for the next one.

“Through investments in child, family, school and community functioning, society builds resilience at all these levels,” Hill said. “More resilient children, more resilient families, more resilient school and more resilient communities. Such that when the next inevitable crisis happens, we are better able to weather that storm. Invest in kids. Invest in families. Invest in schools. Invest in your community. Now.”