The COVID-19 pandemic has had and will continue to have serious effects worldwide long after the crisis has passed. Pediatricians and public health experts have been calling attention to an increasingly serious problem: the effects of the COVID-19 pandemic on children’s and adolescents’ physical and mental health.

Multisystem inflammatory syndrome in children

Although COVID-19 is mostly benign in children, causing mild flu-like symptoms, it can also have effects beyond the disease itself. Children can develop multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition.

MIS-C is characterized by inflammation of multiple areas in the body and, although its cause has not yet been determined, many children with this condition have had the virus that causes COVID-19, or have been exposed to someone with the infection. According to the Center for Disease Control and Prevention (CDC) as of 4th October 2021, 5,217 cases of MIS-C had been reported in the U.S. including 46 deaths.

In addition to the risk of children contracting MIS-C, their mental health has been negatively impacted by COVID-19. From a young age, socialization is critical for children’s development. The isolation measures imposed by the pandemic have severely curtailed these activities resulting in a wide array of mental, emotional and behavioral health issues. Particularly for older children, isolation measures to contain the pandemic have decreased opportunities to build crucial social-emotional peer relationships. Globally, 188 countries have imposed countrywide closures, affecting more than 1.5 billion children and youth.

School closures during the pandemic

Mental health issues in children have been aggravated by the pandemic in the form of school closures, which have made school-based mental health services unavailable for children. UNICEF estimates that, globally, schoolchildren have missed 1.8 trillion hours of in-person learning since the beginning of the COVID-19 pandemic and subsequent lockdowns.

According to UNESCO’s latest statistics, more than 870 million students at all levels have been negatively affected in their education. In South Asia alone, more than 400 million children are affected by school closures and limited access to remote learning, reports the U.N.

UNICEF urges governments, local authorities and school administrations to reopen schools as soon as possible, while taking all possible precautions to mitigate transmission of the virus in schools. “Every hour a child spends in the classroom is precious – an opportunity to expand their horizons and maximize their potential. And with each passing moment, countless amounts of opportunity are lost,” said Henrietta Fore, UNICEF’s Executive Director.

Anxiety and depression make up about 40 percent of the mental health problems children suffer and these are aggravated by the pandemic. Studies show that symptoms of anxiety and depression among children and adolescents have approximately doubled compared to pre-pandemic levels. Children living in institutions and migrant children are particularly vulnerable. The pandemic has also increased families’ economic strain. Poor families struggling to pay for rent and food face considerable difficulties in providing for their children’s most basic needs. At the same time, loss of income often induces stress within the family, which may manifest as domestic violence between parents or against their children.

As the death toll of over 700,000 people in the U.S. continues to climb, many children and adolescents have to confront the traumatic experience of losing a parent or a sibling. According to one estimate, 40,000 children have lost a parent to the coronavirus in the U.S. This leaves them at an elevated risk of depression, anxiety and poor educational outcomes.

“Our goal is to help them back to being kids, and that’s really what pediatric rehabilitation is all about – getting kids to live as functional and normal lives as possible,” said Melissa Trovato, M.D., director of rehabilitation at the Kennedy Krieger Institute in Baltimore, Maryland.

Adverse childhood experiences

Stressful events, called Adverse Childhood Experiences (ACEs), have short and long-term consequences, including children’s impaired cognitive and emotional development. According to UNICEF, exposure to at least four ACEs is strongly associated with sexual risk-taking, mental health conditions and alcohol abuse later in life. Mental health is not among governments’ priorities. At a global level, expenditure on mental health is only around 2.1 percent of the median government expenditure on health.

The chronic lack of investment in mental health means that health personnel are not properly trained to address mental health concerns. In addition, widespread stigma of mental health deters children’s parents and young people from seeking treatment, thus limiting their opportunities for emotional healing and social development.

A look at the future

The COVID-19 pandemic has created a ‘new normal.’ The world will never be the same again. Because we still don’t know for sure how the pandemic started, we are still under the threat of new pandemics arising in the future. And we need to be prepared for that possibility. Fortunately, some defense mechanisms have been created to respond to COVID-19, but they must be put into action as soon as a new pandemic starts.

The COVID-19 pandemic has been a test of our solidarity and our compromise with those who are most vulnerable. The UN states, “What started as a public health emergency has snowballed into a formidable test for global development and for the prospects of today’s young generation.” The COVID-19 pandemic has created a prime opportunity for governments to properly address mental health issues for children and adolescents. And they must. The future of our youth depends on it.

César Chelala is an international public health consultant and the author of Adolescents’ health in the Americas, a publication of the Pan American Health Organization.