Nearly a third of parents surveyed in a poll in May said their child was "already experiencing harm" to their emotional or mental health due to social distancing and school and business closures imposed across the country.
Another 14% indicated their kids were "approaching their limits, saying they could continue social distancing a few more weeks until their mental health suffers," according to Gallup, which conducted the survey.
More than three months later, the coronavirus pandemic is ongoing with no end in sight. And kids are returning to school, whether virtually or in person.
Experts say a new school year during the pandemic brings new stresses for children.
"Now they have to adapt to a new normal – because it's not really going back to school, it's going back to a new set of rules at school," said Frank Ghinassi, president and CEO of Rutgers Health University Behavioral Health Care. "So, we're going to see stress and a lot of those kids are going to have to learn to adapt all over again, just like they learned to adapt in February or March. And that adaptation or change always produces stress on individuals."
Amanda Fialk, chief of clinical services at The Dorm, a treatment community for young adults, said the stress of a new school year combined with the pandemic is "a perfect storm" that will affect kids' mental health.
Fialk said that during the pandemic, many kids have become anxious about several things, such as their social lives and navigating technology, and spending more time on it.
Kids who are returning to in-person classes may also experience separation anxiety from their families, who they had been spending more time with during lockdowns. And they may worry about the health of their relatives, she said.
"I think there's also a lot of fear and anxiety about the health of their parents and their grandparents. If they go to school and then come home, are they potentially going to get their loved ones sick?" Fialk said.
She compared returning to society after lockdown to getting in a car accident and then being expected to get back into a vehicle.
But while many kids will experience stress, not all of them will be able to express it, said Ghinassi, who is also senior vice president of the Behavioral Health and Addictions Service Line at RWJBarnabas Health.
"The advice we try to give to parents is to always compare the child's behavior to their own child's baseline," he said. "Very often with younger children, depression may or may not be expressed by the child looking glum or looking down. It can sometimes be the opposite: the child is more agitated or more aggressive."
He said the same is true with anxiety. Children may be withdrawn, or have GI symptoms or disrupted sleep and eating habits, or exhibit aggression and agitation, Ghinassi said.
If a child is not getting pleasure from the things they used to like, that's a sign of anxiety and depression as well. "It's not unlike the symptoms you see in adults," he continued.
Ghinassi pointed out that the impact in-person school has on children is broad. "There's the educational component and the learning component, but equally important is the socialization component and in early developmental phases … .that socialization is as important as the academic learning," he said.
While many children will be affected by virtual learning, "it's not going to impact all children equally," Ghinassi said.
"We're most concerned with kids who are living in environments where school may have been a place where they got two solid meals a day, school may have been the place where they were away from conflict at home," Ghinassi continued. "Kids who are subject to social determinants, poverty, unstable housing, food instability, domestic violence, all of that is going to be amplified because the child doesn't have that island of time away from home."
Ghinassi said both parents and teachers should look out for changes in children's behavior.
"At times like this, we really want to encourage people if they notice changes in their children ... you really want to encourage them to seek professional help. This is the time to reach out in every community," he said.
Fialk said it's important for parents to validate and check in with their children during this time. "Listen to their concerns, validate their emotions. Let them know their concerns and frustrations are understandable," she said.
Fialk also recommended that parents encourage their kids to practice self care, like exercise and good sleeping and eating cycles, as well as make sure their children are doing activities they enjoy.
Michael Rich, director of the Center on Media and Child Health at Boston Children's Hospital, said parents must also pay attention to their own actions.
"Part of it is: Parents are trying to figure out how to get their work done or keep their job," Rich said. "So, I think we have to discipline ourselves to really pay attention to the kids, really listen to them, and not just assume that because they're quiet and not causing any trouble there's nothing going on."
Ghinassi recommended that adults lead by example.
"You want to model resiliency for kids," he said. "I think it can go a long way if parents say, 'Yes, this is a challenging situation, but together we're going to manage this, we're going to do well, we're going to take precautions, we're going to wear masks, we're going to socially distance, we're going to wash our hands. And we're going to get through this together.'"
As for the long-term effects this year will have on children, Ghinassi said it might not be totally negative.
"One theory about this is these kids will have a legacy of having endured a very unusual time, and for some kids that may contribute to ongoing stress," he said. However, others will see it as "an opportunity for them to experience their own resiliency and they were, in a sense, survivors of something. And there is kind of a badge of honor in that for some."
Ghinassi compared today's younger generation to the "Greatest Generation," which experienced the 1918 pandemic, the Great Depression and world wars. "History tells us that individuals find ways to evoke resiliency," he said.
Rich, an associate professor at Harvard Medical School and Harvard T.H. Chan School of Public Health, said a positive way for kids to look at the pandemic is that it is a time of opportunity.
"If you see this as an opportunity to learn something you don't normally have a chance to learn, to do something you don't normally have a chance to do, because of demands of school … then this could be a great opportunity," he said.