NEW YORK — On the first morning of her first vacation in five months, Christine Buividas woke up eager to spend time simply being “Mom” to her two boys. As the patient care director for a 40-bed surgical unit at New York Presbyterian-Queens, Buividas had been at the epicenter of New York City’s COVID-19 storm last spring. In mid-August, a measure of normalcy finally seemed possible.
And so Buividas, Jon Karl, 13, and Christopher, 8, set off to Costco. The trio was among the first to arrive, since frontline healthcare workers were allowed in early.
“Christopher was sitting in the cart and he just looked strange. He said ‘I am not feeling well, I’m going to throw up.’ My kids don’t throw up. He hasn’t thrown up since he was an infant. But you know your kids, and so I grabbed a bag and he threw up. He was shaking. He said he just wanted to go home,” Buividas said.
By the time they returned to their home in the Fresh Meadows neighborhood of Queens, Christopher wouldn’t leave her side. He stood sentry outside the bathroom door when Buividas showered. He was next to her when she washed dishes. As the weeks passed her once bubbly son grew more fearful, prone to empty stares and occasional outbursts.
Christopher is just one of a growing number of young people struggling with mental health and emotional issues during the ongoing COVID-19 pandemic.
As of November 23, there have been over 12.3 million positive cases and 257,000 deaths across the United States. Of those, 601,000 cases and 33,767 deaths were in New York. As the numbers continue to climb, parents and mental health professionals across the state report seeing heightened anxiety, increased social isolation and more angst.
This uptick reflects an already growing incidence among teens of heightened depression, anxiety, eating disorders and post-traumatic stress disorder as the pandemic continues. According to the US Centers for Disease Control and Prevention, suicidal ideation is up among teens through June 2020.
Even before the coronavirus crisis, 16 percent of youth in the US were dealing with a mental health disorder, according to a 2019 JAMA Pediatric study.
“I have definitely seen an upsurge of child mental health issues due to COVID. I see mild disorders that turned extremely serious, or brand-new pathologies due to either fear of COVID itself, or due to quarantine and social isolation, or because of stress around remote schooling,” said Dr. Robyn Koslowitz, clinical psychologist and founder of the Targeted Parenting Institute.
In her practice Koslowitz, who also hosts the Post-Traumatic Parenting podcast and blogs for Psychology Today, is used to treating children and parents who’ve endured trauma. Yet, what she’s seeing with COVID is unparalleled, she said.
“The most intense kind of trauma is the kind when you can’t physically escape; you’re trapped in burning car for example,” Koslowitz said in a Zoom call from her office in New Jersey where blocks and shapes in bold primary colors line shelves. “Is COVID like that? We don’t know. We only know there will be long term effects for everyone… You will not go back to your old selves because there’s going to be a new version of yourself at the end of this. The same goes for kids.”
The new not-so-normal
From a public health standpoint social distancing is necessary. From a social standpoint it can be devastating, particularly when it comes to school, said Dr. Nancy Lee Galina, interim dean and director of the Masters of Social Work program at Touro College.
“I have a patient, a young lady who is a junior in high school,” Galina said. “She had a horrific sophomore year where she lost her friends group. That’s not unusual, but now she’s very depressed and isolated. Unfortunately, where we are with COVID right now it’s not possible to make a new friend group. How do you make a new friend if you are 6 feet apart in the classroom and can’t eat together? She is extremely closed off, isolated and at risk for suicide.”
Of the 728 people Amudim treated for active anxiety between January 1 and October 9 of this year, 223 were aged 18 and under. That compares with 336 active anxiety cases during the same period in 2019, of which only 48 were 18 and under.
“Those are scary numbers,” Gluck said, adding that he’s noticed three distinct phases to the way COVID is affecting youth.
The first phase came in early April, when the shutdowns were still new and much uncertainty reigned. The second period occurred just before and during the summer when people didn’t know if there would be summer camp. The third period occurred just before the start of the school year.
“All this uncertainty, and not knowing creates a lot of anxiety,” Gluck said. “I can’t even try to imagine the long-term effects of this because I can’t see the future right now.”
Coronavirus means death
At Hands On Approaches, which provides occupational therapy for children with emotional, behavioral and academic challenges, Amy and Evelyn Guttmann said they too are seeing more issues now than they did last spring. There are more incidents of children who won’t give up their pacifier, are resisting toilet training, are bedwetting, having trouble falling asleep, or who wake up with distinctive nightmares among those seeking help at their Borough Park, New York, practice, they said.
“I had a child who came in, and her mother wanted me to see a rash near the corner of her daughter’s mouth. She told her daughter to pull down her mask and the child started hyperventilating because she knows she’s not to step outside without the mask,” Amy Guttmann said.
For other young children, the word “coronavirus” itself is fraught with meaning rather than the recommended public health measures such as mask wearing.
Rivkie Feiner, who lives in the upstate New York town of Ramapo, was recently walking down the street holding hands with her four-year-old grandson Yonah.
“I mentioned that a relative had coronavirus and Yonah said, ‘Oh he’s going to die.’ Just like that. So matter of fact,” she said. “That’s what it’s come to mean to them. Coronavirus means death.”
Then on a recent Shabbat when discussing the weekly Torah portion, Feiner nearly made an analogy to COVID. The words barely escaped her mouth, she said, when her 9-year-old interrupted her, “Mom, not everything is about corona.”
“We’re all feeling it. Back in March and April we were all on survival mode. Now it’s very different. I feel frustrated, I feel a blanket of heaviness. Corona has become like a curse word. There is so much uncertainty,” she said. “I’m trying to be upbeat because we have to, but we’re all struggling at different levels.”
Recognizing that struggle and naming those feelings is a good way to help ameliorate the situation, Evelyn Guttmann said.
Children are at a time in their development where their coping responses are being shaped for years to come, she said. Parents can help, by really listening and talking with their kids about accepting this new reality.
“It’s teaching them to be able to say things like, ‘I want to be at school, but I can’t, I miss being with my friends, I want to take the bus to school but here’s what I can do to make it be okay,”’ said Evelyn Guttmann. “We need to hear them and validate them, not deny what they are saying. It’s about helping them go through it and live in this time period.”
Make it better
Last March, first responder Buividas’s unit was the first to receive COVID-19 patients when the pandemic struck. Sometimes her 18- and 19-hour shifts felt like trying to sweep broken glass in the midst of a Category 5 hurricane.
At the time she maintained a rigid ritual. The moment she got home from work, she’d stuff her scrubs in a bag, shower and change. Only then would she see, but not hug, her children, Christopher and John Karl. For the first several weeks she slept in the basement.
My son is in an ocean of pain and we’ve been trying to fend for ourselves
On the occasion she and her kids left the apartment to run errands, they’d drive past the refrigerated trucks parked outside the hospital. Both boys knew the trucks were temporary morgues and they knew Buividas cared for COVID patients. But they didn’t know the details.
They didn’t know how their mom ran around with iPads so her patients could speak with family or so her patients’ families could say their final goodbyes.
“At the height of it the kids were so proud of their mom. It didn’t really hit them,” Buividas said. “Now, my little one [Christopher], who was rambunctious and talkative and happy, is fearful of the unknown. My son is in an ocean of pain and we’ve been trying to fend for ourselves. We’re really struggling. It’s unbelievable how this is affecting little kids.”
Therapist Koslowitz, who is not treating Christopher, said that children with underlying issues such as obsessive-compulsive disorder and anxiety will find this time especially hard.
“There is this health threat all around us and the way trauma works is, it shows you the world isn’t a safe place,” Koslowitz said. “In reality our brain tricks us into thinking the world is safe. If you don’t fall for that illusion you would never get out of bed, you would never do anything. You are learning at a very young age the world is not safe and there is a real threat in the world that you can’t control.”
Christopher only started exhibiting intense anger and anxiety in August. Buividas said that’s partly because during the months of quarantine he lived in a veritable cocoon, which gave him a sense of control. It wasn’t until New York started to slowly reopen and he could venture back into the world that things deteriorated.
While Christopher is getting care and attends school, the situation remains rocky. He breaks down every morning, retching and vomiting, Buividas said. Other times he has angry outbursts.
“It’s really hard and heartbreaking. As an adult it’s hard to deal with anxiety,” she said. “He keeps asking ‘Why is this happening? I want someone to fix me. You’re a nurse, mom, you helped people with COVID. Can’t you help me?’ The hardest part as a mother is not being able to help him.”
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