Parenting: Child Therapy & COVID-19

What are red flags I should look for to know if my child needs help? Dr. Sandra Pimentel, Montefiore’s Chief Child and Adolescent Psychologist, shares advice for parents of children struggling during COVID-19 and explains what therapy looks like for children, including virtual health options.

Dr. Sandra Pimentel, Chief of Child and Adolescent Psychology, discussing child therapy during COVID-19.
Transcript

- No question that during the COVID pandemic, families had been under extreme amounts of stress. There have been behavior changes in kids. Parents have said that their children are more clingy, they're not sleeping as well. So a question we get all the time is what are some of the red flags? How will I know if I should be seeking therapy for my child? And here are some things to keep in mind. One, how much stress? How much distress does this child show when they are upset? How severe are the tantrums? How tearful are they? So how upset do they get? That's one part. The second is how long does it last? What's the duration? When they get upset, does it last the whole day? Does it ruin the whole day? Or do they get upset, and then they come down and are able to adjust after having been upset. And then one of the most important factors when trying to determine a red flag is, does it mess up their functioning? Does it get in the way of doing what they have to do? So when they had school, was getting in the way of them being able to pay attention, or get their schoolwork done, or sit through some of the Zoom classes and whatnot. Is getting in the way of their friendships? Their ability to socially connect, even though connection is such a difficult thing during these times. Do they want to connect? Are they wanting to reach out to friends? Is it getting in the way of family functioning and your ability to get together as a family? Or does it feel like you're maybe really over accommodating when your child does get upset? And then the other factor is, is it messing them up themselves? Are they unhappy? Are they seeming more unhappy than they typically had been with significant mood changes and whatnot? Some of the other things to look out for, sleep, appetite. Are they sleeping more than usual? Sleeping a lot less than usual? Are they eating a lot more than usual? Are they eating a lot less than usual? Are they isolating themselves more? Now, we know teenagers may naturally isolate a bit more. But this is more extreme. So if they're isolating and not really engaging with even family members, that's a red flag to look out for. Do they have physical symptoms? So are they reporting a lot more stomach aches, things like that. Headaches, physical complaints that don't go away or that are repeating more over the course of time. And then of course, if they ever express any thoughts of harming themselves or harming others, that's a definite red flag that parents should seek help for. If parents are concerned about their child's anxiety, distress, sadness during the COVID pandemic, they may want to consider seeking mental health treatment. Parents often ask well, how do I even talk about seeking mental health treatment with my kids? Here are some suggestions. First of all, talking always starts with listening. Talk to them about their feelings. Create an atmosphere where you speak openly about stress, anxiety, sadness. Normalize those feelings, especially during a pandemic, and especially during now, this next phase as we move into the summer. Parents can talk about how they cope and how they seek help. Do they seek out social support? Have they gone to treatment themselves? Creating an atmosphere where we talk about when we are stressed out or upset about something, and normalizing the act of reaching out for help. Whether to a friend or whether to a mental health expert. Another way to listen is to ask kids, Well, what do they know about mental health treatment? What have they heard? Have they heard the term psychologists social worker? What do they associate with the word therapy? What have they heard at school or on television? So listening and correcting any information? There are experts who specialize in dealing with feelings and mental health, and helping demystifying and destigmatize that can be helpful to children. Just like there are coaches that can help you with soccer or basketball, there are therapists who are experts in feelings and helping you deal with feelings. There are instructors and tutors that can help you with these types of things. One of the nice parts about these times is that there are many celebrities, famous people who are talking openly about their anxiety, depression. Who are seeking out treatment or speaking positively about seeking out treatment. Cognitive behavioral therapy, dialectical behavioral therapy. We have Michael Phelps, Lady Gaga, Prince Harry, Kevin Love, we have athletes talking about seeking out help. This might be helpful in speaking to children, and normalizing, destigmatizing seeking mental health treatment. Another option is to perhaps identify someone in the child's own world or life that they may know who has sought out therapy. Especially if it's a same age, whether it's a cousin or a neighbor. And explaining that that person sought out help and it's good to seek out help. Another model to think about is, going to the pediatrician or going to the dentist. Sometimes we go for checkups, sometimes we go to check in and see how we're doing. Sometimes we go when we need something. And so just like that, just like the dental health, we have to take care of our mental health. So that might be an analogy that's useful for parents and children. So what does child therapy look like during COVID-19. During non-pandemic non-lockdown times, going to a therapist usually involves a parent or caregiver taking their child to a physical office space. It looks like another doctor's visit, typically. Where you fill out a lot of forms, you answer a bunch of questions. The provider may ask to meet with the child individually depending on their age. They may meet with parents separately, to ask additional questions. And the goal is really to gather as much information as possible about the main concerns that the child and family are experiencing to come up with a plan. In a treatment like cognitive behavioral therapy, for example, for anxiety, you would set goals and work with the provider to set goals for treatment. Early on, the therapist will sort of explain what therapy looks like. How often is it going to be weekly, more than weekly. How long will the sessions last. 30 minutes, 45 minutes an hour. How will the therapist meet with the family. Will the therapist meet with the child individually, with the parents alone, with the caregivers with the child all together. To get a sense of how the meetings will work moving forward. And it's an opportunity to ask questions as well. And these may change depending on whether it's a younger child or an older child, and what the particulars of the concerns are. In general, anytime working with a child, it's working with the family, it's working with the unit in some way, and the therapist would really explain that. COVID-19 really changed how we deliver much of our care including mental health care. And what happened, was a lot of this had to move to telehealth. Fortunately, technology has afforded us the ability to keep providing services to kids, teenagers and their families during these times. A lot of what I described before applies to the telehealth sessions too. Having an understanding of what therapy looks like, an understanding of how frequently you're going to meet. Who's going to be a part of the sessions. What's changed is the format. So usually either over the phone or via telehealth platform. You may be familiar with FaceTime and Zoom, but there are platforms that are specific to delivery of healthcare. And these platforms are important, because they ensure that the information that's exchanged, the private information that's exchanged is kept secure. And that's something that's very important when it comes to healthcare delivery. Another issue that comes up during telehealth that may be different than usual therapy, is where's the therapy going to happen? Is there a private space in the home where the child or teen has access to be able to talk to his or her provider. Will the parents be present? Will the caregivers be around? How far off will they be? Will they be joining the session? That's something that the therapist and the family would want to work on ahead of time, so that there's an understanding of privacy and how that's going to work. So where the location is, is as important. What's gonna happen in an emergency. That's something that the therapist will also want to talk through with the family, with the child and their parents. What's going to happen in case of an emergency? Where will the parents be? How can we access them? And another important issue is technology glitches happen all the time. So what happens if the session gets disrupted, internet goes down, something. What's the backup plan? So telehealth while it can be similar and can be very valuable in delivering mental health care, also has unique challenges that need to be discussed, in addition to the regular aspects of therapy. The important thing to know is that telehealth delivery is doable, and if parents have concerns about their child, they should not wait in seeking treatment. As we move into this new phase, some areas may be going back to having mental health delivered in person, and there may be differences there too. There'll be more attention to asking questions about symptoms before being able to meet in person. There may be temperature checks at the door. Your provider may be wearing a mask. You may have to wear a mask. Parents, child, caregivers may have to wear a mask, and maintain social distance. So making sure that there's an office space that has at least six or more feet for the delivery of care. But again, the most important aspect is to know that whether the delivery of care is in person, on the phone via telehealth. If you have a concern about your child's care, you can get care for them. And we encourage you to reach out and seek out these types of services.

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The Heart & COVID-19


How does COVID-19 affect the heart? Montefiore’s Division of Cardiology Chief, Dr. Mario Garcia, discusses how COVID-19 affects the heart, what vascular conditions can be caused by COVID-19, who is most at risk, some forms of prevention and when it is important to seek medical care.

What research is Montefiore conducting on the impact COVID-19 has on the heart? Dr. Sandhya Murthy, Attending Cardiologist in Advanced Heart Failure and Transplant at Montefiore, describes what discoveries have been made during the pandemic, the patient groups impacted and how Montefiore’s ongoing research helps guide therapies for the best possible patient outcomes.

What pre-existing health conditions can lead to a higher risk for COVID-19 complications? Dr. Sandhya Murthy, Attending Cardiologist in Advanced Heart Failure and Transplant at Montefiore, describes the conditions that make a patient more vulnerable to severe illness and what precautions those with pre-existing health conditions should take, including heart-healthy habits like exercise and a low-sodium diet.

 

Mental Health and Coping


Mental Health Myths

Is it normal to think about COVID-19 all the time? Montefiore’s Chief Psychologist, Dr. Simon Rego, discusses why it's normal and whether to seek help.

Why am I always anxious? Do I have COVID-19? Will I lose my job? Montefiore’s Chief Psychologist, Dr. Simon Rego, explains how part of our brain works to keep us safe from something that could go wrong, and where and when to seek help for COVID-19 anxiety.

Why can’t I deal with my COVID-19 feelings on my own? Montefiore’s Chief Psychologist, Dr. Simon Rego, explains why it’s not weak to ask for help and why you might need assistance coping with COVID-19.

I’m supposed to be providing COVID-19 help, not asking for it. Montefiore’s Chief Psychologist, Dr. Simon Rego, discusses why healthcare workers should ask for and receive COVID-19 help.

Will people judge me for seeking help for my fears and anxieties about COVID-19? Montefiore’s Chief Psychologist, Dr. Simon Rego, explains ways to overcome concerns about being judged, and why seeking support to cope during this time is perfectly fine and necessary.

I'm just too busy with family and work. How can I find time for my COVID-19 feelings? Montefiore’s Chief Psychologist, Dr. Simon Rego, explains why finding time is important for our self-care, and recommends small things we can do to talk about our COVID-19 feelings that can fit into a busy schedule.

How can a therapist help me cope with COVID-19? Montefiore’s Chief Psychologist, Dr. Simon Rego, explains the tools a therapist can provide to help you handle COVID-19, what happens in a session and what to talk about.

I’ve had therapy, and I’m not sure how it can help with COVID-19? Montefiore’s Chief Psychologist, Dr. Simon Rego, explains what COVID-19 treatment looks like and which approach might work best. 

COVID-19 and Relationships

How can I best stay home with a partner? Montefiore’s Chief Psychologist, Dr. Simon Rego, discusses ways to work through the challenges of staying home with another person, as well as things to work on together.

How can I best stay home alone? Montefiore’s Chief Psychologist, Dr. Simon Rego, shares tools and techniques to help single people stay home, which can help with social isolation.

How do I juggle work, life and COVID-19? Montefiore’s Chief Psychologist, Dr. Simon Rego, discusses ways to maintain focus and a healthy work-life balance during the COVID-19 pandemic.

COVID-19 and Managing Feelings

How do I manage my feelings of anger toward COVID-19? Montefiore’s Chief Psychologist, Dr. Simon Rego, discusses why it's normal to have strong feelings about COVID-19, how to recognize triggers and things we can do to manage anger.

How do I deal with feeling lonely in isolation? Montefiore’s Chief Psychologist, Dr. Simon Rego, discusses managing feelings of isolation during COVID-19, and how to seek help.

How do I deal with my anxiety about finances affected by COVID-19? Montefiore’s Chief Psychologist, Dr. Simon Rego, explains how to manage financial fears during the crisis.

How can I manage addictive behaviors during COVID-19? Montefiore’s Chief Psychologist, Dr. Simon Rego, explains how to avoid negative coping methods during the crisis.

How do I deal with the human toll from COVID-19 and the impact on life as we know it? Montefiore’s Chief Psychologist, Dr. Simon Rego, explains how to cope with the loss of normalcy and changes in our lives as a result of the crisis.

Anxiety Busters

Taking a deep breath can help reduce anxiety. Montefiore’s Supervising Psychologist and Assistant Director of the Trauma-Informed Care Program, Dr. Paul Bulman, demonstrates ways to breathe better when feeling anxious about COVID-19.

Balancing negative thinking with positivity can help reduce anxiety about COVID-19. Montefiore’s Supervising Psychologist and Assistant Director of the Trauma-Informed Care Program, Dr. Paul Bulman, shows how making a gratitude list can spark positive thinking.

Focusing on the moment can help reduce COVID-19 anxiety. Montefiore’s Supervising Psychologist and Assistant Director of the Trauma-Informed Care Program, Dr. Paul Bulman, shares techniques for staying present during this difficult time.

Negative thoughts can create more anxiety. Montefiore’s Supervising Psychologist and Assistant Director of the Trauma-Informed Care Program, Dr. Paul Bulman, provides techniques to combat negative thinking during the COVID-19 crisis, including knowing the triggers and the 3 questions to ask.

Getting a good night's sleep can help combat anxiety caused by the COVID-19 crisis. Montefiore’s Supervising Psychologist and Assistant Director of the Trauma-Informed Care Program, Dr. Paul Bulman, provides techniques for sleeping better during the pandemic.

Keeping your body active is a great way to relieve anxiety and can boost your immune system. Montefiore’s Supervising Psychologist and Assistant Director of the Trauma-Informed Care Program, Dr. Paul Bulman, provides ways to work in regular exercise during the COVID-19 pandemic for physical and mental health.

Essential Workers and COVID-19

Montefiore’s Supervising Psychologist and Director of the Trauma-Informed Care Program, Dr. Dana Crawford, explains how essential workers and their families can handle concerns arising from COVID-19 work.

Montefiore’s Supervising Psychologist and Director of the Trauma-Informed Care Program, Dr. Dana Crawford, explains how the family and close friends of essential workers can navigate concerns arising from their loved ones’ COVID-19 work.

As an essential worker, how can I best handle conversations about COVID-19 with my loved ones? Montefiore’s Supervising Psychologist and Director of the Trauma-Informed Care Program, Dr. Dana Crawford gives essential workers tips on how to have conversations about COVID-19 with loved ones.

If my loved one is an essential worker, how can I best handle sharing my concerns about COVID-19? Montefiore’s Supervising Psychologist and Director of the Trauma-Informed Care Program, Dr. Dana Crawford offers advice on how to communicate about COVID-19 with loved ones who are essential workers.

Surviving COVID-19

What's it like to survive COVID-19? Montefiore’s Dr. Miguelina Germán, Psychologist and Director of Pediatric Behavioral Health Services, shares her personal experience with COVID-19. She talks about quarantining with her family in a two-bedroom apartment, coping with her fiancé contracting COVID-19, asking friends for help and emotionally working through her diagnosis. She also offers advice based on what she learned during this experience.

What happens after recovering from COVID-19? Montefiore’s Dr. Miguelina Germán, Psychologist and Director of Pediatric Behavioral Health Services, shares her personal experience after recovering from COVID-19, and what she learned about symptoms coming back and the importance of self-care after recovery.

Who to tell about your positive COVID-19 diagnosis and when? Montefiore’s Dr. Miguelina Germán, Psychologist and Director of Pediatric Behavioral Health Services, discusses life living with COVID-19, how she decided which family and friends to contact and when was the right time to tell them about her positive diagnosis.

Parenting During COVID-19

How can parents develop resilience in children during the era of COVID-19? Montefiore's Chief of Child and Adolescent Psychology, Dr. Sandra Pimentel, shares some ways parents can create family resiliency, and discusses the value of structure, social support, stress release, focusing on the positive and practicing gratitude.

How can parents talk about what's happening as a result of COVID-19 with kids of all ages? Montefiore's Chief of Child and Adolescent Psychology, Dr. Sandra Pimentel, discusses how to help kids understand COVID-19 using techniques to encourage talking about their feelings resulting from the life changes and uncertainty they're experiencing because of the pandemic, and how parents can model coping methods to help kids make more sense of their world.

How can I help a teenager cope with the life changes and risks caused by COVID-19? Montefiore's Chief of Child and Adolescent Psychology, Dr. Sandra Pimentel, discusses ways to help teens cope with uncertainty and loss due to COVID-19, as well as taking the risks of contracting or spreading the virus seriously.

How can parents manage both their stress and the stress inflicted on their families by COVID-19? Montefiore's Chief of Child and Adolescent Psychology, Dr. Sandra Pimentel, shares techniques to help cope and manage stress in these unprecedented times.

What are red flags I should look for to know if my child needs help? Dr. Sandra Pimentel, Montefiore’s Chief Child and Adolescent Psychologist, shares advice for parents of children struggling during COVID-19 and explains what therapy looks like for children, including virtual health options.

How should parents talk to their kids about the next phase of COVID-19? Dr. Sandra Pimentel, Montefiore’s Chief Child and Adolescent Psychologist, explains what’s important to communicate to children about the ongoing pandemic and how parents can create resiliency in their children by reflecting with them on what has happened, continuing to engage them in safe behaviors and including them in planning ahead. Dr. Pimentel also shares how to handle a child’s worry about the uncertainty of school by validating their feelings and focusing on what we can control.

Addiction During the Era of COVID-19

How is behavioral addiction being affected and manifested during the era of COVID-19? Montefiore’s Director of Addiction Consultation Service, Dr. Howard Forman, describes the impact the pandemic has on those with behavioral addiction, why many people are developing behavioral addiction, and shares what help is available.

How can a person get help for behavioral addiction during the era of COVID-19? Montefiore’s Director of Addiction Consultation Service, Dr. Howard Forman, shares ways to seek help for behavioral addictions that have increased or begun during the era of COVID-19.

How is internet addiction being affected and manifested during the era of COVID-19? Montefiore’s Director of Addiction Consultation Service, Dr. Howard Forman, describes the impact the pandemic has had on those with new or existing internet addictions, and offers guidance on available treatment options.

What are the treatment options for internet addiction during the era of COVID-19? Montefiore’s Director of Addiction Consultation Service, Dr. Howard Forman, shares available treatment options, including ways to receive treatment today from home.

How can the era of COVID-19 motivate recovery from addiction? Montefiore’s Director of Addiction Consultation Service, Dr. Howard Forman, describes how the pandemic has impacted those with existing addictions and describes how this time can be used to recover from addiction.

How can someone struggling with addiction get help during COVID-19? Montefiore’s Director of Addiction Consultation Service, Dr. Howard Forman, discusses how video visits and technology have transformed addiction care for the better during the pandemic, made care accessible to people in a whole new way, and how to get medical help if needed.

How can someone access medication for addiction recovery during the era of COVID-19? Montefiore’s Director of Addiction Consultation Service, Dr. Howard Forman, explains the ways Montefiore eased how people can have access to medication during the era of COVID-19 with more flexible personalized medication pick-up and delivery scheduled tailored to the individual.

What is gambling disorder and help during the era of COVID-19? Montefiore’s Director of Addiction Consultation Service, Dr. Howard Forman, explains what gambling disorder is, how lack of pleasure and activity during the era of Covid-19 created a new wave of gambling addiction for many people, and ways to get and seek help.

How has stress affected addiction during the era of COVID-19? Montefiore’s Addiction Psychiatry Program Director, Dr. Merrill Herman, explains how increased levels of anxiety and depression caused by the pandemic impact addiction, why people self-medicate, and how treatment can make a difference.

 

Pediatrics


MIS-C During the Era of COVID-19

What is Multisystem Inflammatory Syndrome (MIS-C) in children, what to look for, and how is it treated? Dr. Nadine Choueiter, Montefiore’s Director of Noninvasive Imaging and Pediatric Cardiology, explains the symptoms of MIS-C, what is known so far about what causes it, and why follow-up care is important after children are discharged from the hospital.

 

Neurosurgery


The Brain and COVID-19

How does COVID-19 impact the brain? Montefiore’s Chief of Division of Cerebrovascular Neurosurgery and Surgical Director of the Montefiore Comprehensive Center for Stroke Care, Dr. David Altschul, explains the neurological symptoms associated with COVID-19 and details when they can occur, who is at risk of experiencing them, and their long-term impact.

What research is Montefiore-Einstein conducting to explore COVID-19’s impact on the brain? Montefiore’s Chief of Division of Cerebrovascular Neurosurgery and Surgical Director of the Montefiore Comprehensive Center for Stroke Care, Dr. David Altschul, shares the details of the ongoing, wide-ranging, multi-disciplinary biomarker analysis to determine who is at higher risk for serious reaction to COVID-19 as well as neurological complications.

Are those with pre-existing neurological conditions at greater risk of getting COVID-19? Montefiore’s Chief of Division of Cerebrovascular Neurosurgery and Surgical Director of the Montefiore Comprehensive Center for Stroke Care, Dr. David Altschul, clarifies the risk of contracting COVID-19 or experiencing recurring symptoms for those with pre-existing neurological conditions.

What symptoms from pre-existing neurological conditions could return with COVID-19? Montefiore’s Chief of Division of Cerebrovascular Neurosurgery and Surgical Director of the Montefiore Comprehensive Center for Stroke Care, Dr. David Altschul, gives examples of symptoms that can be triggered by COVID-19 and when to seek immediate care.

Montefiore’s Chief of Division of Cerebrovascular Neurosurgery and Surgical Director of the Montefiore Comprehensive Center for Stroke Care, Dr. David Altschul, discusses a range of options from the most advanced medical treatments for strokes and seizures to over-the-counter medications for minor neurological symptoms.

Stroke & COVID-19

Why are some COVID-19 patients having strokes? Montefiore’s Medical Director at the Comprehensive Center for Stroke Care, Dr. Charles Esenwa, explains why some COVID-19 patients experience strokes, who is most at risk and what causes these COVID-19-associated strokes.

If I am diagnosed with COVID-19, what can I do to help prevent a stroke? Montefiore’s Medical Director at the Comprehensive Center for Stroke Care, Dr. Charles Esenwa, explains why it’s important to keep taking existing medications while sick with COVID-19.

Dr. Charles Esenwa, Medical Director at Montefiore's Comprehensive Center for Stroke Care, shares the symptoms of a COVID-19-related stroke and what to do.

What is the recovery process for patients who have experienced COVID-19 related strokes? Montefiore’s Dr. Charles Esenwa, Medical Director at the Comprehensive Center for Stroke Care, describes how Montefiore treats the unique challenges of COVID-19 related strokes with a multi-disciplinary team to ensure the best possible chance for long-term recovery.

The Nervous System & COVID-19

How does COVID-19 impact the nervous system? Dr. Richard Zampolin, Neuroradiologist at Montefiore, explains how COVID-19 impacts the nervous system, its potential long-term effects and the research Montefiore is currently conducting in this area.

Trusted Information Resources

Centers for Disease Control and Prevention

The leading national public health institute of the United States
 

NY.gov

For the latest COVID-19 guidelines and information from New York State 

World Health Organization

UN agency responsible for international public health