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Rutgers experts discuss mental, behavioral health issues in children due to pandemic

Daniela Moscarella, a pediatric clinical instructor at the Rutgers School of Nursing, said that it is important for parents and teachers to monitor the behavior of children during this time and take action if they are showing any warning signs of mental, behavioral or physical health issues. – Photo by

Recent findings have shown that stress caused by the coronavirus disease (COVID-19) pandemic has worsened children’s mental and behavioral health, and has created physical problems such as overeating, according to an article from Rutgers Today.

Rutgers experts discussed these issues, the signs that indicate when a child needs help and how parents can help their children during this time.

Mamilda Robinson, specialty director and clinical instructor of the Psychiatric-Mental Health Nurse Practitioner program at the Rutgers School of Nursing, said the findings, which can be found on the Centers for Disease Control and Prevention website, displayed specific issues involving anxiety, depression and behavioral disorders in children.

Children typically have a tough time talking about their feelings, and their behavior can be confusing to parents since anxiety and depression look different depending on age, said Daniela Moscarella, a pediatric clinical instructor at the Rutgers School of Nursing and president-elect for the New Jersey Chapter of National Association of Pediatric Nurse Practitioners.

“Younger children generally have regressive behaviors like bed-wetting, clinging excessively to a parent or caregiver and increased periods of crying,” she said. “As children get older, they lose interest in activities they previously enjoyed, perform poorly in school, have difficulty concentrating and being attentive and are irritable.”

Moscarella said that children also typically get more headaches, stomachaches and generalized body discomforts, while adolescents usually appear more agitated, seem to be withdrawn, act out or use alcohol and drugs, with declining school grades being seen across all age groups.

Children are believed to be at a greater risk for being affected if they are using public insurance, living in poverty, living in single-parent households, having unmet health needs, having a parent with behavioral health issues, lacking a primary care provider or are male, Moscarella said.

She also said that adverse childhood experiences should be evaluated for all children since negative experiences could have an impact on their healthcare, even continuing into their adult years.

One potentially severe consequence of pandemic stress, besides decreasing mental and behavioral health alone, is overeating, which can have both a physical and emotional effect on a child’s health throughout his or her life, Moscarella said.

While stress and emotional disturbances typically decrease appetite, she said, children have been found to be more prone to overeating when their parents use food as a reward.

“Children who gain a significant amount of weight in early childhood are at risk for hypertension, heart disease and diabetes,” Moscarella said. “Issues with self-esteem also begin and can carry on into adulthood, which can (oftentimes) lead to depression.”

Robinson said that parents and teachers need to consider that children might react differently to stress compared to adults and that it is important for them to note any change, such as poor sleep and eating patterns, in a child’s behavior or normal routine, and intervene accordingly.

Since children are routine-oriented, they benefit greatly from structured activities, Moscarella said. For instance, leaving the house to attend school is an important part of the routine that parents create for their kids at a young age, she said.

“School attendance allows for peer-to-peer interaction, essential during every developmental stage, beginning in toddlerhood and lasting into adolescence,” Moscarella said. “Pandemic life is not conducive to normal developmental events, and it is having a significant impact on this population."

The school environment also provides children the opportunity to take part in teamwork activities and have structured exercise time, she said, and many children suffer from food insecurity and are unable to eat unless provided food by the school.

With virtual school, she said children have been breaking routines and spending hours in front of the computer at home, which is a hindrance to their developmental milestones. As a result, Moscarella said children have been found to be more withdrawn, anxious, depressed and uninterested with daily activities during the pandemic.

“Teachers are having a difficult time maintaining engagement in activities that normally were of interest to most children,” she said. “Not only is this a stressor on the children but also on the families who have had to modify their work schedules to support their children’s learning from home.”

Moscarella said that to reduce stress, she recommends relaxation techniques like art therapy, walking, reading, listening to music, exercising, playing with a pet, practicing an instrument, writing, completing puzzles or meditating.

When children are anxious, parents can help by enforcing regular routines and ensuring their children are eating healthy and getting a sufficient amount of sleep, she said. Similarly, teachers can encourage children to find activities that help decrease stress and look out for irregular changes in behavior, Moscarella said.

“Socialization with peers is an integral part of child development,” Robinson said. “It is ... important to also recognize that children need to be healthy and safe in order to thrive.”


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