America’s top priority: Help kids
As pediatricians at a New York City hospital hit hard by the pandemic, we would not minimize the seriousness of COVID-19 and agree that it is essential to control its spread. Our hospitals are still caring for children with multisystem inflammatory syndrome, a serious but rare condition seen in children that is linked to COVID.
However, the effects of social isolation and limited in-person instruction are placing an entire generation’s long-term well-being at risk. We are now at the tipping point where it is no longer about whether school, camps and activities should restart, but how we can help them implement the CDC’s strategy for reopening.
Across our three pediatric disciplines — cardiology, obesity and mental health — we have seen the devastating consequences the COVID-19 pandemic is having on our young patients’ health and happiness.
After reopening our pediatric cardiology offices to more routine outpatient visits in the summer of 2020, we began noticing common complaints among our patients: their ability to exercise had declined and they fatigued more easily during activities. One teen athlete, so out of shape, was no longer able to compete after returning to soccer. That was one of many patients whose fitness had declined because of a lack of access to physical activities.
Our pediatric cardiology group performed a study comparing cardiopulmonary exercise stress test results between children and young adults up to age 21 who were tested at three to six months into the pandemic to those tested before COVID-19 restrictions were implemented. Our study, published in the journal Pediatric Cardiology, demonstrated a measurable decline in the physical fitness of children during the pandemic. These findings suggest that the loss of opportunities for children to participate in organized school, recreational activities and summer camps contribute to a decline in their cardiovascular health, placing them at risk for long-term disorders, including obesity.
In our obesity practice, we are seeing children who had been making progress losing weight before the pandemic return with an average weight gain of 10 to 20 pounds due to the lack of physical activity, sedentary remote learning, poor sleep and poorly balanced dietary choices. Many of our families have lost consistent access to nutritious and adequate foods, such as fresh produce, and instead are eating more processed foods.
Before COVID-19, obesity affected almost one-fifth of American children ages 2 to 19 years of age. Now, these numbers are expected to rise, with modeling studies predicting at least a 3-4% weight gain in children during the pandemic. These changes will have longstanding consequences if not addressed immediately. Children with obesity are more likely to become adults with obesity, who develop associated health problems including type 2 diabetes, stroke and heart disease.
We are also seeing how the pandemic has exacerbated an already existing mental health crisis in youth. Before the pandemic, one in five children had a mental health problem, and suicide was the second leading cause of death in children beginning at age 10. Now, youth with mental health concerns are pouring into our pediatric primary care offices.
Some refuse to leave their homes because they are scared of the COVID-19 virus. Some are experiencing excessive grief due to losses they experienced while others worry about whether their parents’ unemployment threatens their housing or what they will eat.
Every week, more children screen positive for mental health concerns, and more children say they are having thoughts about suicide. School-aged children tell us they would rather die than live in a world with COVID-19. Social isolation is a risk factor for suicidal behaviors, while feeling connected and engaged in school and activities are protective factors. Our youth are isolated right now with so much uncertainty about the future, making it harder to cultivate hope and resilience during these times.
Across the country, too many children might not even see a specialist or stay in the emergency room for days waiting for one of the few inpatient psychiatry beds that are still open, a dire shortage that has only worsened with the pandemic.
We must intervene now to prevent further health complications and mitigate the detrimental effects this pandemic is having on children.
We must ensure schools receive funding to provide essential healthy meals to families and physical activity outdoors or virtually. We should be urgently vaccinating teens 16 and over, and every pediatric clinic should have the Pfizer vaccine available for that group, with plans to rapidly vaccinate younger children before the next school year as soon as a vaccine is authorized for younger ages.
Children are our future, and we must prioritize their well-being right now.
Censani, Dayton and Green are pediatricians specializing respectively in obesity, cardiology and mental health at NewYork-Presbyterian Komansky Children’s Hospital and are associate professors of clinical pediatrics at Weill Cornell Medicine.