Recently, COVID-19 vaccines were approved for young children ages 6 months to 5 years. To some it may seem like life is getting back to normal. But, after two years of social isolation, unprecedented loss of parents and family members and economic uncertainty, life has not returned to normal for our youngest citizens.
Children are often a policy afterthought, as they have no voice and little political capital. This has especially been true during the pandemic. Evidence tells us that we have failed our children as we have observed rising rates of depression and anxiety, social and emotional concerns, routine immunization deferrals, and of course, academic declines likely caused by absenteeism and decreased in-person instruction days.
Over the past two plus years schools and daycares — social safety nets for many — closed abruptly with no alternatives provided. Data recently shared by the Biden administration show that post-pandemic America’s students are on average two to four months behind in key subjects such as reading and math.
While COVID-19 vaccines for adults were rapidly developed, our youngest still predominantly remain unvaccinated. Vaccine hesitancy among parents may also continue to exacerbate the challenges that children face. Across the board, specialists who focus on the health and wellbeing of children — teachers, pediatricians and child care workers — are among the lowest paid. This is evidence of the value, or lack of value, that we place on the care of our children.
Data sources tell us that the pandemic has worsened children’s mental health. Numerous studies suggest that children are more anxious, have more problems sleeping, more problems paying attention, feel sadder, and are more likely to engage in self-injurious or self-harm behaviors than during pre-pandemic times. Across all age groups, but especially for adolescents, social isolation (a key component of late adolescent development) has increased. And yet, services for mental health support have not increased; some have even become less accessible or moved to virtual only.
We applaud recent efforts to fund community mental health and preventative programs. Nearly $35 million dollars have been allocated to strengthen such organizations, but it is just a drop in the bucket.
However, improving children’s mental health is more complex than increasing funding and supporting existing networks. Destigmatizing access to mental health care and making services available in the daily lives of children is key. It is about increasing social connections, creating networks for mentorship, increasing programs to teach children about self-care and mental wellness and increasing the technical support for people already in children’s lives such as sports coaches, mentors, faith leaders and other community group members. Some of this is supported by grant funding through Health and Human Services. But other services require greater collaboration within our health care, education, health and social support systems.
Solutions exist, but we need political will and social investment to make them a reality. This discussion is timely given a confluence of factors related to the early childhood programs and realizing the best return on investment of our public dollars. Federal and state spending on children in all 50 states is largely directed at school-age children and adolescents, despite clear evidence showing the importance of early child development experiences. We do not prioritize spending on our youngest children.
The American Rescue Plan (ARP), passed in March 2021 through bipartisan support, offers some opportunities and some hope. The ARP, at $1.9 trillion dollars, has multiple funding streams that we could use to advocate for and support children’s health and social development. However, because this money is being allocated to state and local governments, it is up to each to decide how to spend their money. And to be clear, children are rarely chosen.
The ARP allocates $200 million for the Nurse Corps Loan Repayment Program — these funds could be allocated to prioritize nurses who choose to work in underserved populations, provide care to pediatric patients, or work in school or mental health settings, where they are integral to the health of children (and often underpaid, understaffed and asked to do superhuman tasks).
One of the untapped and underappreciated resources to support the health of children is our school nurse team. As a start, we need funds to ensure that there is a school nurse available in each school, in order to safeguard and care for children’s health. We know that many children don’t have access to regular healthcare, but the majority of children do attend school, and as such school nurses are well positioned to provide a safety net, in partnership with counselors and therapists, as well as pediatric health providers.
As parents and pediatric clinicians, it’s all too clear to us that we are in uncharted waters. As we contemplate the way forward, we must center our children, their well-being and their futures. Meeting the challenges that face our children will require a concerted effort between parents, policymakers, clinicians and schools.
Ashley Darcy Mahoney, Ph.D., NNP-BC, FAAN, is a professor and neonatal nurse practitioner at The George Washington University School of Nursing. Danielle Altares Sarik, Ph.D., APRN, CPNP-PC, is a nurse scientist and pediatric nurse practitioner and a senior fellow at the Center for Health Outcomes and Policy Research at the University of Pennsylvania. Aparna Kumar, Ph.D., MPH, APRN, PMHNP-BC, is an assistant professor and a psychiatric mental health nurse practitioner at Thomas Jefferson University and is the program director of its Psychiatric Mental Health Nurse Practitioner program.