By Taylor Knopf

Child advocates are worried that increased hardships due to the coronavirus pandemic could have long-term negative physical and mental health impacts for kids.

In July, 30 percent of North Carolina adults with children reported that they were behind on their rent or mortgage payments and/or they could not afford enough food for their families, according to data collected by the U.S. Census Bureau.

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Because kids have been relatively spared from serious illness caused by COVID-19, “there might be a

Courtesy of the National Institute for Health Care Management Foundation

false sense that nothing bad is happening to young children,” said Harvard Pediatrics Professor Jack Shonkoff, during a recent National Institute for Health Care Management Foundation webinar.

But he added, “in fact, the stresses that their families are experiencing have an enormous effect on many, many children.”

The economic side effects of the pandemic caused increases in food and housing insecurity across the country, according to the NIHCM Foundation analysts. Elevated stress in the home is often a predictor of abuse. Because child care centers and schools have been closed, there are fewer people to detect and report signs of abuse, according to the foundation report. Additionally, child advocacy centers across the U.S. have reported seeing 40,000 fewer children during the pandemic, those are multidisciplinary organizations that investigate child abuse allegations and provide mental health treatment, training and case management to families where abuse has occurred.

There are 35 accredited and 12 provisional child advocacy centers in North Carolina.

The Exchange Family Center, a Durhan nonprofit aimed at preventing child abuse and neglect, initially saw a drop off in clients when stay-at-home orders went into effect and services moved online.

Executive Director Rachel Galanter said that families were overwhelmed and many said they couldn’t commit to more virtual calls when the center switched to telehealth. People reported feeling overtaxed juggling jobs, child care and virtual schooling all in the same space with limited bandwidth, she said.

“It’s incredibly stressful to be a parent right now. We see that not just for the families we support, but for our own staff,” Galanter said. “It’s like being a computer that’s running a really big program all the time. Everything is glitchy, harder to do and slower. We are all operating that way.”

Neglect, abuse, food insecurity, homelessness and substance abuse in the home are a few examples of what experts call Adverse Childhood Experiences (ACEs), which have been shown to increase a person’s risk of developing mental health problems. Another study found the higher a child’s ACE score, the more likely they are to be incarcerated later in life.

Children with a higher number of adverse experiences are also more likely to grow into adults with physical health problems such as cancer, high blood pressure, liver disease or diabetes, according to a groundbreaking study conducted in the 1990s by the Centers for Disease Control and Prevention and Kaiser Permanente.

Those findings have come full circle during the COVID-19 pandemic, as those with chronic health conditions — such diabetes or high blood pressure — are also at higher risk of developing serious complications from the virus, Shonkoff noted.

Stress is toxic

The science around ACEs has led to a greater understanding of how early experiences help shape the brain architecture and how toxic stress disrupts the circuitry of a developing brain, Shonkoff explained.

Early adverse experiences have also been found to negatively impact a person’s developing immune system, metabolic regulatory systems and cardiovascular system.

ACEs research helps explain not only why kids with tough home lives struggle in school, but also why they are more likely to develop the most common chronic diseases decades later, Shonkoff said.

Stress hormones trigger elevated heart rate, blood pressure and inflammatory responses, he explained. Stress is usually present for a short time, and then the body returns to its baseline levels. But if stress becomes a chronic condition, these levels stay elevated and the toxic stress has a “wear and tear” effect on the body’s systems, Shonkoff said.

Not only does this negatively affect the individual, but ACEs are the building blocks to the prevalent diseases that cost our health care system the most.

Shonkoff said that three of the five most costly chronic illnesses are impacted by early adverse experiences — cardiovascular disease ($294 billion/year), diabetes ($189 billion/year) and depression ($99 billion/year).

He said it’s time that medical academic establishments embrace that adversity and social determinants are real health risks, not primarily a referral to social services.

In his line of work, people often ask Shonkoff about the best ways to combat ACEs. The health and well-being of children are directly tied to the adults who care for them, he said.

“Science-informed investments that reduce hardships on pregnant women and families raising young children offer a promising pathway to enormous saving in health care costs decades later,” he said.

New and better normal

As the coronavirus pandemic has upended nearly every aspect of life, people often say they wish everything would just return to normal.

“But normal wasn’t such a great thing for most people in our country. We want a ‘better normal,’” said the founder of ACEs Connection Jane Stevens during the NIHCM Foundation webinar.

Courtesy of ACEs Connection

The pandemic and the renewed push for racial justice have offered the country opportunities for growth and change, she said. ACEs science is a relatively new understanding of why humans behave the way they do, and it is crucial to addressing solutions, she said.

Those solutions are often counterintuitive, Stevens said, as they focus less on the individual adverse experience and more on supporting the whole person and their community.

That can be challenging during this time of social distancing.

Though the Exchange Family Center in Durhan initially saw a drop off in program participation, by mid-September, Galanter said the center was serving almost as many families through telehealth as they were before the pandemic.

And some parents who previously emailed weekly with new issues were seeing huge improvements with their children and home lives due to the virtual therapy sessions.

“This is our new normal and families are engaging with it,” she said.

Due to increased economic strains, the center’s staff continues to connect people to food and other resources. Galanter said the undocumented families they work with were hit particularly hard since they were ineligible to receive stimulus checks or enhanced unemployment compensation and couldn’t apply for public assistance. However, Galanter said it’s been difficult for a swath of different people as some have lost work or had to work less or stop working altogether to care for children.

But the pandemic has prompted new and creative solutions for helping families as well. The center’s staff have found new ways to support families during this time of social distancing, such as dropping off puzzles and activities for families to do together. Puzzles were particularly helpful for a family with two children with autism who were struggling with the disruption to their school and social routines, Galanter said.

“This wasn’t something we necessarily would have done before,” she said. “At this point, we are stepping in ways we may not have in the past.”

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Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...