Life in a pandemic: How will we protect our children?

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Last week during a video visit, my sixteen-year old patient looked pale. Her face was drawn and her eyes looked tired. When I asked how she was feeling, a great tremor overtook her and tears raced down her cheeks. She told me her father had lost his job and they are on the verge of losing their apartment. Worried, she said, “I am really scared. Where would we go when they ask us to leave? How will we find a place to live? We don’t even have enough money to buy food. Will I be homeless?”

With so many uncertainties stalking her life, she does not know what the future holds for her family. 

This grim reality is true not only for her, but for millions of children across the U.S. As a child psychiatrist, I wonder how the economic impact of this pandemic will affect children’s physical and mental health. I worry about the children already living in precarious situations, even before coronavirus complicated their lives.

COVID-19 is both a pathological ailment and a sociological illness. The COVID-19 pandemic has decimated our economy and disrupted relationships. Our economic engine, roaring six weeks ago, has come to a screeching halt and caused untold miseries to people in every walk of life. 

Many small businesses are shuttered and more than 16 million people have signed up for unemployment benefits, a number that is expected to rise in the coming weeks. Businesses still running are forced to resort to pay cuts and/or reduced hours for their employees. Additionally, in terms of financial security, most Americans live on the razor’s edge, with nearly half of all Americans unable to come up with $400 in savings in an emergency.

There is a saying “it takes a village to raise a child.” When the whole village is in danger, who cares for the children?

When families experience a financial crisis, they first cut down on nonessential spending, such as birthday parties, recreational travel, music lessons and sports. These activities are important to the emotional, physical and cognitive development of children. Even many essential necessities, such as education and housing, may not be feasible if the pandemic continues for much longer. As more state governments suffer from lower tax revenues, various public benefits and government-sponsored programs that support children and families may be curtailed.

There is a strong association between socio-economic status and the overall well-being of children. Empirical studies demonstrate that even temporary periods of poverty negatively impact the long-term health of children. For example, the 2008 economic recession significantly affected almost every aspect of children’s well-being, including food, housing, education and healthcare. 

If the COVID-19 pandemic causes a prolonged recession, many families will struggle to obtain or retain adequate housing. Children in such families are at risk to suffer a host of problems ranging from lower academic performance to poorer social and emotional adjustment, which in turn may increase the rate of school dropouts. These same low-income families may also experience limited access to nutritious food because of high costs and other factors; food insecurity is linked to behavioral problems, lower educational performance, delay in developmental milestones, childhood obesity and frequent hospitalizations.

Perhaps the greatest concern is economic uncertainty caused by COVID-19 will put children at a higher risk for neglect and maltreatment. During my training as a child psychiatry fellow, I often come across children suffering from maltreatment and neglect resulting from unstable family environments. While establishing the causality of child neglect and maltreatment is complex, well known risk factors include financial instability in their families, substance use by caregivers, stress, depression and lack of social support. Undoubtedly, all of these risk factors will amplify with the anticipated recession by the pandemic.  

During this challenging time, we need to be proactive concerning our children’s safety and future. As we have learned from previous recessions, effective government policies and strengthening of the safety net programs could substantially reduce the negative impact of the financial crunch on children and their families.

As Congress and the Trump administration contemplate new measures of support for Americans — on top of the nearly $2 trillion package unveiled two weeks ago — I hope adequate funding will be directed to support the government services and safety net programs many American families depend upon for their food, shelter and health care services.

We must remember the investment we make in our children today will contribute to the prosperity of the United States and humankind tomorrow.

Afifa Adiba, M.D., is Child and Adolescent Psychiatry fellow at Yale Child Study Center, Yale University, and vice chair Of Connecticut State Medical Society-Resident Fellow Section.

Tags child health care Child safety Coronavirus COVID-19 COVID19 Food insecurity Health care safety net Stimulus Package

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