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The world is learning more about the uncommon but puzzling ways Covid-19 can show up in kids, keeping worried parents on the lookout for symptoms of the disease. We should also be concerned about how toxic stress brought on by the pandemic, or made worse by it, will affect children’s developing brains and bodies and their future health.

In millions of households, kids are experiencing an incredible amount of stress and anxiety. They’ve lost the stability and safety of schools and day cares, and with it their social connections to friends and teachers. They’re dealing with their own feelings of fear and uncertainty caused by the coronavirus — and there is no clear end in sight.


Meanwhile, they’re seeing parents and other caregivers struggle with the emotional and psychological distress of an unprecedented pandemic. With the unemployment rate at 11% and expected to stay high, millions of children are living through the aftermath of their parents’ loss of jobs and income.

Decades of studies tell us that the kind of trauma and stress many children are experiencing during the Covid-19 emergency has the potential to embed itself in children’s DNA, dramatically affecting their brains and other critical body systems and, as a result, their health across a lifetime. In my practice as a pediatrician working with children exposed to trauma, I have seen firsthand how families’ struggles can have indelible effects on children’s health and well-being.

We must act now to use the science of early childhood development to address the Covid-19-related stress in children’s and caregivers’ lives. If we don’t, the pandemic will in the short term put millions more children than before at risk for hunger, homelessness, abuse, and neglect. Over the long term, it will lead to more children with developmental delays, asthma, diabetes, mental illness, heart disease, cancer, Alzheimer’s disease, and other poor health outcomes.


The fallout will be worst for children who were already living in poverty and experiencing adversity before the pandemic struck, and for children of color, who have disproportionately felt the health and economic effects of the twin public health crises of Covid-19 and racism.

The good news is that children’s developmental trajectories are not set in stone. But this nationwide public health and economic disaster is exacerbating systemic problems — such as food insecurity, domestic violence, and lack of access to mental health care — that we’ve long struggled to address and that deeply affect children’s health and brain development.

Despite herculean efforts of food banks, schools, and nonprofits, 2 in 5 households with mothers with children under age 12 experienced food insecurity in April. Our knowledge of past disasters tells us domestic violence was likely increased by stay-at-home orders. And health officials are raising the alarm about a potential rise in deaths by drug overdose and suicide because of the psychological toll Covid-19 is taking on people across the nation, which means thousands of children could lose their loved ones.

Science-based solutions — shown by research to be effective at improving children’s health — could help us reverse the impact of the coronavirus crisis on children’s well-being and improve health equity long after the pandemic is behind us.

Early detection and early intervention are a kid’s best shot at health and well-being. One of the medical advances that helps identify potential problems early involves health providers screening every child for adverse childhood experiences (ACEs). These include growing up in a household with mental health or substance abuse problems, witnessing or experiencing violence, losing a family member to suicide, and the like. The more ACEs children have, the more likely they are to experience changes to the biological stress response, which in turn leads to a range of health problems and chronic diseases in childhood and adulthood.

As surgeon general of California, I spearhead the ACEs Aware initiative. Launched in January, it trains and pays providers with Medi-Cal — my state’s version of Medicaid — to screen children and adults for ACEs. By screening kids and grown-ups, we can identify how to intervene and improve their current and future health and break the intergenerational cycle of adversity.

This kind of effort should be done in every state. By screening nationwide in pediatricians’ offices, community clinics, family practices, school health centers, and other health care settings, and continuing to do so into the future, we can get ahead of the toxic effects the coronavirus crisis could have on the physical and behavioral health of our children for years to come.

The science of early childhood has shown that the quality of children’s relationships with their caregivers is one of the most important predictors of their future health. So in addition to screening children for ACEs, we should continue to provide relief to parents and other caregivers, as Congress and some states, including California, have done through Covid-19 relief measures like direct financial support and eviction and rent relief. During Covid-19, California also specifically invested $42 million to protect children who are at heightened risk for abuse and mistreatment due to Covid-19.

We don’t know exactly how the social isolation, school closures, and economic disruption, and other stress caused by Covid-19 will affect children’s health, but we know it will. Our hopes of ending the Covid-19 crisis, getting close to 4.5 million cases and more than 150,000 deaths in the United States as I write this, are in the hands of scientists undertaking the monumental task of finding treatments and vaccines. But we must also recognize the science of early childhood development and systematically put into practice what we know works. That’s the only sure way to give every child a solid chance for a better, healthier future.

Nadine Burke Harris is a pediatrician and the surgeon general of California.

  • At first look an important perspective on the lack and incompetence in our nation and corporate world affects on children. Well yes, not having a Frances Perkins or Eleanor Roosevelt to play a contemptuous role has been not only gut wrenching but torturous for those of us aware of both historical context and childhood development.
    HhOWEVER the use of a checklist for past or present trauma ? NO another money grabbing bag of tricks.
    If American citizens really cared everyone would be asking for the removal of this administration and trying to crease networks of restorative social justice. Children are amazingly reliant what they need is the truth and to know tools are being used to solve the problem. Charles Kingsley in his Waterbabies book filled with isms including an anti Irish slant still write some of the most in depth thinking on childhood. If an adult is not sure or unaware say so and don’t lie.
    We have not even begun to understand trauma as this traumatic time clearly indicates.

  • My 86 year old mother who experienced all the tulip-bulb soup hell in WWII as oldest daughter from the tender age of 6 to 11 smiles wisely when she reads an article like this. She knew there were Jews hidden in her house, and that her father went underground to not have to serve the enemy’s navy, and that he got food delivered, and that her mother showed the food-stamps truck to the secret distribution location. All of this was high-risk. She knows everything about survival, and about making the best of life after the horrific ordeal – because you survived. This Covid time is like a mild / lukewarm war time (without traitors, brutal killings & disappearances). Right now is (another) time to demand more of ourselves, to “suck it up” (no matter what age) and to be much less of a victim-catering society. Survivors are not the victims.

    • My mother puzzles through all this as she wonders why she raised three children and has only one grandchild. Her parents survived famine and immigration, went on to create toxic family dynamics in the new World, and it has all come crashing to a halt in the second generation. I appreciate the article. The comment is specious.

  • I think it’s important when writing about ACEs to be sure to also advance the reality that many children encountering ACEs do have good and loving family connections. Our local school district Superintendent and Board look utterly mentally ill themselves suggesting that children have no support networks but schools, and in believing that the vast majority of parents are BAD for their own children, they are willing to ignore our district Health Director who made it pefectly clear we cannot keep up with testing and tracing now, and that there’s no way the health department can do schools if they open for face-to-face. The school district has NO PLAN to screen, let alone test and trace. These schools are in our communities. They are so certain we are raping our own kids, they are going to kill all of us with underlying conditions and immune compromised. We need STATs reliable STATs in every article so you too are not inflaming minds to behave irrationally.

  • Thanks to you, and for your company’s for making people’s to be very about what was happening in the world. May god protect everyone of us and the world in general thanks. Good luck and good health and a good future for everyone.

  • I have seen many articles about the stress and strain that the pandemic may be putting on children, yet little conclusive evidence. Prior to this pandemic, we had a pandemic of depression, suicide and gun violence that plagued schools all over the country. There would be talk, thoughts and prayers whenever an incident occurred (monthly since early 2000), but little action, little resolution. Since the pandemic, we have had ZERO school shootings. My kids may be a little restless from time to time, but they’ve never been healthier mentally. Free from the stress and strain of our antiquated school system, they no longer have to suffer the burdens of piles of unnecessary homework, inundation of tests and constant strain to improve school system status. Beyond that was the pressure to conform within the same dated process. We warehouse our children in post war institutional settings unnecessarily. In the Information age, the process of learning has quickly become years behind and will continue to lose ground as we peripherally address modern learning systems. Kids these days learn faster and better on their own, through a multitude of sources available to them. Our traditional school does little to benefit and enlighten their lives. Our educational system must endeavor to provide a new type of education that is tailored for each individual student–something that is within reach right now. They can be socialized in pods that allow them to decide who they want to be around. School can evolve to something we don’t recognize from something that our Grandparents would still have no issues recognizing.

    • Agreed. I’m hearing this from many corners. As a disability rights advocate, I see the worst of schools. The physical, verbal and mental abuse of children by teachers, aides and administrators, the refusal to accommodate, the bigotry, seclusion, physical and chemical restraint, school to prison pipeline, and bullying that is STILL utterly ignored in the school system. I’m seeing lots of mentally happier kids too.

  • I have five great grandchildren all under the age of five and the best thing I know how to do is to love and support my daughters who are their grandmothers. Just tell us what to do, specifically; if possible, we will do it. I am a retired high school teacher, so you have to give me a sample lesson plan for early childhood stress relief.

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