Children will pay long-term stress-related costs of covid-19 unless we follow the science

The world is learning more about the uncommon but puzzling ways Covid-19 can show up in kids, keeping worried parents on the lookout for symptoms of the disease. We should also be concerned

about how toxic stress brought on by the pandemic, or made worse by it, will affect children’s developing brains and bodies and their future health. In millions of households, kids are

experiencing an incredible amount of stress and anxiety. They’ve lost the stability and safety of schools and day cares, and with it their social connections to friends and teachers. They’re

dealing with their own feelings of fear and uncertainty caused by the coronavirus — and there is no clear end in sight. Meanwhile, they’re seeing parents and other caregivers struggle with

the emotional and psychological distress of an unprecedented pandemic. With the unemployment rate at 11% and expected to stay high, millions of children are living through the aftermath of

their parents’ loss of jobs and income. Decades of studies tell us that the kind of trauma and stress many children are experiencing during the Covid-19 emergency has the potential to embed

itself in children’s DNA, dramatically affecting their brains and other critical body systems and, as a result, their health across a lifetime. In my practice as a pediatrician working with

children exposed to trauma, I have seen firsthand how families’ struggles can have indelible effects on children’s health and well-being. We must act now to use the science of early

childhood development to address the Covid-19-related stress in children’s and caregivers’ lives. If we don’t, the pandemic will in the short term put millions more children than before at

risk for hunger, homelessness, abuse, and neglect. Over the long term, it will lead to more children with developmental delays, asthma, diabetes, mental illness, heart disease, cancer,

Alzheimer’s disease, and other poor health outcomes. The fallout will be worst for children who were already living in poverty and experiencing adversity before the pandemic struck, and for

children of color, who have disproportionately felt the health and economic effects of the twin public health crises of Covid-19 and racism. The good news is that children’s developmental

trajectories are not set in stone. But this nationwide public health and economic disaster is exacerbating systemic problems — such as food insecurity, domestic violence, and lack of access

to mental health care — that we’ve long struggled to address and that deeply affect children’s health and brain development. Despite herculean efforts of food banks, schools, and nonprofits,

2 in 5 households with mothers with children under age 12 experienced food insecurity in April. Our knowledge of past disasters tells us domestic violence was likely increased by

stay-at-home orders. And health officials are raising the alarm about a potential rise in deaths by drug overdose and suicide because of the psychological toll Covid-19 is taking on people

across the nation, which means thousands of children could lose their loved ones. Science-based solutions — shown by research to be effective at improving children’s health — could help us

reverse the impact of the coronavirus crisis on children’s well-being and improve health equity long after the pandemic is behind us. Early detection and early intervention are a kid’s best

shot at health and well-being. One of the medical advances that helps identify potential problems early involves health providers screening every child for adverse childhood experiences

(ACEs). These include growing up in a household with mental health or substance abuse problems, witnessing or experiencing violence, losing a family member to suicide, and the like. The more

ACEs children have, the more likely they are to experience changes to the biological stress response, which in turn leads to a range of health problems and chronic diseases in childhood and

adulthood. As surgeon general of California, I spearhead the ACEs Aware initiative. Launched in January, it trains and pays providers with Medi-Cal — my state’s version of Medicaid — to

screen children and adults for ACEs. By screening kids and grown-ups, we can identify how to intervene and improve their current and future health and break the intergenerational cycle of

adversity. This kind of effort should be done in every state. By screening nationwide in pediatricians’ offices, community clinics, family practices, school health centers, and other health

care settings, and continuing to do so into the future, we can get ahead of the toxic effects the coronavirus crisis could have on the physical and behavioral health of our children for

years to come. The science of early childhood has shown that the quality of children’s relationships with their caregivers is one of the most important predictors of their future health. So

in addition to screening children for ACEs, we should continue to provide relief to parents and other caregivers, as Congress and some states, including California, have done through

Covid-19 relief measures like direct financial support and eviction and rent relief. During Covid-19, California also specifically invested $42 million to protect children who are at

heightened risk for abuse and mistreatment due to Covid-19. We don’t know exactly how the social isolation, school closures, and economic disruption, and other stress caused by Covid-19 will

affect children’s health, but we know it will. Our hopes of ending the Covid-19 crisis, getting close to 4.5 million cases and more than 150,000 deaths in the United States as I write this,

are in the hands of scientists undertaking the monumental task of finding treatments and vaccines. But we must also recognize the science of early childhood development and systematically

put into practice what we know works. That’s the only sure way to give every child a solid chance for a better, healthier future. _Nadine Burke Harris is a pediatrician and the surgeon

general of California._