“For decades, enCourage Kids Foundation has been a champion for city hospitals, helping us to address the health disparities we encounter across underserved communities. As the largest public health care system in the United States, we see some of the city’s most vulnerable infants, kids, and teens, and your support allows us to treat them with the dignity and respect they deserve. Thank you for caring for the city’s kids!”
– Dr. Mitchell Katz, President and Chief Executive Officer – NYC Health + Hospitals
Future Challenges
Over the past several weeks, we’ve been highlighting stories of courage and resilience from our featured pediatric Healthcare Heroes:
Meghan Kelly - Child Life Program Director, Children’s Hospital at Montefiore
Meghan Kelly demonstrated great bravery in sharing her battle with COVID-19 early in the pandemic, when the most we knew about it was that “you died from it”. In addition to fighting the virus, she also had to fight the guilt from not being able to support her CHAM team in person during the early weeks of the pandemic. By sharing her journey in real-time, she inspired many others to remain hopeful in their own recoveries.
Nicole Perez - Coordinator of Child Life Services, NYC Health + Hospitals/Elmhurst
Nicole Perez took us into the “epicenter of the epicenter” at Elmhurst Hospital in Queens, NY, where everyone’s lives were turned upside down. No matter how sad, frustrated, afraid, or exhausted they were, they pulled together as a team in order to keep showing up for their patients. Nicole was also able to find solutions to help some of the communities’ most vulnerable patients - newborn children.
Dr. Gerald M. Loughlin - Professor of Pediatrics, Weill Cornell Medicine/NewYork-Presbyterian
Dr. Gerald M. Loughlin, a true champion of child life, shared that because it was a “healthier” time for kids, his pediatric team, including child life specialists, were able to pivot and help adult COVID-19 patients. This was especially impactful when helping the palliative teams communicate between significantly ill patients and family members at home. Additionally, they were a great support in lifting the spirits of their colleagues who were coping with the emotional and physical strain of navigating this new world.
Dr. Kusum Viswanathan - Pediatric Hematology-Oncology, Brookdale University Hospital
Medical Center
And Dr. Kusum Viswanathan (affectionately known as Dr. Vis) proudly shared how a year into the pandemic, Brookdale Hospital has done a tremendous job in vaccinating its community - one made up of some of the most vulnerable demographics to the disease. She was also able to embrace telemedicine to stay in touch with patients, and technology also helped her expand the reach of her sickle cell support group, funded by enCourage Kids - serving even more children and families.
One thing that stood out the most was how the core focus of child life specialists included skills that allowed them to easily pivot within various departments - becoming integral players throughout the hospitals as they battled the virus.
Child life specialists develop coping strategies for pediatric patients and their family members to decrease the stress and anxiety that come with the challenges of hospitalization. Their goal is to make a hospital experience as comfortable and positive as possible, which will help achieve better health outcomes overall. One of their most important roles is to explain a child’s diagnosis and/or treatment in a way that the child will be able to understand and know exactly what is going on.
These are services that could greatly benefit patients of any age, and the pandemic proved that was true.
And though our stories have seemed to have taken us full-circle from outbreak to vaccine, one thing we haven’t yet covered is – what challenges can we and pediatric hospitals anticipate in the future because of the pandemic?
A Return to "Normal"
As communities begin to open up and kids start returning to school, this return to “normal” will mean an increase in hospitalization for children.
According to Dr. Loughlin, who specializes in pediatric respiratory issues, it was the healthiest year for kids with asthma - one benefit of their having to wear masks and not being in school. Viral infections were down and it was also a nonexistent season for influenza and respiratory syncytial virus (RSV), a common respiratory virus that can become quite serious in infants and older adults.
Likewise, pediatric units saw a vast decline in trauma injuries - most likely because kids were at home and not participating in activities and sports.
The upside of this was hospitals were able to focus on treating the influx of adult COVID-19 patients. According to Dr. Loughlin, “The healthcare system couldn’t have handled a virus that affected children as adversely as it affected the older adults. If both those systems got hit at the same time, we just wouldn’t have gotten through this.”
The downside, of course, was that kids were missing out on the social and mental benefits that come with attending school and social interactions.
“What play is all about is learning how to share, how to use your voice, how to take turns, how to navigate, learning to be empowered, how to negotiate. These are all things you do when you're playing, whether it’s on the playground, in a classroom, during an after school activity, on a sports team, or with a club,” shared Meghan.
These factors have led to another concern:
Mental and Social Anxieties
All of our featured heroes agree that the toll this pandemic has taken on children of every age has and will contribute to future mental and social anxieties.
Nicole has seen children in her community have to deal with stresses that include parents losing spouses and jobs, or dealing with medical and financial issues, and that can have a damaging effect. “I really do see children read so much into how their parents feel, and as much as parents want to shield them away from that, they are very much aware of what’s going on.”
The incidences right now of depression and anxiety are concerning for Dr. Loughlin because “suicide is the second leading cause of death between the ages of 10 and 20 - and all of those problems have really been magnified.”
Dr. Viswanathan agrees and thinks that this is a problem that the entire country will have to deal with - especially when considering children who have lost loved ones. “I think mental health professionals need to be prepared for an onslaught and I think pediatricians need to be prepared, and really look at patients’ mental health carefully.”
Meghan has concerns that younger kids will also face developmental delays due to increased screen time and less personal interactions. She is also curious to see the research studies that will come out of this that will look at things like remote learning and what it’s doing to kids - especially those whose parents don’t speak English or aren’t tech savvy to help their kids.
One early study has shown that disparities exist in remote versus in-person learning. “As of January and early February of this year, 43% of elementary students and 48% of middle school students in the survey remained fully remote. And the survey found large differences by race: 68% of Asian, 58% of Black and 56% of Hispanic fourth graders were learning entirely remotely, while just 27% of White students were.” [Source: NPR]
Remote learning has especially amplified disparities that have already existed.
Disparities in Education
For some of society's most vulnerable children, they may have limited resources at home, including limited or no internet connections and no computer or only one for multiple people.
Even when the Department of Education in NYC stepped in to supply many students with computers and iPads, challenges were still present, especially for Black and Hispanic students who had low student engagement during the spring when they transitioned completely to remote learning.
On top of that, many may live in crowded homes with no way for them to have a constructive isolated space with no distractions. This greatly inhibits their ability to do well with remote learning.
“For many patients, home is not a sanctuary or a place they want to be. It may not be a safe place full of abundance,” Nicole shares.
Nicole also sees patients who receive various therapies at school, such as occupational, physical and speech. These are services that don’t always translate well over Zoom, if they are even able to get online.
How will these issues affect children when our return to “normal” also means a return to hospital visits?
And how can we be prepared to help?
Future Support
Our hospital partners are turning to us as they brace for the impact the pandemic will have on the health and well-being of their patients in the wake of a year filled with stress and isolation.
Dr. Viswanathan believes that detecting a child might have a mental health issue or experiencing anxiety might be something that takes the presence of a trained person. “My dream would be that every pediatric outpatient center was staffed by either a child life specialist or social worker” who could pick up on these symptoms.
In addition, for many kids, challenges that have existed before March 2020 are now magnified. These can be especially difficult for children who live in families that are experiencing great hardship due to food and housing insecurity, who are from marginalized neighborhoods, and those with few resources.
Having served pediatric units for over 35 years, enCourage Kids recognizes the importance of supporting child life departments. We understand the disparities that their communities have been experiencing since well before the pandemic, and have helped fund programs that specifically speak to their needs. This is especially important as many pediatric hospitals rely heavily on philanthropy to fill the gaps in their budgets.
If the pandemic has taught us anything, it’s that these services are more important than ever.