The COVID-19 pandemic has significantly affected the mental health and well-being of children and adolescents, exacerbating an existing children's mental health crisis. Research from the Centers for Disease Control and Prevention (CDC) and other sources indicates that behavioral health concerns, educational setbacks, and developmental impacts have increased substantially during and following the pandemic period. This article examines the documented effects of the pandemic on children's mental health, observed behavioral changes, and recommended therapeutic approaches to support recovery and resilience.
Increased Behavioral Health Concerns
CDC scientists conducted comprehensive studies examining pediatric emergency department (ED) data before and during the pandemic to understand changes in health-seeking behaviors and mental health outcomes. These studies, published in CDC's Morbidity and Mortality Weekly Report in February 2022, analyzed data for children and adolescents (age 0–17 years) from 2019 through January 2022.
The research revealed a complex pattern in healthcare utilization. While pediatric ED visits decreased overall during the pandemic, specific categories of visits increased significantly. Notably, behavioral health concerns showed substantial growth among certain age groups. For older children (5–11 years) and adolescents (12–17 years), weekly ED visits increased for self-harm, drug poisoning, and psychosocial concerns throughout 2020, 2021, and 2022 when compared to pre-pandemic levels in 2019.
These findings highlight a critical public health concern: although overall healthcare utilization decreased, children and teens experiencing behavioral and mental health challenges were increasingly seeking emergency care. This trend suggests heightened emotional distress and potentially delayed access to routine mental health services during the pandemic period.
Gender Disparities in Mental Health Outcomes
One striking finding from the CDC research concerned gender disparities in pandemic-related behavioral health impacts. The second report from this series indicated that teenage girls may have experienced the largest overall increase in behavioral and psychosocial concerns during the pandemic.
Specifically, the proportion of ED visits for eating disorders among teenage girls doubled compared to pre-pandemic levels. Additionally, tic disorders more than tripled in this population. These findings align with other studies that have noted increases in tic-like symptoms among girls during the pandemic period.
The disproportionate impact on teenage girls raises important questions about the specific stressors this group faced during the pandemic and potential biological, social, or environmental factors that may have contributed to these outcomes. Researchers have noted that more work is needed to understand the differences between tics and functional tic-like symptoms and why more girls than boys were affected during the pandemic.
Educational Setbacks and Their Connection to Mental Health
The pandemic's impact extended beyond immediate health concerns to significantly affect educational outcomes, which are intrinsically linked to mental health and development. Research indicates that student academic performance had been declining before 2020, but math and reading scores dipped even further during the pandemic, creating additional stressors for children and families.
The disruptions to education varied dramatically among states, school districts, and communities, contributing to growing gaps in learning. For students who were in kindergarten when the pandemic began, now approaching middle school, researchers estimate a loss of approximately two years of social-emotional learning. This developmental gap has manifested in observable behavioral changes that professionals have noted in educational settings.
Educational experts emphasize that mental health and academic performance are interconnected. As one education administrator noted, "If we don't concentrate on social-emotional learning, then we're probably not going to see as fast of an improvement in academics as we want. Trust me, if a child is upset sitting in the classroom, they are not going to be listening to math."
Social-Emotional Developmental Impacts
The pandemic's disruption to normal social development has resulted in observable changes in children's social-emotional functioning. Among children who experienced critical developmental periods during school closures, professionals have noted behaviors more commonly seen in younger grades.
Specifically observed developmental impacts include:
- Increased sensory-seeking behavior (such as touching others more frequently)
- Reduced self-awareness (for example, not noticing when wearing a shirt inside out)
- Greater difficulty with reading social situations and understanding social cues
These developmental challenges suggest that extended periods of reduced social interaction during formative years may have affected children's social-emotional growth in measurable ways. The long-term implications of these developmental gaps remain an area of ongoing research and concern.
Support Strategies for Children and Families
Research indicates that the well-being of parents, teachers, and other adults directly affects that of children. A report from the U.S. surgeon general highlighted the enormous stress and burdens placed on parents during the pandemic and emphasized the need for more support for caregivers of children.
Mental health professionals recommend balanced parenting approaches that combine warmth and support with consistent boundaries. Experts note that in the post-COVID period, many parents have emphasized affection and support but may have relaxed rules and boundaries. While acknowledging that children "have gone through this really hard time," professionals encourage reestablishing boundaries, particularly around screen use, which spiked during the pandemic.
Child psychologists recommend several evidence-based strategies for supporting children's mental health during the recovery period:
- Deep listening and validation of children's feelings and experiences
- Encouraging children to ask questions and express concerns
- Demonstrating compassion and avoiding assumptions about children's behaviors
- Maintaining consistent routines and expectations
- Providing opportunities for social interaction and development
The Role of Schools in Recovery
Schools play a crucial role in addressing both educational and mental health needs following pandemic-related disruptions. Some educational institutions have implemented innovative approaches to support recovery. For example, the Richmond Public Schools district in Virginia ran a pilot program that added 20 days to the school calendars of two elementary schools. Initial results from this intervention indicated an increase in literacy levels and improved student attendance at the end of the year.
Educational experts emphasize that schools should address both academic and social-emotional needs simultaneously. Teacher burnout has increased during the pandemic, with rates of teacher absences and demand for substitutes on the rise. Supporting educators is therefore essential to creating effective learning environments that also support children's mental health.
Research suggests that interventions focused only on children produce some gains, but providing support for entire families leads to greater improvements in both learning and mental health outcomes. Family-centered approaches that address the needs of both children and their caregivers appear most effective in supporting comprehensive recovery.
Building Resilience in Post-Pandemic Times
Research demonstrates that children possess greater resilience than often recognized. Building on this inherent resilience, mental health professionals emphasize the importance of creating supportive environments that facilitate healing and growth.
Studies indicate that solutions to address pandemic-related impacts on children's mental health must involve investments not just in children but also in families and schools. A comprehensive approach that addresses multiple levels of influence—individual relationships, family dynamics, school environments, and community resources—is most likely to produce positive outcomes.
As researchers continue to study the pandemic's impact on children's mental health, clinicians are developing targeted interventions based on emerging evidence. The CDC has emphasized the importance of early and increased awareness for health concerns that could arise due to delayed medical care and heightened emotional distress during the pandemic, particularly among children and teens.
Conclusion
The COVID-19 pandemic has significantly affected children's mental health, with documented increases in behavioral health concerns, educational setbacks, and developmental impacts. Research indicates that while pediatric ED visits decreased overall during the pandemic, visits related to self-harm, drug poisoning, and psychosocial concerns increased among older children and adolescents. Teenage girls appear to have been disproportionately affected, with doubling of eating disorder-related visits and more than tripling of tic disorder visits.
Educational disruptions have contributed to developmental gaps, particularly in social-emotional learning for children who were in kindergarten during the pandemic's onset. These challenges are interconnected, with mental health and academic performance influencing each other.
Evidence-based approaches to supporting children's recovery include balanced parenting that combines warmth with consistent boundaries, school-based interventions that address both academic and social-emotional needs, and family-centered support strategies. As research continues to evolve, clinicians are developing increasingly targeted interventions to address the specific impacts of the pandemic on children's mental health.
The findings from multiple studies underscore the importance of early identification of behavioral and psychosocial concerns and the provision of appropriate interventions at the right time. By implementing comprehensive support strategies that address the needs of children, families, and schools, communities can help mitigate the pandemic's impact on children's mental health and promote resilience in the post-pandemic era.