The most recent data from the American Academy of Pediatrics (AAP) and the Children's Hospital Association show number of cases per 100,000 children in the United States have risen dramatically with most increases corresponding with the September reopening of schools nationwide (Roper, 2020). With more than 1 million children diagnosed with the infection, concerns about potential long-term sequelae with children and teens have prompted pediatric providers to ask how they can support their patients and families. AAP (2020) recently published interim guidance on supporting the emotional and behavioral health needs of children, adolescents, and families during the pandemic. As a preface to specific guidance, they reviewed in detail the impact of the pandemic that is compounded by isolation and an interruption in learning and in the support systems for families. The wide range of emotional and behavioral health and economic challenges stressing the well-being of families is exacerbated in populations with higher baseline risk such as vulnerable and marginalized individuals and communities. The impact of structural racism has resulted in disproportionate challenges on communities of color. Concerns about long-term sequalae of the effects of COVID-19 on children and families must not be ignored.

Specific guidance for pediatric providers was offered on emotional and behavioral responses among children and teens. Typical reactions to stress in infants and children include: sleep, toileting, and feeding disruptions along with increased separation anxiety, and irritability. Adolescents often exhibit withdrawal, fearfulness, overt anxiety, irritability, aggressive and oppositional actions, and a variety of somatic complaints. Although teens may be able to more effectively verbalize their stressors, they often deliberatively hide their complaints out of shame or fear of burdening others. Both younger and older children may exhibit changes in temperament and resistance to change (AAP, 2020).

AAP (2020) urges providers to start to screen for emotional and behavioral changes if they do not already do so and to take into consideration other factors such as social determinants of health, food insecurity, parental/caregiver well-being, remote learning, special health care needs, LGBTQ identification, and incarceration. Specific guidance includes recommendations on: general anticipatory screening related to emotional and behavioral health; open and honest communication and conversations with children about their COVID-19 related concerns; social isolation and the need to promote safe socialization; the risks of and need for selective screen and media interaction; and, the importance of building resilient behaviors. They include a brief but detailed screening tool used in New Hampshire that can assist providers to check in with their families. Some examples of screening questions to consider asking parents or caregivers include: Now is a difficult, stressful time for everyone. How are you? Are you okay and safe? Is there anything you need? and Is everyone in your family able to get what they need to get by? Do you need help connecting to resources? Examples of questions for children include:

How is virtual learning working for you? How is it affecting you? Your family? Do you need help with anything?Who is taking care of you? Who do you feel safe talking to about needs and worries? How is everyone in your family getting along? Are you worried about anyone?

More information about how to talk to children and families is available at the New Hampshire Children's Trust: https://www.nhchildrenstrust.org/covid-19

Although we can all be hopeful about the roll-out of vaccines, the impact of COVID-19 will have long-term effects on children and families. Pediatric nurses are experts in screening, support, and advocacy. We have always been instrumental in making sure that children and families are healthy, safe, and thriving. This is critically important now during this public health crisis.

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