CASTLE POINT, Mo. — Lucretia Wilks, who runs a small day care out of her home in north St. Louis County, is used to watching young children embrace, hold hands and play together in close quarters.
But the covid-19 pandemic made such normal toddler behavior potentially unsafe.
"It's weird that they now live in a time where they're expected to not hug and touch," said Wilks, founder of Their Future's Bright Child Development Center, which cares for about a dozen children ranging from infants to 7 years old. "They're making bonds, friendships, and that's how they show affection."
Day care and other child care providers said they are relieved to see covid cases drop as vaccines roll out across the United States. But even as the nation reopens, mental health and child development experts wonder about what, if any, long-term mental health and development consequences young children may face.
In the short term, medical and child development experts said the pandemic has harmed even young children's mental health and caused them to miss important parts of typical social and emotional development. Besides not being able to get as close to other people as usual, many young children have seen their routines interrupted or experienced family stress when parents have lost jobs or gotten sick. The pandemic and its economic fallout have also forced many families to change caregiving arrangements.
"Coronavirus is impacting children and families in many ways mentally. The biggest and most obvious way is in the children's structure and routine," said Dr. Mini Tandon, an associate professor of psychiatry at the Washington University School of Medicine in St. Louis. "Young kids thrive in structure and routine, so when you disrupt that, things go awry pretty quickly in their day-to-day lives."
Tandon, who has spoken frequently with parents and caregivers since the pandemic began, said she and her peers have seen more severe anxiety and high levels of stress in young children than in the past.
Child behavior experts pointed to a number of problems exacerbated by the pandemic in a National Center on Early Childhood Health and Wellness webinar last year, including separation anxiety and clinginess, sleep issues and challenges learning new information. Children have also shown regressive behaviors — wetting the bed even though they've been potty-trained, for example.
For young children, changes in caregiving arrangements can be a huge source of stress. And the financial strain of the pandemic forced many families to rethink how they cared for their youngest children.
The average monthly child care cost in Missouri, for example, is $584 for 4-year-olds and $837 for infants, according to Procare Solutions, which works with over 30,000 programs for children. That has been too high for some parents who lost their jobs in the pandemic. President Joe Biden's covid relief plan signed into law in March gives monthly payments of up to $300 per child this year and his latest proposal would help reduce child care costs and increase access to preschool, if approved.
But in the many months when day care has been out of reach, some parents have had to rearrange their work schedules to care for infants or toddlers while also helping school-age children with virtual learning. Others have relied on grandparents for help, although that option was potentially dangerous before vaccines were available. Keeping children apart from grandparents has been tough for both kids and seniors.
Even when parents could afford day care, fear of getting or spreading covid affected their choices about whether and when to send them. And some facilities closed temporarily during the pandemic.
Aimee Witzl, 34, of St. Louis, an accountant and new mom, said she and her husband were hesitant to send their daughter, Riley Witzl, to day care early in the pandemic. Riley was born prematurely in November 2019 and had to spend nine weeks in the neonatal intensive care unit before coming home. So, the couple waited until August to send her to day care part time, then until January to send her full time.
"We were already high-risk," Witzl said. "Then covid happened, so we kept her home even longer than planned."
Fortunately, she said, no one in her family has contracted the virus.
In March 2020, the Early Childhood Development Action Network, a global collection of agencies and institutions promoting child health and safety, put out a "call to action" shared by the World Health Organization saying they were concerned about the pandemic putting "children at great risk of not reaching their full potential" because the early years are a "critical window of rapid brain development that lays the foundation for health, wellbeing and productivity throughout life."
Tandon, the Washington University psychiatrist, said she's especially worried about young children who may have been isolated in unsafe homes where they were mistreated. Maltreatment is more likely to go unnoticed, she said, when children are outside of the day cares and schools where adults are required to report child abuse and neglect.
But Tandon said the stresses of the pandemic can affect the mental health of any child, which motivated her to write a children's book about a girl dealing with anxiety during the pandemic.
Now, though covid vaccinations still remain months away for the youngest children, a shift is occurring that may cause a new round of disruptions for them. Nancy Rotter, a child psychologist and assistant professor at Harvard University, said young children may be experiencing separation anxiety as they fully transition back into their schools and day cares after being at home with their parents.
To help kids heal, the Centers for Disease Control and Prevention suggests families make sure kids stay connected to relatives and friends. The agency also advises that parents do their best to recognize and address fear and stress in themselves and their kids and seek professional help if needed. CDC experts suggest parents talk about emotions and provide opportunities for children to express their fears in a safe place.
Yet as children and toddlers return to a new normal, it may not be as strange to them as it is for adults. Though the pandemic has presented stressors, Rotter said, children can be very resilient.
"Supportive caregivers and supportive emotional environments help with resilience in the child," she said. "Resilience is not just what's in the child, but what's within the child's environment. It's the home, religious community, school and day care environment that aid in the child's development and how they cope with changes."
And the pandemic may leave behind one benefit for children: the emphasis on washing hands. Child care experts said good hygiene habits are an important life lesson that will likely last beyond this health crisis.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
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