Psychosocial Effects of COVID-19 on Children

Introduction

The COVID-19 pandemic precipitated a secondary health crisis characterized by profound psychosocial distress among children and adolescents. Recognizing the severity of this impact, the American Academy of Pediatrics (AAP), along with the American Academy of Child and Adolescent Psychiatry (AACAP) and the Children’s Hospital Association (CHA), declared a national state of emergency in children’s mental health in October 2021,. The psychosocial sequelae of the pandemic resulted from a complex interplay of social isolation, disruption of routine, fear of infection, bereavement, and economic instability.

Escalation of Mental Health Disorders

There was a documented surge in pediatric emergency department (ED) visits for mental health conditions during the pandemic.

Depression and Anxiety: Feelings of isolation, chaos derived from virtual schooling, and anxiety about family health contributed to rising rates of internalizing disorders. High school students reported significant adversity, with female students and those identifying as LGBTQ+ experiencing the highest rates of poor mental health,.
Suicidality: Studies indicated that suicidal behavior and ideation in youths were higher during months of school closures in 2020 compared to 2019,.
Eating Disorders: Adolescent girls showed a distinct spike in ED visits for eating disorders. Contributing factors included the loss of daily routine, lack of social connections, heightened anxiety, and increased exposure to social media during lockdowns,.
Other Manifestations: Increases in tic disorders and obsessive-compulsive disorder (OCD) were also observed, particularly among teen girls.

The shift to remote education had deleterious effects beyond academic regression. Schools serve as critical hubs for social development, physical activity, and mental health support.

Emotional Health: Virtual education was linked with worsening emotional health and decreased physical activity. The lack of in-person interaction deprived children of peer support and social skill development.
Screen Time: Pandemic restrictions led to a significant increase in screen time. Problematic media use was linked to higher levels of parental stress. Excessive screen use also resulted in physical complaints such as eye strain, blurry vision, and dry eyes.
Sleep Disruption: The loss of structured school days contributed to sleep disturbances, which are closely linked to mood regulation and behavioral health.

Bereavement and Complicated Grief

A tragic psychosocial effect was the loss of primary caregivers, creating a generation of "COVID orphans."

Scale of Loss: By April 2021, an estimated 40,000 children in the U.S. had lost a parent to COVID-19. This loss was disproportionately higher among racial and ethnic minority groups.
Complicated Grief: Childhood grief became more complicated due to the inability to engage in traditional mourning rituals (e.g., funerals), social isolation preventing community support, and the traumatic nature of sudden deaths. This environment increased the risk of maladaptive grief responses and long-term psychological trauma.

Family Dynamics and Child Safety

The pandemic placed unprecedented stress on family units, exacerbating risk factors for maltreatment.

Child Abuse and Neglect: While ED visits for child abuse dropped during the pandemic (likely due to reduced detection by mandatory reporters like teachers), hospitalizations for severe injuries related to abuse increased.
Domestic Violence: Economic hardship and confinement increased intrafamilial stress. Surveys indicated a rise in intimate partner violence and the use of corporal punishment (spanking) against children,.
Parental Stress: Job losses and the burden of homeschooling negatively impacted parental mental health, which in turn correlated with declining mental and behavioral health in children, particularly in families with young children.

Vulnerable Populations

The psychosocial burden was not borne equally.

Children with Special Health Care Needs (CSHCN): Families of CSHCN experienced greater disruptions to daily life and therapy services, reporting higher stress levels and more frequent negative family interactions compared to other households.
Disparities: Black, Latino, and Native American children faced higher rates of caregiver loss and economic instability, compounding the psychological toll,.

Psychosomatic and Physical Consequences

Psychosocial stress manifested physically in many children.

Obesity: The pandemic exacerbated risk factors for obesity, including sedentary behavior and stress eating. Body mass index (BMI) rates nearly doubled for children and adolescents during the pandemic compared to pre-pandemic rates,,.
Functional Disorders: Pandemic-related stress was observed to lead to or exacerbate functional gastrointestinal disorders in children, highlighting the gut-brain interaction under psychological duress.