Cases of anxiety and depression are spiking among young teens feeling the stress and uncertainty of the COVID-19 pandemic, said Charlene Wong, an associate professor of pediatrics at Duke School of Medicine.
“I’ve had patients describe it to me as being stuck in an anxiety attack and having a really hard time getting out of that,” Wong said this week during a remote media briefing to discuss reopening schools and the impact of COVID-19 on children. Wong specializes in adolescent and young adult care.
Wong was joined by Ibukun Christine Akinboyo, an assistant professor of pediatrics in the Division of Pediatric Infectious Diseases at the Duke School of Medicine and a medical director of pediatric infection prevention at Duke University Medical Center; and Lisa Gennetian, an associate professor of early learning policy studies in Duke’s Sanford School of Public Policy and a faculty affiliate in the Center for Child and Family Policy.
The panel also discussed reopening schools and the economic impact of the pandemic, particularly on vulnerable students.
Wong said pediatricians are seeing more children who didn’t previously have behavioral issues, depression or anxiety being diagnosed with those conditions. “Those who already had these diagnoses, having exacerbations,” she said.
School mental health officials told Policy Watch in May  that they expect a greater number of students, teachers and support staff members will return to campuses in the fall needing their services.
Since then, state leaders have taken some action to respond to the issue. Gov. Roy Cooper signed into law a bill requiring the State Board of Education to adopt a school-based mental health policy and to require districts to adopt and to implement a mental health policy that includes a mental health training program and a suicide risk referral protocol.
Bills were also introduced — but not enacted — during the legislative short session that would have significantly increased the number of school nurses, psychologists, counselors and social workers employed by the state.
When the pandemic hit, it closed schools and upended an economy that had been booming – at least for some segments of society. The stalled economy has forced millions of Americans out of work. The nation’s unemployment rate fell to 11.1% in June, an improvement over the 14.7% rate in April and the 13.3% reported in May, but the US remains in a deep recession.
Experts say job losses and financial distress are felt by children as well as parents. “Particularly for our older youth, they’re very aware of the economic stress that their parents and their families are experiencing,” Wong said.
Gennetian said the number of children living in poverty will increase as a result of the pandemic. She said some estimates suggest that child poverty could grow by 5 million children if unemployment increases and there’s no further federal assistance for families with children. “Children who were previously not poor are going to become poor and children who are poor are going to be experiencing even further deprivation and poverty,” Gennetian said. “Children of color will be particularly hit hard.”
The National Center for Child Poverty  estimates that about 15 million children in the U.S., live in families with incomes below the official federal poverty threshold – a number that numerous advocates say greatly underestimates the actual cost of living .
Educators and health professionals also fear that cases of child abuse and neglect will go undetected during the pandemic because schools are closed and families are reluctant to visit health care facilities because of the coronavirus. “Some of these safety net locations where we pick up abuse and neglect in our very vulnerable children are not there for these children and families,” Wong said. “Certainly, for those children who experience abuse during the COVID-19 pandemic, this will be an adverse childhood experience, which will have lifelong consequences for children and their well-being.”
On Tuesday, Gov. Roy Cooper directed schools to reopen in August  with a mix of in-person instruction and remote learning. Districts may also offer remote-only learning if it’s the best course for their community.
Akinboyo noted that coronavirus infections are often milder in younger children. And because they have not been in school or other crowded settings, there have been few reported cases of children transmitting the virus, she said.
“But I will say, that particularly in our area, we’ve had childcare settings that have been open all through the pandemic, and they’ve had kids from infancy to 3 to 5 years of age, and until recently, we haven’t seen rapid spread in childcare settings,” Akinboyo said.
However, now that the prevalence of the virus in the community has increased, so too, have infections among childcare workers and children. “That’s not unexpected when community prevalence goes up,” Akinboyo said.
And last month, an 8-year-old Durham girl died of complications o f the coronavirus.
The panelists agreed that a state law requiring all students to be in classrooms the first five days of schools is ill-advised. “Certainly, that could cause a spike in spread,” Wong said, noting that the first week of school will be a difficult one with staff members working out the kinks of a new system.
Akinboyo said the state must allow families the flexibility to decide whether to send their children back to classrooms. “Having all children in school for the first five days doesn’t seem consistent with the approach to reduce transmission within schools,” Akinboyo said, when asked what advice she would give policy makers. “Allow for flexibility and find child-centered metrics that protect children, teachers, staff and anyone associated with the school.”
Wong said state and local officials must make decisions that protect the most vulnerable children.
“I would really hope that all policymakers prioritize in-person learning, particularly for our youngest children and our most vulnerable children who don’t have a safe place during the day or who don’t have adequate nutrition and to make sure we match the limited resources of in-person learning to those at most need.”