Pandemic Recovery for Children—Beyond Reopening Schools

Abstract

We are clinicians in busy health centers, and we are seeing the impact of school closures for in-person learning-including school disengagement, mental health challenges, unhealthy weight gain, food insecurity, immunization delay, and soaring rates of new-onset type 2 diabetes. 1 These immediate, visible consequences of school closures are harbingers of long-term outcomes, including decreased life expectancy for US schoolchildren. 2 Across the country, jurisdictions have eased restrictions, reopened schools, and returned to business as usual, and vaccine eligibility has expanded to include children 5 years and older. It is easy to focus primarily on these hopeful signs of progress during the pandemic, and fall back on the argument that children are resilient. However, we cannot waver in our focus on children. Children are resilient, but this resiliency requires individual support, systemic scaffolding, societal investment, and scientific research into the short-, medium-, and long-term impacts of the pandemic on children. In this issue of JAMA Pediatrics, Viner et al 3 present an important international review of the impacts of school closures on the health and well-being of children during the first wave of the pandemic (February through June 2020) and urge a balance between measures to contain infectious disease and to bolster the physical and mental health of children. The findings in this study can help identify clinical practices, policy and systems interventions, and research priorities that may mitigate the harms caused by school closures.In their research, the authors conducted a review following Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines to examine school closures during social lockdown and mental health, health behaviors, and child well-being during the first wave of the pandemic. Their search strategy used a machine learning approach and included both medical and educational research databases as well as consultation with experts in the field to identify any studies that may have been missed. They initially identified more than 16 000 possible studies, of which they conducted a full review of 151 and then deemed 36 of those to be relevant. They presented a narrative review that grouped studies by outcome(s) of interest and weighted studies based on type and quality. The heterogeneity of the studies precluded a metaanalysis. As a result of this approach, they were able to take a wide-ranging look at research during the initial phase of the pandemic, and ultimately report findings from 36 studies representing 11 countries. Outcome measures were mental health and well-being; child abuse notifications; sleep; health behaviors including physical activity, screen time, and diet; and overweight.

The youngest are hit hardest: The influence of the COVID-19 pandemic on the hospitalization rate for children, adolescents, and young adults with anorexia nervosa in a large German representative sample

“…Moreover, COVID-induced suspension of routine paediatric care, which had been established in Germany many years ago, has likely resulted in less control of growth parameters such as weight and height, thus contributing to the onset and deterioration of a restrictive eating disorder with the consequence of hospital treatment. We urgently need care delivery systems that reach children and adolescents with mental disorders at home and at school, such as mobile health units [40], to prevent and diagnose debilitating disorders such as childhood AN at earlier times. The age groups were predefined by the data storage system of the health insurance institution.…”

I paradossi di un'assistenza non basata sui reali bisogni

“…Le soluzioni sarebbero relativamente facili, almeno come tentativi per sperimentare nuovi modelli innovativi di assi-stenza. In altre Nazioni (Stati Uniti) si parla, in questo momento storico, di Unità territoriali mobili che si affiancano alle scuole e che potrebbero essere in grado di favorire anche i programmi vaccinali 5 . Unità mobili che fanno le visite domiciliari, che si occupano dei bisogni delle famiglie che per diversi motivi, socio-economici e anche sanitari, sono in maggiore difficoltà 5 .…”

“…In altre Nazioni (Stati Uniti) si parla, in questo momento storico, di Unità territoriali mobili che si affiancano alle scuole e che potrebbero essere in grado di favorire anche i programmi vaccinali 5 . Unità mobili che fanno le visite domiciliari, che si occupano dei bisogni delle famiglie che per diversi motivi, socio-economici e anche sanitari, sono in maggiore difficoltà 5 . In un contesto come quello dell'assistenza italiana, rivolta alla salute dell'infanzia e dell'adolescenza, uno potrebbe immaginare che queste Unità territoriali non siano altro che una équipe formata da pediatri che si uniscono in gruppi funzionali, con infermieri di comunità qualificati, con psicologi, con educatori socio-sanitari, con la collaborazione indispensabile dei Servizi comunali e del Terzo settore.…”

COVID-19 Policies, Pandemic Disruptions, and Changes in Child Mental Health and Sleep in the United States

“…However, such policies may have unintended consequences for child mental health . It is important to evaluate psychological sequelae and sleep deterioration of pandemic-related economic crises and disrupted schooling on children . Yet, to date, rigorous quantitative information is lacking.…”

“…[4][5][6] It is important to evaluate psychological sequelae 2,3,7,8 and sleep deterioration [9][10][11] of pandemic-related economic crises 12 and disrupted schooling 13,14 on children. [15][16][17][18][19][20][21] Yet, to date, rigorous quantitative information is lacking.…”