Tagged Parenting

How to Help a Teen Out of a Homework Hole

Adolescence

How to Help a Teen Out of a Homework Hole

The more students fall behind in the pandemic, the less likely they are to feel that they can catch up.

Credit…Marta Monteiro
Lisa Damour

  • Feb. 26, 2021, 2:33 p.m. ET

Pandemic school is taking its toll on students, especially teens. A recent study, conducted by NBC News and Challenge Success, a nonprofit affiliated with the Stanford Graduate School of Education, found that 50 percent more kids in high school report feeling disengaged from school this year than last. In December, Education Week reported that schools were seeing “dramatic increases in the number of failing or near-failing grades” on report cards.

A major symptom of school disengagement is not turning in homework, a problem that can easily snowball. The further students fall behind, the more overwhelmed they often become and the less likely they are to feel that they can catch up.

The good news is that finding out about missing homework is a first step to helping kids get back on track. You just need to keep a few considerations in mind.

Empathy will get you further than anger

At this point in the pandemic, finding out that your child has let schoolwork slide may trigger an angry response. Everyone is worn down by the demands of pandemic life and many parents are already operating on their last nerve. Getting mad, however, is likely to cause kids to adopt a defensive or minimizing stance. Instead, try to be compassionate. What students who have fallen behind need most are problem-solving partners who want to understand what they are going through.

If you’re having trouble summoning your empathy, bear in mind that there are many good reasons a student could fall off pace this year. For instance, Ned Johnson, a professional tutor and co-author of the book “The Self-Driven Child,” noted that most teens have very little experience managing email, which is now a main source of information for those in remote or hybrid arrangements. “We know how overwhelmed we as adults are by email. Imagine not being comfortable with it, and then suddenly getting everything — from Zoom links to assignments — that way.”

Some students learning remotely may also have unreliable broadband service; others may miss key information because their attention is split between the teacher on the screen and distractions at home.

“Many adults are having the exact same issues,” said Ellen Braaten, a psychologist and the executive director of the Learning and Emotional Assessment Program at Massachusetts General Hospital. “They are really productive when they can physically be at work, but may find themselves less attentive in the unstructured environment of working from home.”

Even teens who are attending school in person and using familiar systems for tracking assignments may be having a hard time managing their work now. The mental skills that help us stay organized — commonly called executive functioning — are being undermined by psychological stress, which is unusually high among today’s teens.

Work together to diagnose the problem

Finding out that your child is in academic trouble can tempt you to jump to solutions. It’s best, however, to properly diagnose the problem before trying to address it. Liz Katz, assistant head for school partnership at One Schoolhouse, an online supplemental school, suggested looking into the reasons students fall behind at school. Some don’t know what they’re supposed to be doing, others know and aren’t doing it, and still others “are doing their best and just can’t meet expectations.”

As you talk with a teenager about where things have gone off the rails, be kind, curious and collaborative. “This isn’t about you being in trouble or getting off the hook,” you might say. “It’s simply about figuring out what’s going wrong so we can solve the right problem.”

Students who are struggling to keep track of what’s expected of them may need to reach out to their teachers, either for clarification about specific assignments or for general guidance on where and when they should be looking for information about homework. As a parent or caregiver, you can coach them on how to approach their instructors. Start by pointing out that teachers are almost always eager to lend support to students who seek it. You can also offer to give feedback on a draft email to an instructor explaining where the student got lost and what they have already tried.

“For many students, the ability to ask for help is not fully formed,” said Ms. Katz, “or it can feel like an admission that they’ve done something wrong. Normalizing and praising self-advocacy is so important.”

For students who know what they’re supposed to do but aren’t doing it, other approaches make sense. They may be having a hard time sustaining motivation and need support on that front, or they may be swamped with commitments, such as caring for younger siblings, that make it impossible to complete their schoolwork. Here, parents and students will want to work together to make a realistic plan for addressing the biggest priorities in light of these circumstances. This might mean coming to an agreement about where the teen’s energies should be directed or exploring what additional support might be put in place.

In some cases, academic problems may be linked to issues with mental health. If there’s a question of whether a student is suffering from depression or anxiety; using drugs; or exhibiting any other significant emotional or behavioral concern, check in with the school counselor or family doctor for a proper assessment. Treatment should always take precedence over schoolwork. “If you’re depressed,” Dr. Braaten said, “no amount of executive function coaching is going to help, because that’s not the issue.”

Some students have subtle learning or attention disorders that became an issue only when school went online. Under regular conditions, said Mr. Johnson, instructors can notice when a student is tuning out and bring back his or her attention in a gentle way. Unfortunately, “Teachers really can’t do that effectively on Zoom.” If this is a concern, parents should consider checking in with teachers or their school’s learning support staff to get their read on the problem and advice for how to move forward.

Step back to see the big picture

“We all need to be easier on ourselves,” Dr. Braaten said, “and to sort through what students really need to do and what they don’t.” Well-meaning parents might hope to motivate students by emphasizing the importance of high grades, but that can make it harder for kids to recover from a substantial setback.

As students start to work their way back, give some thought to how comprehensive their turnaround needs to be. Do they really need to get equally high grades in every class? Could they instead direct their energy toward getting square with the courses they care about most? Could they work with their teachers to agree upon trimmed-down assignments for partial credit? According to Mr. Johnson, “Lowering expectations, for now, can actually help kids to get back on track.”

Dr. Braaten also noted that much of what students gain from school is not about content, but about learning how to solve problems. Engaging teens in constructive conversations to figure out how they fell behind can be an important lesson unto itself. “Having a 16-year-old who understands, ‘When I’m stressed, this is how I react,’” says Dr. Braaten, “may put us further ahead in the long run.”

In any school year, students learn a great deal beyond academic content. This year, more than most, might be one where students gain a deep understanding of how they respond when feeling overwhelmed and how to ask for help or rebound from setbacks — lessons that they will draw on long after the pandemic is gone.

Navigating My Son’s A.D.H.D. Made Me Realize I Had It, Too

Navigating My Son’s A.D.H.D. Made Me Realize I Had It, Too

Experts say some symptoms, especially in women, are mistaken for other conditions such as mood disorders or depression.

Credit…Natalia Ramos

  • Feb. 25, 2021, 2:25 p.m. ET

I heard my 7-year-old son’s cries of frustration loud and clear despite the closed door between us. Seconds earlier, I’d left him stationed at a desk in my bedroom, hoping he’d complete at least a portion of his virtual school assignments without me at his side while I left to wash the dishes.

“This is so BORING,” he groaned. Finishing each of his math problems required enduring an animated character’s long-winded ovations and cheers. The work was easy for him, but the system didn’t allow him to zip through it. Pulling up a chair, I sat with him in solidarity as he finished up.

Remote learning is daunting for most parents; it’s particularly thorny when your child has attention deficit hyperactivity disorder. As I tried to guide my son through his online lessons over the course of the pandemic, I began to see parallels between his struggles and my own. While hyperactivity was never an issue for me, we had many other traits in common: impulsivity, distractibility, lack of organization and low frustration tolerance — all key signs of A.D.H.D.

Primary school was easy for me; from third grade on, I was enrolled in gifted classes and earned straight A’s. Nonetheless, I recall many tear-laden homework sessions where exasperation over a tricky math problem threw me into emotional overload. During study sessions, I often became disinterested and zoned out, rereading sections of text until I could focus enough to absorb the information. I attributed my difficulties to character flaws: I was spacey and forgetful, a master procrastinator lacking drive and ambition.

Though I received an academic scholarship and entered college with a 4.2 grade point average and 15 credits from Advanced Placement classes, my performance at university was subpar. Lacking structure, it was tough for me to stick to any semblance of routine. In large lecture halls where I was an unknown in a sea of students, I floundered. I changed my major five times and eventually lost my scholarship. I never imagined an underlying neurological disorder was at play.

People who have A.D.H.D. but who do relatively well in school often don’t get diagnosed until later in life, said Lidia Zylowska, associate professor of psychiatry at the University of Minnesota Medical School and author of “Mindfulness for Adult A.D.H.D.” She said the expression of A.D.H.D. symptoms can change as life gets more complex, becoming more overwhelming as responsibilities increase in adulthood. For those who have advantages such as intelligence and family support, “school may be a place where you thrive. But when you don’t have that support, whether it’s in college, or you get your first job,” or if you become a parent, Dr. Zylowska said, “that’s when the impairment really starts showing up.”

No one in my family (nor my husband’s) had been given an A.D.H.D. diagnosis, yet research suggests a strong genetic component to the disorder. “We’ve known for many years that A.D.H.D. runs in families; it’s not just a childhood disorder,” said Mark Stein, director of A.D.H.D. and related disorders at Seattle Children’s Hospital. He said 20 percent to 30 percent of children with A.D.H.D. will have another family member who has it. “A big part of it is genetics, but it’s also awareness. Once you’re aware of what A.D.H.D. is, you’re more likely to recognize it in others,” he said.

Dr. Stein said it’s not unusual for parents to realize they have A.D.H.D. after their child is diagnosed, as in my case. “That’s a real common pathway,” he said. “A child has symptoms and problems and is being evaluated, and then the parent for the first time looks at their life and views it from the frame of, ‘Well, maybe I have this, and this is why I had those difficulties.’”

As a 3-year-old, my son was evaluated by a school psychologist because of hyperactive, disruptive behavior in preschool. He was formally given an A.D.H.D. diagnosis at age 5; by then I’d become his tireless advocate, collaborating with our school district to ensure he was set up for success in the classroom. In 2020, I reached out to my doctor about my concerns about my own symptoms and received a preliminary diagnosis of A.D.H.D; I’ll undergo a comprehensive neurological evaluation this spring.

When I was in elementary school in the ’80s, no one ever brought up the possibility that I had A.D.H.D. Experts say that’s not uncommon. Because men tend to exhibit more disruptive symptoms than women, they’re far more likely to be given diagnoses early on, said Russell Barkley, a psychiatry professor at Virginia Commonwealth University Medical School and author of “12 Principles for Raising a Child With A.D.H.D.

Dr. Stein noted: “For 10 or 15 years now we’ve been talking about how it’s not identified in females, and that it’s often missed, and even though we’ve improved somewhat it’s still much more likely to be missed in females, especially in moms.”

Research shows girls with A.D.H.D. tend to internalize their struggles rather than acting out. “Girls tend to be a little bit more inattentive and less hyperactive,” Dr. Barkley said. “If they’re disruptive, it’s mainly talking too much and socializing, whereas the boys, if they’re disruptive, it tends to be more reactive emotion and aggression, as well as defiance and oppositional behavior.”

Dr. Stein said the increasing stressors and external demands of motherhood can worsen A.D.H.D. symptoms. “I think of A.D.H.D. women as typically suffering in silence,” he said. They may seek care for something like being demoralized or having low self-esteem, or feeling overwhelmed, he said. “It’s often assumed this is a mood disorder or depression.” He added, “We’re treating the effects and the aftereffects” of A.D.H.D., “but not the underlying cause.”

I’ve had anxiety for most of my adult life; experts say the longer A.D.H.D. goes untreated, the more likely people are to experience comorbidities like anxiety, depression, substance abuse, and bulimia/binge eating. About 30 percent of children with A.D.H.D. have an anxiety disorder, a statistic that increases in adulthood. While many women do have depression and anxiety, Dr. Barkley said, “It’s just that it’s being picked up as the primary problem without looking behind the curtain, so to speak, to see what else might be there that could also be contributing to these difficulties.”

Dr. Zylowska said treatment tools for adult A.D.H.D. are very similar to those for children, but newly diagnosed adults often have an additional problem of struggling with feelings of self-doubt and shame. “You sort of have this long-life experience of getting in your own way, of having good intentions, but not being able to deliver, and that can be really demoralizing,” she said. Part of the treatment is to “help develop this less judgmental, less negative view of yourself, understanding A.D.H.D. as a neurobiological difference and developing self-acceptance and self-compassion, which can really be important,” Dr. Zylowska said.

Mindfulness-based therapy is a helpful self-regulation tool for working through feelings of inadequacy and shame, and developing self-compassion, she said.

Medication can play a role in managing A.D.H.D. symptoms for many people, but Dr. Stein said it’s part of an individualized treatment plan that may also include good nutrition and sleep. While A.D.H.D. can be a big problem for kids in school, adults often have more control about choosing to be in an environment that suits the way their brains work. “It’s less of a problem if you have the right fit with your occupation,” he said, because it’s easier to focus if you find a career you’re passionate about.

This diagnosis has been eye-opening for me. My treatment plan will most likely include medication, but my doctor is waiting for data from my scheduled neurological evaluation before she prescribes me anything. There are so many options when it comes to A.D.H.D. medications; testing will ensure that I receive the most effective one based on my individual needs. Experiencing the improvement medication may have on my daily functioning will allow me to make a more informed decision if and when the time comes to medicate my son. Thus far, it hasn’t been recommended for him.

Meanwhile, I’m able to more deeply empathize with my son when he is frustrated; after all, I’ve been there too.

Heidi Borst is a freelance writer and mother of one based in Wilmington, N.C.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

During the pandemic, suicidal thinking is up. And families find that hospitals can’t handle adolescents in crisis.

Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”
Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”Credit…Jacob Biba for The New York Times
Benedict Carey

  • Published Feb. 23, 2021Updated Feb. 24, 2021, 5:00 a.m. ET

When the pandemic first hit the Bay Area last spring, Ann thought that her son, a 17-year-old senior, was finally on track to finish high school. He had kicked a heavy marijuana habit and was studying in virtual classes while school was closed.

The first wave of stay-at-home orders shut down his usual routines — sports, playing music with friends. But the stability didn’t last.

“The social isolation since then, over all this time, it just got to him,” said Ann, a consultant living in suburban San Francisco. She, like the other parents in this article, asked that her last name be omitted for privacy and to protect her child. “This is a charming, funny kid, also sensitive and anxious,” she said. “He couldn’t find a job; he couldn’t really go out. And he started using marijuana again, and Xanax.”

The teenager’s frustration finally boiled over this month, when he deliberately cut himself.

“We called 911, and he was taken to the emergency room,” his mother said. “But there they just stitched him up and released him.” The doctors sent him home, she said, “with no support, no therapy, nothing.”

Ann and her son are like many families over the last year. Surveys and statistics show that for young people who are anxious by nature, or feeling emotionally fragile already, the pandemic and its isolation have pushed them to the brink. Rates of suicidal thinking and behavior are up by 25 percent or more from similar periods in 2019, according to a just-published analysis of surveys of young patients coming into the emergency room.

For these teenagers, there aren’t many places to turn. They need help, but it’s hard to come up with a psychiatric diagnosis. They are trying to manage a surprise interruption in their lives, a vague loss. And without a diagnosis, reimbursement for therapy is hard to come by. And that is assuming parents know what kind of help is appropriate, and where to find it.

Finally, when a crisis hits, many of these teenagers end up in the local emergency department — the one place desperate families so often go for help.

Many E.R. departments across the country are now seeing a surge in such cases. Through most of 2020, the proportion of pediatric emergency admissions for mental problems, like panic and anxiety, was up by 24 percent for young children and 31 percent for adolescents compared to the previous year, according to a recent report by the Centers for Disease Control and Prevention.

And the local emergency department is frequently unprepared for the added burden. Workers often are not specially trained to manage behavioral problems, and families don’t have many options for where to go next, leaving many of these pandemic-insecure adolescents in limbo at the E.R.

“This is a national crisis we’re facing,” Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C. “Kids are having to board in the E.R. for days on end, because there are no psychiatric beds available in their entire state, never mind the hospital. And of course, the child or adolescent is lying there and doesn’t understand what’s happening in the E.R., why they’re having to wait there or where they’re going.”

What Adolescents Are Feeling

Most teenagers and young adults have done fine through this pandemic year, provided that their families have stayed healthy and economically stable. They may be irritable or missing their friends, but their support networks have been enough to get them through the pandemic.

For the young people coming undone, however, pandemic life presents unusual challenges, pediatricians say. Most are temperamentally sensitive and after months of being socially cut off from friends and activities, they have much less control over their moods.

“What parents and children are consistently reporting is an increase in all symptoms — a child who was a little anxious before the pandemic became very anxious over this past year,” said Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine. It is this prolonged stress, Dr. Spinks-Franklin said, that in time blunts the brain’s ability to manage emotions.

Jean, an artist and mother of two living in Hendersonville, N.C., said that her 17-year-old son was doing fine through last spring. But the months of virtual classes and loss of simple social pleasures — hanging out with friends, playing chess — changed him through the fall months.

“Now, he’s become very reclusive, he has mood swings, he cries a lot,” Jean said. “This giant boy, crying — it’s terrible to see.” The young man has had panic attacks, twice followed by a blackout. During one, he fell and injured his face.

Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.
Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.Credit…Brett Deering for The New York Times

Lisa, a mother of three in Asheville, said that the months of virtual classes and relative social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”

His grades slipped badly, and he began to withdraw. “Next, he was telling us he couldn’t make himself do the work, that he didn’t want to disappoint us all the time, that he was worthless. Worthless.”

These young people do not necessarily qualify for a psychiatric diagnosis, nor are they “traumatized” in the strict sense of having had a life-threatening experience (or the perception of one.) Rather, they are trying to manage an interruption in their normal development, child psychologists say: a sudden and indefinite suspension of almost every routine and social connection, leaving a deep yet vague sense of loss with no single, distinct source.

The result is grief, but grief without a name or a specific cause, an experience some psychologists call “ambiguous loss.” The concept is usually reserved to describe the experience of immigrants, displaced from everything familiar, who shut down emotionally in a new and strange country. Or to describe disaster survivors, who return to neighborhoods that are hollowed out, transformed.

“Everything that used to be familiar and give structure to their lives, and predictability, and normalcy, is gone,” said Sharon Young, a therapist in Hendersonville. “Kids need all these things even more than adults do, and it’s hard for them to feel emotionally safe when they’re no longer there.”

System Overload

The resulting changes in behavior can seem sudden: A bright sixth-grader is found cutting herself; a sweet-natured sophomore takes a swing at a parent or sibling. Parents, frightened, often don’t know where to go for appropriate help. Many don’t have the resources or knowledge to hire a therapist.

Families that land in the emergency departments of their local hospitals often find that the clinics are poorly equipped to handle these incoming cases. The staff is better trained to manage physical trauma than the mental variety, and patients are often sent right back home, without proper evaluation or support. In severe cases, they may linger in the emergency department for days before a bed can be found elsewhere.

In a recent report, a research team led by the C.D.C. found that less than half of the emergency departments in U.S. hospitals had clear policies in place to handle children with behavior problems. Getting to the bottom of any complex behavior issue can takes days of patient observation, at minimum, psychiatrists say. And many emergency departments do not have the on-hand specialists, dedicated space or off-site resources to help do the job well.

For Jean, diagnosing her son has been complicated. He has since developed irritable bowel syndrome. “He has been losing weight, and started smoking pot due to the boredom,” Jean said. “This is all due to the anxiety.”

Nationwide Children’s Hospital in Columbus, Ohio, has an emergency department that is a decent size for a pediatric hospital, with capacity for 62 children or adolescents. But well before the arrival of the coronavirus, the department was straining to handle increasing numbers of patients with behavior problems.

“This was huge problem pre-pandemic,” said Dr. David Axelson, chief of psychiatry and behavioral health at the hospital. “We were seeing a rise in emergency department visits for mental health problems in kids, specifically for suicidal thinking and self-harm. Our emergency department was overwhelmed with it, having to board kids on the medical unit while waiting for psych beds.”

Last March, to address the crowding, Nationwide Children’s opened a new pavilion, a nine-story facility with 54 dedicated beds for observation and for longer-term stays for those with mental challenges. It has taken the pressure off the hospital’s regular emergency department and greatly improved care, Dr. Axelson said.

Over this pandemic year, with the number of admissions for mental health problems up by some 15 percent over previous years, it is hard to imagine what it would have been like without the additional, devoted behavioral clinic, Dr. Axelson said.

Other hospitals from out of state often call, hoping to place a patient in crisis, but there is simply not enough space. “We have to say no,” Dr. Axelson said.

“We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it,” said  Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C.Credit…Jacob Biba for The New York Times

Dr. Rachel Stanley, the chief of emergency medicine at Nationwide, said that most hospitals have far fewer resources. “I worked at a hospital in Michigan for years, and when these kinds of kids come in, everyone dreaded seeing them, because we didn’t feel like we had the tools to help,” she said. “They have to go into a safe room; they can’t be in a shared area. You have to provide a sitter for the child, a staff person to stay with them all the time to make sure they’re not suicidal or homicidal. It could take hours and hours to get social workers involved, and all this time they’re getting worse.”

Anne, the consultant in the Bay Area, said that her son’s visit to the emergency room this month was his third in the past 18 months, each time for issues related to drug withdrawal. On one visit, he was misdiagnosed with psychosis and sent to a locked county psychiatric ward. “That experience itself — locked for days in a ward, with no one telling him why, or how long he’d be there — was the most traumatic thing he’s experienced,” she said.

Like many other parents, she is now looking after an unstable child and wondering where to go next. A drug rehab program may be needed, as well as regular therapy.

Lisa has hired a therapist for her son, a Zoom session every other week. That seems to have helped, she said, but it is too early to tell. And Jean, for the moment, is hoping the infection risk will diminish soon, so her son can get a safe job.

All three parents have become keen observers of their children, more aware of shifting moods. Listening by itself usually helps relieve distress, therapists say. “Trying to educate parents is a routine part of the job,” said Dr. Robert Duffey, a pediatrician in Hendersonville. “And of course we need these kids back in school, so badly.”

But medical professional say that until the health care system finds a way to equip and support emergency departments for what they have become — the first and sometimes last resort — parents will be left to navigate mostly on their own, leaning on others who have managed similar problems.

“Covid has put our system under a microscope in terms of the things that don’t work,” said Dr. Baum, the pediatrician in Asheville. “We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it, all these kids coming in for pandemic-related issues. Hospitals everywhere are scrambling to adjust.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

During the pandemic, suicidal thinking is up. And families find that hospitals can’t handle adolescents in crisis.

Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”
Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”Credit…Jacob Biba for The New York Times
Benedict Carey

  • Feb. 23, 2021, 3:48 p.m. ET

When the pandemic first hit the Bay Area last spring, Ann thought that her son, a 17-year-old senior, was finally on track to finish high school. He had kicked a heavy marijuana habit and was studying in virtual classes while school was closed.

The first wave of stay-at-home orders shut down his usual routines — sports, playing music with friends. But the stability didn’t last.

“The social isolation since then, over all this time, it just got to him,” said Ann, a consultant living in suburban San Francisco. She, like the other parents in this article, asked that her last name be omitted for privacy and to protect her child. “This is a charming, funny kid, also sensitive and anxious,” she said. “He couldn’t find a job; he couldn’t really go out. And he started using marijuana again, and Xanax.”

The teenager’s frustration finally boiled over this month, when he deliberately cut himself.

“We called 911, and he was taken to the emergency room,” his mother said. “But there they just stitched him up and released him.” The doctors sent him home, she said, “with no support, no therapy, nothing.”

Ann and her son are like many families over the last year. Surveys and statistics show that for young people who are anxious by nature, or feeling emotionally fragile already, the pandemic and its isolation have pushed them to the brink. Rates of suicidal thinking and behavior are up by 25 percent or more from similar periods in 2019, according to a just-published analysis of surveys of young patients coming into the emergency room.

For these teenagers, there aren’t many places to turn. They need help, but it’s hard to come up with a psychiatric diagnosis. They are trying to manage a surprise interruption in their lives, a vague loss. And without a diagnosis, reimbursement for therapy is hard to come by. And that is assuming parents know what kind of help is appropriate, and where to find it.

Finally, when a crisis hits, many of these teenagers end up in the local emergency department — the one place desperate families so often go for help.

Many E.R. departments across the country are now seeing a surge in such cases. Through most of 2020, the proportion of pediatric emergency admissions for mental problems, like panic and anxiety, was up by 24 percent for young children and 31 percent for adolescents compared to the previous year, according to a recent report by the Centers for Disease Control and Prevention.

And the local emergency department is frequently unprepared for the added burden. Workers often are not specially trained to manage behavioral problems, and families don’t have many options for where to go next, leaving many of these pandemic-insecure adolescents in limbo at the E.R.

“This is a national crisis we’re facing,” Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C. “Kids are having to board in the E.R. for days on end, because there are no psychiatric beds available in their entire state, never mind the hospital. And of course, the child or adolescent is lying there and doesn’t understand what’s happening in the E.R., why they’re having to wait there or where they’re going.”

What Adolescents Are Feeling

Most teenagers and young adults have done fine through this pandemic year, provided that their families have stayed healthy and economically stable. They may be irritable or missing their friends, but their support networks have been enough to get them through the pandemic.

For the young people coming undone, however, pandemic life presents unusual challenges, pediatricians say. Most are temperamentally sensitive and after months of being socially cut off from friends and activities, they have much less control over their moods.

“What parents and children are consistently reporting is an increase in all symptoms — a child who was a little anxious before the pandemic became very anxious over this past year,” said Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine. It is this prolonged stress, Dr. Spinks-Franklin said, that in time blunts the brain’s ability to manage emotions.

Jean, an artist and mother of two living in Hendersonville, N.C., said that her 17-year-old son was doing fine through last spring. But the months of virtual classes and loss of simple social pleasures — hanging out with friends, playing chess — changed him through the fall months.

“Now, he’s become very reclusive, he has mood swings, he cries a lot,” Jean said. “This giant boy, crying — it’s terrible to see.” The young man has had panic attacks, twice followed by a blackout. During one, he fell and injured his face.

Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.
Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.Credit…Brett Deering for The New York Times

Lisa, a mother of three in Asheville, said that the months of virtual classes and relative social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”

His grades slipped badly, and he began to withdraw. “Next, he was telling us he couldn’t make himself do the work, that he didn’t want to disappoint us all the time, that he was worthless. Worthless.”

These young people do not necessarily qualify for a psychiatric diagnosis, nor are they “traumatized” in the strict sense of having had a life-threatening experience (or the perception of one.) Rather, they are trying to manage an interruption in their normal development, child psychologists say: a sudden and indefinite suspension of almost every routine and social connection, leaving a deep yet vague sense of loss with no single, distinct source.

The result is grief, but grief without a name or a specific cause, an experience some psychologists call “ambiguous loss.” The concept is usually reserved to describe the experience of immigrants, displaced from everything familiar, who shut down emotionally in a new and strange country. Or to describe disaster survivors, who return to neighborhoods that are hollowed out, transformed.

“Everything that used to be familiar and give structure to their lives, and predictability, and normalcy, is gone,” said Sharon Young, a therapist in Hendersonville. “Kids need all these things even more than adults do, and it’s hard for them to feel emotionally safe when they’re no longer there.”

System Overload

The resulting changes in behavior can seem sudden: A bright sixth-grader is found cutting herself; a sweet-natured sophomore takes a swing at a parent or sibling. Parents, frightened, often don’t know where to go for appropriate help. Many don’t have the resources or knowledge to hire a therapist.

Families that land in the emergency departments of their local hospitals often find that the clinics are poorly equipped to handle these incoming cases. The staff is better trained to manage physical trauma than the mental variety, and patients are often sent right back home, without proper evaluation or support. In severe cases, they may linger in the emergency department for days before a bed can be found elsewhere.

In a recent report, a research team led by the C.D.C. found that less than half of the emergency departments in U.S. hospitals had clear policies in place to handle children with behavior problems. Getting to the bottom of any complex behavior issue can takes days of patient observation, at minimum, psychiatrists say. And many emergency departments do not have the on-hand specialists, dedicated space or off-site resources to help do the job well.

For Jean, diagnosing her son has been complicated. He has since developed irritable bowel syndrome. “He has been losing weight, and started smoking pot due to the boredom,” Jean said. “This is all due to the anxiety.”

Nationwide Children’s Hospital in Columbus, Ohio, has an emergency department that is a decent size for a pediatric hospital, with capacity for 62 children or adolescents. But well before the arrival of the coronavirus, the department was straining to handle increasing numbers of patients with behavior problems.

“This was huge problem pre-pandemic,” said Dr. David Axelson, chief of psychiatry and behavioral health at the hospital. “We were seeing a rise in emergency department visits for mental health problems in kids, specifically for suicidal thinking and self-harm. Our emergency department was overwhelmed with it, having to board kids on the medical unit while waiting for psych beds.”

Last March, to address the crowding, Nationwide Children’s opened a new pavilion, a nine-story facility with 54 dedicated beds for observation and for longer-term stays for those with mental challenges. It has taken the pressure off the hospital’s regular emergency department and greatly improved care, Dr. Axelson said.

Over this pandemic year, with the number of admissions for mental health problems up by some 15 percent over previous years, it is hard to imagine what it would have been like without the additional, devoted behavioral clinic, Dr. Axelson said.

Other hospitals from out of state often call, hoping to place a patient in crisis, but there is simply not enough space. “We have to say no,” Dr. Axelson said.

“We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it,” said  Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C.Credit…Jacob Biba for The New York Times

Dr. Rachel Stanley, the chief of emergency medicine at Nationwide, said that most hospitals have far fewer resources. “I worked at a hospital in Michigan for years, and when these kinds of kids come in, everyone dreaded seeing them, because we didn’t feel like we had the tools to help,” she said. “They have to go into a safe room; they can’t be in a shared area. You have to provide a sitter for the child, a staff person to stay with them all the time to make sure they’re not suicidal or homicidal. It could take hours and hours to get social workers involved, and all this time they’re getting worse.”

Anne, the consultant in the Bay Area, said that her son’s visit to the emergency room this month was his third in the past 18 months, each time for issues related to drug withdrawal. On one visit, he was misdiagnosed with psychosis and sent to a locked county psychiatric ward. “That experience itself — locked for days in a ward, with no one telling him why, or how long he’d be there — was the most traumatic thing he’s experienced,” she said.

Like many other parents, she is now looking after an unstable child and wondering where to go next. A drug rehab program may be needed, as well as regular therapy.

Lisa has hired a therapist for her son, a Zoom session every other week. That seems to have helped, she said, but it is too early to tell. And Jean, for the moment, is hoping the infection risk will diminish soon, so her son can get a safe job.

All three parents have become keen observers of their children, more aware of shifting moods. Listening by itself usually helps relieve distress, therapists say. “Trying to educate parents is a routine part of the job,” said Dr. Robert Duffey, a pediatrician in Hendersonville. “And of course we need these kids back in school, so badly.”

But medical professional say that until the health care system finds a way to equip and support emergency departments for what they have become — the first and sometimes last resort — parents will be left to navigate mostly on their own, leaning on others who have managed similar problems.

“Covid has put our system under a microscope in terms of the things that don’t work,” said Dr. Baum, the pediatrician in Asheville. “We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it, all these kids coming in for pandemic-related issues. Hospitals everywhere are scrambling to adjust.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

Got a Pandemic Puppy? Learn How to Prevent Dog Bites

The Checkup

Got a Pandemic Puppy? Learn How to Prevent Dog Bites

With new puppies and kids at home, doctors are worried about treating more children for dog bites.

Credit…Manon Cezaro

  • Feb. 23, 2021, 2:33 p.m. ET

The surge in pet adoptions during the pandemic brought much-needed joy to many families, but doctors are worrying about a downside as well: more dog bites.

A commentary published in October in The Journal of Pediatrics noted an almost threefold increase in children with dog bites coming into the pediatric emergency room at Children’s Hospital Colorado after the stay-at-home order went into effect.

The lead author, Dr. Cinnamon Dixon, a medical officer in the Pediatric Trauma and Critical Illness Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said: “If someone were to tell me they were going to get a new dog during Covid, I would first and foremost want to make sure that family is prepared to have a new entity in their household, a new family member.”

Dr. Dixon said that as a pediatric emergency room doctor, taking care of children who get bitten had been a priority for her. Still, she said, from the stories she heard, she often felt “that dogs are victims in this as well.”

Brooke Goff, a partner in the personal-injury law firm the Goff Law Group in Hartford, Conn., said, “We’re definitely seeing a huge uptick in dog bite cases.”

Ms. Goff said that dog bites harm children in ways that go well beyond the physical damage. “It creates major emotional issues and PTSD,” she said. “If you’ve ever spoken to a dog bite victim as an adult that was bitten as a child, they are deathly afraid of dogs.”

Dog bites are “an underrepresented public health problem” in the United States, said Dr. Dixon, the daughter of a veterinarian who grew up around animals. The Centers for Disease Control and Prevention’s best estimates from old research put the number of dog bites at 4.5 million a year. There are over 300,000 nonfatal emergency department visits a year related to dog bites, and among children, the greatest incidence is in school age children, aged 5 to 9, but the most severe injuries are among infants and young children, presumably because they are less mobile, and lower to the ground, with their heads and faces closer to the dogs.

Dr. Robert McLoughlin, a general surgery resident at the University of Massachusetts Medical School in Worcester, was the first author on a 2020 study of hospitalizations for pediatric dog bite injuries in the United States. He said that his research grew out of an interest in pediatric surgery and pediatric injury prevention. “I had seen a lot of cases of toddlers with head and neck injuries,” he said.

The study showed that younger children, ages 1 to 4 and 5 to 10, were much more likely to need hospitalization than those over 11. In the youngest children, most injuries are to the head and neck, and beyond the age of 6, extremity wounds (arms, legs, hands) become increasingly prevalent and predominate after the age of 11, Dr. McLoughlin said.

The bites that require hospitalization and surgical repair are the most serious injuries, such as toddlers bitten in the face and neck, where many critical structures can be damaged, including eyes and ears, and there can be devastating cosmetic damage done as well. But hand injuries can also have a very lasting impact and need expert repair.

For dog bite prevention, Dr. Dixon said, “the No. 1 strategy remains supervision.” Children should learn to leave dogs alone when they are eating, when they are sleeping with a favorite toy, when they are caring for their puppies. They should not reach out to unfamiliar dogs. And dog owners should keep their dogs healthy and should socialize and train them from an early age.

“It’s important we take responsibility for our animals,” said Ms. Goff, who has a dog named Daisy that she brings with her to the office. “Most dogs don’t bite to attack, they bite because they’re scared or provoked.”

Ms. Goff also emphasized that from the point of view of liability, anyone who owns a dog should have insurance coverage. In her state, Connecticut, a strict liability state, “I don’t have to prove anybody was at fault,” she said, and the dog owner is responsible for the damages. “If you can afford the dog, you can afford the insurance,” she said.

She said that it’s important as well that dog bites be reported because of the need to track dogs who bite multiple times, but reassured those who were worried that a dog might be destroyed that, at least in Connecticut, unless there is a catastrophic or fatal injury, “our forgiveness about animals extends quite heavily.”

When dogs do show aggressive behavior, Dr. Dixon said, owners should seek expert help from a veterinarian or “a behavioral expert in canine aggression — ideally before something bad happens.”

Dr. Judy Schaechter, a professor of pediatrics and public health at the University of Miami, said that given the increase in puppy buying during the Covid epidemic, “We’re now a year into this; puppies may be big, strong dogs at this point.” And with many parents juggling work from home with their children’s school issues, it can be difficult for them to supervise all the children (and pets) all the time.

Bites often occur, Dr. Schaechter said, “around playing and feeding behaviors.” Small children are particularly at risk, in part because they may be close to the dog’s food dish, or on the ground when food falls, and the dog may see the child as competition. “Any dog can bite, any breed can bite, and that can be horrific,” she said, but a medium or large dog, or a dog with a very strong jaw, “can quickly do a lot more damage.”

When Dr. Dixon saw children who had been bitten in the emergency room, “the most common story I would hear over and over,” she said, involved “resource guarding,” in which the child seemed to be encroaching on something that belonged to the dog. “The child was next to the dog’s food or had gone next to a dog’s toy or was playing with the dog and the dog jumped up and grabbed the arm instead of the bone,” she said.

Dr. McLoughlin sees opportunities for programs to address dog bite prevention, perhaps drawing lessons from programs that discuss “stranger danger.” It’s important to teach children not to approach strange dogs, he said, but also to help them interpret dogs’ behavior, “to identify when a dog is saying leave me alone, give me some space.” He is interested in the possibility of taking dogs into schools in order to educate children about dogs they may encounter outside their homes, but emphasized that parents should be teaching even very young children about how to approach a dog — including that they should always ask the owner first.

Dr. Schaechter pointed to research on the benefits of having a dog in the family, from the joys of companionship and the lessons children learn from caring for a pet to the medical evidence that children may be at lower risk of allergy and asthma if they are exposed early to animals. The bond between children and their pets is the substance of so many books and movies, Dr. Schaechter said. “It’s real — but don’t let that be so romantic that a child ends up being hurt or scarred.”

[Get the C.D.C.’s advice on dogs, the A.A.P.’s advice on dog bite prevention, and more tips from the American Veterinary Medical Association]

What Families Can Learn From the Texas Storm

What Families Can Learn From the Texas Storm

Take these steps when critical services are affected by freezing temperatures.

From left, Charles Flynn, 9, Lucille Flynn, 12, and their mother, Erica Flynn, at their home in Austin, Texas, before fleeing to a hotel. The frigid temperatures caused electrical grids to fail, sending indoor temperatures plummeting. 
From left, Charles Flynn, 9, Lucille Flynn, 12, and their mother, Erica Flynn, at their home in Austin, Texas, before fleeing to a hotel. The frigid temperatures caused electrical grids to fail, sending indoor temperatures plummeting. Credit…Andrew Flynn
Christina Caron

  • Feb. 19, 2021, 1:18 p.m. ET

After days of record-breaking cold and winter storms in Texas that disrupted the electrical grid and froze water lines, millions of people are now being told to boil their water for safety.

Other families have no tap water at all. Valerie Contreras, 20, who lives in Austin, Texas, had to take shelter with her infant son at her parents’ home nearby during the storm. She said her family is melting snow in buckets to flush the toilets, and boiling snow water to wash the dishes.

She uses bottled purified water for her son’s baby formula, but is down to her last two gallons.

With critical services disrupted by severe weather, families are scrambling to navigate dangerous conditions. So we asked experts for tips on how to stay safe. Even if you haven’t yet lost drinking water or power, some of this advice might help you plan ahead in the event of a similar emergency. As climate change accelerates, more electric grids may be crippled by unexpected weather events, putting people at risk of losing power.

A weather crisis combined with the pandemic can “feel pretty hopeless and endless,” said Dr. David J. Schonfeld, the director of the National Center for School Crisis and Bereavement at Children’s Hospital Los Angeles. “Your goal is to be able to identify what the current situation is, figure out what’s most important for you to do at this point and be able to deal with that one issue.”

Conserve warmth and make an exit plan

When the power goes out, there are certain precautions you can take to avoid heat loss, like placing rolled-up towels at the base of exterior doors or stuffing rags in cracks under the doors. Closing curtains and blinds can also keep heat inside, according to the National Weather Service.

The service also advised that residents “move all activities to a main room and close the remaining interior doors to retain heat,” adding that people should wear layers of loosefitting and lightweight warm clothing, and have extra clothing layers handy.

Christina DiVirgilio, 36, who lives in Spring, Texas, a suburb of Houston, bundled her sons, 5 and 11 months, in undershirts and fleece pajamas along with gloves, hats and robes.

“They kept pretty warm for the most part,” she said.

Her youngest slept in a portable crib in Ms. Divirgilio’s walk-in closet, which turned out to be the warmest spot in the house. And because they had stocked up on batteries ahead of the storm, they were able to keep their electric fireplace going throughout the week, ensuring that temperatures in their apartment didn’t dip below 48 degrees Fahrenheit.

If you have a wood-burning fireplace, you can start a fire, provided that you have been cleaning and inspecting your chimney annually. The American Academy of Pediatrics recommends that you take a flashlight and check that the damper or flue is open, which will draw smoke out of the house.

But if it’s very cold, sometimes it might not be safe to stay at home, especially if you have small children, who are more prone to heat loss than adults. The most fortunate will be able to flee to a home with heat by sheltering with family or friends, staying at a hotel or renting a home in a nearby area.

Ms. Contreras and her 13-month-old son quickly drove to her parents’ home because her apartment was so cold the liquid dish soap froze into a solid block, snow blew under her doorway and ice crystallized on the floor. Eventually the thermostat in her living room stopped working, displaying only the letters “Lo.”

“We just could not take the cold anymore. It was horrible,” she said. “You could literally see your breath inside my apartment.”

If you’re staying with people you don’t normally live with, ideally, everyone age 2 and older should wear a mask and try to eat in separate rooms, if possible, said Dr. Carl Baum, a professor of pediatrics and emergency medicine at the Yale School of Medicine and a member of the executive committee for the A.P.A.’s Council on Children and Disasters.

“You don’t want to be the next superspreader event,” he said.

Those who cannot find a place to stay can check their state’s list of warming shelters, if they are in need of power and able to travel.

Beware of carbon monoxide poisoning

When the frigid weather hit Texas this week, hundreds of people in Houston used barbecue pits or portable generators indoors, resulting in carbon monoxide poisoning, the Houston Chronicle reported on Tuesday. Many of the cases were in children.

Portable generators that run on fuel are often used to provide homes with electricity or heat during a power outage, but they can be dangerous when used improperly.

The Federal Emergency Management Agency says to place these generators outdoors and away from windows, keep them dry and properly grounded and never plug them into a wall outlet or main electrical panel.

Other outdoor appliances that are powered by fossil fuels, like camping stoves, can also release carbon monoxide, and should not be used indoors.

Cars left running in a garage and malfunctioning gas stoves, gas dryers and fuel-fired furnaces can all release dangerous levels of carbon monoxide.

According to the Centers for Disease Control and Prevention, the most common symptoms of carbon monoxide poisoning include headache, dizziness, weakness, upset stomach, vomiting, chest pain and confusion.

You cannot smell or see carbon monoxide gas, not even when it builds to deadly levels. According to the Texas Poison Center Network, it is considered the leading cause of death from poisoning in the United States, which is why it’s important to also install a carbon monoxide detector in your home.

Avoid contaminated water and protect your pipes

As of Friday morning, more than 14 million people in 160 counties in Texas are facing disruptions in their water service, according to a spokeswoman for the Texas Commission on Environmental Quality.

If your community is under a boil water advisory, the C.D.C. says you should either use bottled water or boiled tap water for your family and your pets because your community’s water could be contaminated.

It’s not enough to pour your water through a filtered pitcher or faucet attachment. Tap water should be brought to a full rolling boil for at least 1 minute. If you live at an elevation above 6,500 feet, you should boil the water for 3 minutes before allowing it to cool, the C.D.C. says.

And if you have appliances connected to a water line, like a refrigerator, do not use the water or ice that it produces while the boil water advisory is in effect.

Rather than washing dishes, you might consider using disposable plates, cups and utensils. According to the C.D.C., household dishwashers are safe to use if the water reaches a final rinse temperature of at least 150 degrees, or if the dishwasher has a sanitizing cycle.

If you don’t have a dishwasher, you can wash and rinse the dishes like you normally would. The C.D.C. then recommends soaking the rinsed dishes in a separate basin with 1 teaspoon of unscented household liquid bleach for each gallon of warm water. Let the dishes air dry completely before using again.

Babies who drink formula should be fed ready-to-use formula if possible. If you don’t have any available, try to find bottled water labeled de-ionized, purified, demineralized or distilled.

When the boil water order is lifted, residents will be asked to flush their water lines to clear plumbing of potentially contaminated water.

If you are a homeowner, you can take steps to protect your pipes from freezing. The American Red Cross recommends keeping garage doors closed if there are water supply lines in the garage, opening kitchen and bathroom cabinets to allow warmer air to circulate around plumbing and letting cold water drip from the faucet. You can also consider installing insulating materials like a “pipe sleeve” on exposed water pipes.

If you only see a trickle of water coming out of your faucet, or none at all, your pipes may be frozen or damaged. In that case, experts recommend turning off the main water supply to the house to prevent water damage when the temperatures rise or the power comes back on.

Prepare for potential difficulties in getting food

Ideally, if you know winter weather is on the way, you’ll stock up at the grocery store ahead of time. But what if the weather takes you by surprise? Or you haven’t been venturing outside as regularly because of the pandemic?

When the power went out earlier this week, Andrew Flynn, 45, immediately booked a hotel for his wife and two kids in Austin, Texas, but then the hotel ran out of food.

On Tuesday, he said, “I spent three hours driving around central Austin yesterday and all of the grocery stores had long lines.”

He finally visited a gas station and bought non-perishables like ramen and rice so his family could make meals in their slow cooker.

His kids, 9 and 12, “haven’t loved it,” he said. But allowing them to have some candy or potato chips after their “Crock-Pot mixture” provided some incentive, he added.

If your kids are cold and cranky and you cannot give them comfort food, at some point you need to level with them in a gentle but direct way.

You can try saying: “I’m sorry, we don’t have your favorite food or even food you like at this point, but you’re going to have to eat this,” Dr. Schonfeld suggested. “Or, let’s figure out something you can eat even if it’s not particularly healthy.”

But not everyone has a car or the ability to drive around in search of food. Check to see if hunger relief organizations or food banks are providing food to people in the community and how it is being distributed. Friends might also have extra to spare.

Rawlins Gilliland, 75, who lives in Dallas, lost power for three days but his gas stove was still working so he kept himself busy making vegetable soup for his neighbors, including the large family that lives next door.

“My survival mechanism during this was that we do what we can,” he said.

His neighbors helped him out, too. When the power came back, he discovered that his heater had given out, so one of his neighbors drove more than 50 miles to get a replacement part and help him install it. The heater is working again and he’s no longer wearing his lined boots and layers of polar fleece indoors. “Right now, I feel extremely excited because things are under control here,” he said on Friday. “I wish people really did realize that collectively that we’re all in these things together.”

Covid Vaccines for Kids Are Coming, but Not for Many Months

Covid Vaccines for Kids Are Coming, but Not for Many Months

Pfizer and Moderna are testing their vaccines on children 12 and older and hope to have results by the summer.

A 15-year-old participating in Moderna’s teen Covid vaccine trial received a shot in Houston this month.
A 15-year-old participating in Moderna’s teen Covid vaccine trial received a shot in Houston this month.Credit…Brandon Thibodeaux for The New York Times
Apoorva Mandavilli

  • Feb. 12, 2021, 5:00 a.m. ET

As adults at high risk for Covid-19 line up to be immunized against the coronavirus, many parents want to know: When will my child get a vaccine?

The short answer: Not before late summer.

Pfizer and Moderna have enrolled children 12 and older in clinical trials of their vaccines and hope to have results by the summer. Depending on how the vaccines perform in that age group, the companies may then test them in younger children. The Food and Drug Administration usually takes a few weeks to review data from a clinical trial and authorize a vaccine.

Three other companies — Johnson & Johnson, Novavax and AstraZeneca — also plan to test their vaccines in children, but are further behind.

When researchers test drugs or vaccines in adults first, they typically then move down the age brackets, watching for any changes in the effective dose and for unexpected side effects.

“It would be pretty unusual to start going down into children at an early stage,” said Dr. Emily Erbelding, an infectious diseases physician at the National Institutes of Health who oversees testing of Covid-19 vaccines in special populations.

Some vaccines — those that protect against pneumococcal or meningococcal bacteria or rotavirus, for example — were tested in children first because they prevent pediatric diseases. But it made sense for coronavirus vaccines to be first tested in and authorized for adults because the risk of severe illness and death from Covid-19 increases sharply with age, said Paul Offit, a professor at the University of Pennsylvania and a member of the F.D.A.’s vaccine advisory panel.

“We’re trying to save lives, keep people out of the I.C.U., keep them from dying,” Dr. Offit said. That means prioritizing vaccines for the oldest people and for those with underlying conditions.

People younger than 21 account for about one-quarter of the population in the United States, but they make up less than 1 percent of deaths from Covid-19. Still, about 2 percent of children who get Covid-19 require hospital care, and at least 227 children in the United States have died of the disease.

“It is a significant disease in children, just not necessarily when you compare it to adults,” said Dr. Kristin Oliver, a pediatrician and vaccine expert at Mount Sinai Hospital in New York.

Children will also need to be vaccinated in order for the United States to approach herd immunity — that long-promised goal at which the pandemic slows to a halt because the virus runs out of people to infect.

Scientists have estimated that 70 to 90 percent of the population might need to be immunized against the coronavirus to reach herd immunity, especially with more contagious variants expected to circulate widely in the country.

“Not all adults can get the vaccine because there’s some reluctance, or there’s maybe even some vulnerable immune systems that just don’t respond,” Dr. Erbelding said. “I think we have to include children if we’re going to get to herd immunity.”

It will also be important to immunize children in racial and ethnic populations that are hit hardest by the pandemic, she added.

Abhinav, 12, a participant in the Pfizer vaccine trial at Cincinnati Children’s Hospital last month.
Abhinav, 12, a participant in the Pfizer vaccine trial at Cincinnati Children’s Hospital last month.Credit…Cincinnati Children’s Hospital

Pfizer and Moderna’s clinical trials in adults each enrolled about 50,000 participants. They had to be that large in order to show significant differences between the volunteers who received a vaccine and those who got a placebo. But because it is rarer for children to become seriously ill with Covid-19, that kind of trial design in children would not be feasible, because it would require many more participants to show an effect.

Instead, the companies will look at vaccinated children for signs of a strong immune response that would protect them from the coronavirus.

The Pfizer-BioNTech vaccine was authorized in December for anyone 16 and older. The company has continued its trial with younger volunteers, recruiting 2,259 adolescents from 12 to 15 years of age. Teenagers are roughly twice as likely to be infected with the coronavirus as younger children, according to the Centers for Disease Control and Prevention.

Results from that trial should be available by summer, said Keanna Ghazvini, a spokeswoman for Pfizer.

“Moving below 12 years of age will require a new study and potentially a modified formulation or dosing schedule,” Ms. Ghazvini said. Those trials will most likely start later in the year, but the plans will be made final after the company has data from older children, she added.

Moderna’s vaccine, which was also authorized in December, is on a similar track for pediatric testing. In December, the company began testing adolescents ages 12 through 17, and plans to enroll 3,000 volunteers in this age group. The company expects results “around midyear 2021,” said Colleen Hussey, a spokeswoman for Moderna.

Based on the results, Moderna plans to assess the vaccine later this year in children between the ages of 6 months and 11 years.

Infants may have some antibodies at birth from vaccinated or infected mothers, but that maternal protection is unlikely to last through the first year of age. And with their relatively weak immune systems, babies might be particularly susceptible to infection if community transmission is high.

The trials will also assess the vaccine’s safety in children — and hopefully ease any fears that parents have. One-third of adults in the United States have said they do not plan to have their children immunized against the coronavirus, according to a recent poll conducted by Verywell Health.

Given the low risk of Covid-19 in children, some parents might be skeptical of the urgency to inoculate their children with a brand-new jab, Dr. Offit said. “For that reason, the vaccine would have to be held to a very high standard of safety,” he said.

More than 42 million people in the United States have been immunized so far, with few lasting side effects. And the F.D.A. has set up multiple systems to carefully monitor any serious reactions to the vaccine.

“They’re really looking at the data very, very closely,” Dr. Oliver said. “As a pediatrician and a mom, I have really good confidence that those systems work.”

Once a vaccine for children is available, schools can reintroduce extracurricular activities that involve close contact, like band practice, team sports and choir. But in the meantime, there is ample evidence that schools can reopen with other precautions in place, Dr. Oliver said.

“I don’t think we need to anticipate having a vaccine in order to open schools in the fall,” she said. “We should be planning now for opening schools.”

Dr. Oliver also urged parents to make sure children are immunized for other diseases. According to the C.D.C., orders for non-flu childhood vaccines through the Vaccines for Children Program are down approximately 10.3 million doses over all.

“Now’s the time to really catch up on missed doses of those vaccines,” she said. “Measles, HPV, tetanus boosters, pertussis boosters — all of that is really important.”

Connecting My Children to Their Heritage in Mandarin

Ties

Connecting My Children to Their Heritage in Mandarin

Although my parents’ English is serviceable, it is only in Mandarin that they’re at ease, that they can inhabit their own skins.

Credit…Lucy Jones

  • Feb. 12, 2021, 5:00 a.m. ET

On Sunday afternoons, my grandfather would sit by my elbow while I gripped his prized calligraphy brush, tracing inky lines on tissue-thin paper. “Many Chinese consider calligraphy a high form of art,” my grandfather reminded me whenever my attention flagged or arm drooped.

I’d sigh in response — this weekly ritual just felt like more school.

Growing up as a child of first-generation Chinese immigrants, I was used to straddling two worlds — that of my parents and the country they emigrated from, and America, where the pressure to assimilate buffeted us constantly. The message was clear in the media and popular culture of the 1980s: It was better to speak English, exclusively and without an accent; to replace thermoses of dumplings with hamburgers. My father’s college classmate, also a Chinese immigrant, proudly boasted that his kids knew no Mandarin, a claim confirmed when his son butchered the pronunciation of his own name while my parents looked on with unconcealed horror.

My parents, instead, dug in their heels against this powerful wave that threatened to wash out the distinctive features of their past. I spoke no English until I started preschool, but in Mandarin — according to my grandmother — I was a sparkling conversationalist, a Dorothy Parker of the toddler set. The school administrators wrung their hands, worried that I’d fall behind, but my father shrugged, figuring (correctly) that I’d learn English quickly enough.

But as I grew older, Chinese lost ground, inch by incremental inch. And while I happily accepted the bills tucked in crimson envelopes that adults bestow on children for Lunar New Year and consumed my weight in mooncakes during the Moon Festival in autumn, I didn’t feel connected to the culture.

Before my children were born, I had already decided that I would teach them Mandarin, but I hadn’t spoken it with any consistency since I left home for college. At the time, mine was more a nebulous wish, a feeling that they ought to be able to speak the language of their grandparents, the first language their mother encountered.

It was awkward at first. I was a new mother, home alone for the first three months with my daughter — a wriggling, needy, nonverbal lump. Speaking to her in any language, much less a language in which I had not strung more than a few words together in over 15 years, seemed daunting.

Parenting books advised narrating your actions as a gentle entry into communication with your baby. Gamely, I started excavating long-buried words: “ball,” “eat,” “sleep,” “play.” Most words, however, lingered on the periphery, frustratingly out of reach.

As this exercise continued, the gaps in my Mandarin became more and more obvious. After a nap one morning, when my daughter was especially alert, wide eyes tracking my movements, I started a game with her. I gently tugged on her nose, pointed to her stomach, grabbed a foot — naming each body part after her answering giggle. When I got to her arm, the game stalled. What was the word for “arm?” I panicked. Had I already reached the boundaries of my knowledge?

Since those sleepless days, much of my Mandarin has come back to me — the long dormant part of my brain awakening and reforging connections to my earliest memories, when the lilt and rhythm of Mandarin dominated my conscious thoughts.

These days, the ready availability of Chinese language media, from books to television shows to music, is a much-needed boon to parents like me — second-generation immigrants, often with a tenuous grip on the language, who nevertheless want to pass it on to their children.

The first time I stepped into the local library in my Bay Area hometown, I was amazed to find a well-stocked Chinese section in the children’s wing. I emerged with an armful of books, their fanciful pages filled with half-remembered refrains, echoes from my childhood. Like the mischievous Monkey King, Sun Wu Kong, whose spirited high jinks seized my daughter’s imagination, or the tale of Chang E, the lady who lives on the moon, which prompted late night examinations of the moon’s pocked surface.

Learning Mandarin is more popular than ever. As a kid, my Saturday class was populated by students like me, with parents who spoke Mandarin exclusively at home. But the demographics of Mandarin learners today run the gamut from heritage speakers to those without a familial connection but with other motivations to learn (an affinity for the culture, an appreciation of Asia’s growing importance in the world’s economy).

In 2015, the Obama administration set up an initiative to increase fivefold the number of students learning Mandarin in five years. Today, more than 300 Mandarin immersion schools operate all over the United States. The language and customs I had hidden and compartmentalized, considering them “weird” as a child, have entered the mainstream.

But it’s an uphill slog. According to the Foreign Service Institute, Mandarin, a Category Four language, takes four times as many hours to master as languages like Spanish or Italian. And, as I can personally attest to, maintaining fluency is a lifelong commitment.

Still, when I see my youngest converse with his grandfather in rapid-fire Mandarin or when my daughter insists on fish for Lunar New Year (“fish” and “abundance” are homonyms in Mandarin — it’s somewhat of a sport among the Chinese to play with these happy coincidences), the time spent poring over books and taking them to activities feels well-spent. Although my parents’ English is serviceable, it is only in Mandarin that they’re at ease, that they can inhabit their own skins.

In Mandarin, I can almost see the people they were before they uprooted their lives in search of better opportunities in a foreign land. I think about how frightening it must have been, what an act of bravery it was, to raise their children in a language whose rhythms and meanings will always remain cryptic to them, to know that those children will forever be wai guo ren — “foreigners.”

For the Moon Festival performance at my youngest child’s preschool last fall, he recited Li Bai’s “Quiet Night Thoughts”— perhaps China’s most celebrated poem by its most famous poet. For generations of Chinese children, it’s the first piece of literature they memorize — trotted out for all occasions, but most often for the Moon Festival because of its four poignant lines, which describe how the glow of the full moon reminds the poet of his distant home.

Decades ago, my Chinese teacher explained to me how the steadfast moon connects all those who seek its light, no matter how far apart they are. So, too, does language, mediating culture and history and memory, connect future generations to past ones. Buried in Mandarin’s rounded vowels and tones, in the whimsical idioms that pepper our speech, in the Tang era poems every child knows, are irrevocable pieces of me, of my family.

Before my bed the bright moon’s glow

Seems like frost on the ground

Raising my head, I gaze at the moon

Lowering my head, I think of home

My son’s voice rang out with confidence and his chubby arms swept up to indicate the moon above. Joy and wonder alighted on my father’s face as he listened to the familiar verses tumble out of his grandson — verses that had been spoken by my father as a little boy in Taiwan, by my grandparents when they were students in China, and by countless boys and girls before that.


Connie Chang is a writer and mother of three in Silicon Valley.

Emptying the Dishwasher Can Enrich Kids’ Mental Health

Emptying the Dishwasher Can Enrich Kids’ Mental Health

Guiding children toward mastery of new skills can help them thrive — and get some household chores done at the same time.

Credit…Jack Taylor

  • Feb. 11, 2021, 5:00 a.m. ET

I begged my 12-year-old to help me with the pandemic task of learning to dye my hair at home. I could have done it myself, but I’ve learned that small opportunities to feel useful and successful are good for kids’ mental health, which I’m especially attuned to in our current circumstances.

Among the other ideas I’ve tried during these long months: Letting my kids practice phone skills by having them call to order takeout and asking them for help with setting up the Wi-Fi booster. In some cases, it would be faster to just do these things without their “help,” but I’m doing it deliberately, to benefit my kids.

It might seem like a strange time to ask parents to take a new approach — don’t we have enough to juggle? But focusing on helping our kids develop what psychologists call “self-efficacy,” or a person’s belief that they are capable of successfully meeting the tasks or challenges that face them, can yield immediate benefits.

But can such small tasks really instill a sense of control right now, in a pandemic? It’s possible, experts say, and allowing kids to try to meet real-life challenges is the best way for them to build that healthy self-efficacy. Albert Bandura, the Stanford University psychologist who first developed the concept of self-efficacy in the 1970s, called these important first-person accomplishments “mastery experiences.”

Lea Waters, professor of positive psychology at the University of Melbourne, Australia, said self-efficacy “is a primal part of the formula of good mental health, because without that sense of efficacy, without that belief that I can get things done, you can really easily see how a young person or even an adult would not only lose their confidence, but lose their motivation to move forward.” Humans thrive on a sense of control and capability; low self-efficacy, or learned helplessness, is associated with anxiety, depression, lack of hope and lack of motivation, she said, while higher self-efficacy is associated with life satisfaction, self-confidence, social connection and growth mind-set.

Mastery experiences don’t have to be grand accomplishments. Dr. Waters pointed to things as small as kids completing “a Lego build that was a little bit hard,” packing their own backpacks or walking the dog by themselves.

She suggests that parents become detectives who notice a child’s successes and narrate them. This purposeful shift toward noticing and acknowledging small wins helps parents take a positive approach while it also helps kids internalize a sense of their growing abilities.

“We can spot those things and acknowledge, ‘You did that really well; you did that all by yourself,’ or ‘You didn’t need as much help from me this time around,’” she said. These successes build up what she called a “bank account” of feelings of efficacy for children that they can draw on the next time they face a challenge, when parents can remind the child, “You know, last time you felt that way, and then you ended up being able to do it all by yourself.”

Of course, you don’t want to pile on more responsibilities than a child can handle. Parents should always be attentive to children’s health, ensuring that they don’t see signs of mental health issues that warrant professional support, said the child and adolescent psychotherapist Katie Hurley, author of “The Happy Kid Handbook.

“Every kid is different,” said Ms. Hurley. “Take a deep breath and say, ‘What is my kid like without a pandemic?’” Watch for concerning changes in sleep; eating significantly less or more; new anxious behaviors such constant reassurance-seeking or clinginess; a significant loss of focus; and less interest in connecting with friends, even in favorite ways like social media or video games, she said. “Trust that when you feel that in your gut that something isn’t right, then it’s probably a good idea to get help.”

Apart from monitoring health concerns, the impulse to “help” our kids by doing more for them is sometimes more about us than it is about our kids, said Ned Johnson, co-author of “The Self-Driven Child: The Science and Sense of Giving Your Kids More Control Over Their Lives.”

Research has shown that when parents jump in to help kids with a frustrating problem, that intervention can lower parent anxiety while leaving the child’s anxiety elevated, Mr. Johnson said. That’s because the anxious parent gains a sense of control from taking action rather than remaining helpless on the sidelines, but the child is still left feeling ineffectual and stressed.

It can be hard for parents to let children do more, and perhaps mess up, when a parent could do a task more quickly and effectively. But the pandemic has lowered the stakes in some common family situations. For example, when kids are doing remote learning and don’t have to catch the bus, they can take on responsibility for waking themselves up. If the child oversleeps, the parents aren’t stuck playing chauffeur; only the child will experience the natural consequences of lateness, Mr. Johnson said, making it easier for parents to let go of some control.

With everyone spending more time at home, families can share tasks more readily, too, even if they’re not done perfectly. A preschooler with a broom may not necessarily be cleaning the floor well, but the child feels that efficacy-building sense of accomplishment and helpfulness when they are encouraged to try it for themselves, Mr. Johnson said, and “the experience of coping increases.”

If this all sounds like too much work in a pandemic, remember that parents who encourage their children’s strengths and self-efficacy not only help their kids, but also themselves. “Parents are really depleted,” Dr. Waters acknowledged, but a positive, proactive approach is “kind of a win-win. It’s good for your kids,” and seeing children thrive is “good for us as parents as well,” she said. And her research has found that using a strengths-building approach — finding areas where your kids can take on more responsibility — is also correlated with an increase in parental self-efficacy, a sense that “you are doing the right thing as a parent.”

Courtney E. Ackerman, author of several positive psychology books, also counsels parents not to wait until the present crisis is over to instill more self-efficacy in children. Yes, working on developing resilience in these unpredictable times may feel like shoveling while the snow is still falling, she said, but that’s OK. “I think it’s always snowing,” she said. “It’s a specifically difficult time now with the pandemic, but life is full of ups and downs.”

Now is an excellent time, perhaps better than any other, she said, to work on building a sense of self-efficacy in kids. And if that means parents aren’t the only ones endlessly loading and unloading the dishwasher, so much the better.

Sharon Holbrook, the managing editor of Your Teen magazine, is writing a book about how to raise capable kids.

How to Help When Adolescents Have Suicidal Thoughts

Credit…Grace J Kim

The Checkup

How to Help When Adolescents Have Suicidal Thoughts

Even when rates of suicidal ideation increase, there are ways to keep kids safe.

Credit…Grace J Kim

  • Feb. 6, 2021, 5:00 a.m. ET

With some evidence suggesting that more adolescents have been reporting suicidal thoughts during the pandemic, experts and parents are looking for ways to help.

One issue is that the Centers for Disease Control and Prevention has not yet compiled and released statistics on suicide deaths, so it’s not clear whether the problem is worse than usual. But there are questions about whether suicide risks are increasing — especially in particular communities, like the Black and brown populations that have been hit hardest by the pandemic.

Even during normal times, many mental health problems tend to emerge in adolescence, and young people in this group are particularly vulnerable to social isolation. In Las Vegas, an increase in the number of student suicides during the pandemic spurred the superintendent’s recent decision to reopen schools.

“We don’t have the data to know the relationship of suicidality in children and youth and the Covid epidemic,” said Dr. Cynthia Pfeffer, a professor of psychiatry at Weill Cornell Medical Center who has worked extensively on grieving and bereavement in children and adolescents. “The tremendous stress for families might make a child feel like they need to get out, or feel depressed.”

During the early months of the pandemic, there may have been some sense of common purpose — the kind of spirit that can increase people’s resilience after a disaster. In a research letter published on the JAMA network in late January, researchers compared internet searches related to suicide during the two months before and four months after March of 2020, when the United States declared a national pandemic emergency. Searches using the term “suicide” went down significantly in the 18 weeks after the emergency was declared, compared with what was predicted.

In a new study in the journal Pediatrics, researchers looked at the results of more than 9,000 suicide screenings that had been performed on 11- to 21-year-olds who had visited a pediatric emergency department in Texas. Everyone coming in, for any reason, was asked to complete a questionnaire which asked, among other things, about suicidal thoughts or suicide attempts in the recent past.

The researchers compared the responses from the first seven months of 2019 with those from the same months in 2020. They wanted to see if there was evidence of more suicide-related thoughts and behaviors between March and July of 2020 as the pandemic took hold. Ryan Hill, an assistant professor of pediatrics at Baylor College of Medicine who was first author on the study, said that his team expected that while in January and February, the pandemic would not have been on people’s minds, “we expected to see some differences later — and we did see some, but they were not consistent.”

Dr. Hill and his team found higher rates of suicidal thoughts in some, but not all, months of 2020. “In March and July, the rate of ideation was substantially higher than in 2019,” Dr. Hill said. “Something’s going on — we interpret it as due to the pandemic, though other things were going on in 2020.”

Dr. Christine Moutier, the chief medical officer at the American Foundation for Suicide Prevention, emphasized that even when rates of suicidal ideation increase, suicide rates do not have to rise.

“I think it is terrific that there is more universal screening going on; it represents an opportunity to employ some of the evidence-based strategies that we know can help,” she said.

In a comment published in JAMA Psychiatry last October, Dr. Moutier wrote about how important it is to prioritize suicide prevention during the pandemic. She included several strategies for health care providers, communities, government, and also friends and family to do just that, with some designed to improve social connections by taking advantage of technologies for virtual check-ins and visits. Her foundation also recently released a statement on what parents can do to protect children’s mental health during remote learning.

“Now more than any other time is a time for parents, for any adults who work with adolescents and youth, to be paying attention to the well-being of all adolescents,” Dr. Moutier said. “It’s really a time to be checking in.”

Parents should think about the different ways adolescents might respond to stress, said Dr. Rebecca Leeb, a health scientist at the Centers for Disease Control and Prevention who led a team on emotional well-being and mental health in the pandemic. Perhaps they are withdrawing and sleeping more; eating more or less; or trying drugs, alcohol or tobacco.

Parents can encourage their teenagers to get out of the house and to use the right safety measures — masks, hand-washing, distancing — so that they can spend time outside with friends. She emphasized that “social interaction” is important, whether that’s “exercise or drawing or hiking or taking the dog for a walk.” Kids take cues from their parents, she added, so adults should do those things as well.

It’s also important to make sure that your own mental health is taken care of before you “jump in and start checking in on your kid’s mental health,” Dr. Moutier said. Find moments to relax and laugh, she said, and make sure to talk about how you’re maintaining your own wellness and resilience, so that you can acknowledge and model the importance of those coping strategies for your kids.

Checking in with your kids might also give them an opportunity to open up, said Dr. Moutier, which, for many families, is something that they used to do in the car.

“Our children will feel loved and cared for if we’re practicing that kind of dialogue,” she said. “Do not shy away from asking the deeper, harder questions.” Dr. Moutier recommended being curious about your teenager’s world, asking things like, “How is that situation at school affecting you and your friends?”

Laura Anthony, a child psychologist at Children’s Hospital Colorado and an associate professor at the University of Colorado School of Medicine, said that one common mistake that even she sometimes makes is trying to solve a child’s problems. “What I need to do is just listen,” she said.

She works as the co-leader of the hospital’s youth action board, and teenagers with mental health histories compiled suggestions about how they would like their parents to help. One suggestion: Don’t assume that your kids are struggling all the time, Dr. Anthony said. Instead, consider questions like, “What’s taking up your head space?” Or, “What are you grateful for?”

[Click here for more of the Children’s Hospital Colorado teenagers’ advice on helping teens through the pandemic.]

Another suggestion: Parents should not discipline kids by taking away their phones. “Our teens say, this is not the time for a lot of punishment, you need to give us encouragement, help us have fun,” Dr. Anthony said, “and taking away the phone is really like taking away a lifeline.”

We need better data on mental health, Dr. Leeb said, and on well-being and quality of life. “We are learning a great deal,” she said. “I personally am hopeful for the future,” adding that she’s had several discussions with her children (who are 11, 15 and almost 18) about what the future looks like.

Ask teenagers, “How is this time affecting you?” Dr. Moutier said, and if they are experiencing any kind of struggle. And make it clear that no challenges are insurmountable, she said, “those are really important words for parents to say.”

Giving kids a sense of agency is also vital, said Dr. Sarah Vinson, an associate professor of psychiatry and pediatrics at Morehouse School of Medicine. “Think how kids can be part of the solution,” she said, whether that’s encouraging them to do volunteer work, or helping them understand that concrete steps, like wearing masks, can play a vital role in “reclaiming our day-to-day lives from this pandemic.”

If you’re concerned that your child is depressed or anxious, or if an adolescent talks about feeling overwhelmed, Dr. Anthony suggested asking directly, “Are you having any thoughts of suicide?” You don’t need to ask them every day, but if you’re having any concerns, you should definitely ask.

“Help is out there and it works,” Dr. Anthony said, pointing to the increased availability of virtual mental health services. “Suicidality is partly not being able to see the future,” she said. “If we can change that, we can see remarkable changes.”

Much as the hardships of the Great Depression and World War II forged what is known as “the Greatest Generation,” she said the challenges of the pandemic could strengthen today’s young people.

“I think we are going to have a generation of really remarkably resilient kids and teens who grow up to be really remarkable human beings as adults.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

At a Heavy Metal Concert, Balancing Independence With Boundaries

Ties

At a Heavy Metal Concert, Balancing Independence With Boundaries

My mother, a freewheeling feminist, gave me freedom, while her mother gave me a nest of safety. Both shaped how I’m raising my own daughter.

Credit…Lucy Jones

  • Feb. 5, 2021, 5:00 a.m. ET

A cloud of marijuana smoke drifted by as my 13-year-old daughter asked, “Mom, can I walk around and meet people?” We were standing in an outdoor line for Warped Tour, a music festival with acts typically described as “pop punk” or “metalcore.” That is, hardcore heavy metal. Men in ghoulish masks playing electric guitars and growling lyrics about the devil.

It was 2018, long before the pandemic brought us the concept of social distance. Festivals like this one involved spending hours in extremely close range of other people’s breath and sweat as they screamed along with the bands. My daughter loved this music. I did not. I have no idea where she picked up a taste for it. All I knew was that she wouldn’t hold my hand anymore — she was too old for that, she said. She still had her blonde hair, but in a few months, she would dye it deep red and start adorning the corners of her eyes with eyeliner “wings.” She’s a smart kid — and even though she’s her own person, she’s also at the point in her development where it’s normal for her to “follow the crowd,” which scares me a little.

She asked me again if she could go explore. I said no. She asked me why, just as a car drove by with a shirtless woman hanging out of the sunroof screaming, “Unleash the beast!”

“I need to get inside and get my bearings before I feel safe enough for you to walk around on your own,” I told her.

“I know, but still!” she pleaded.

How many parents parent the way they were parented? Probably a fair number. Many of us also deliberately push back against what our parents did. I do both, perhaps because I was raised by two women — my mother and grandmother — who had very different parenting styles.

My mother, elated with the freedom of her fresh divorce, wanted to make me strong and independent, an adult before my time. Her mother, the martyr, shielded me from the world by giving me a nest of comfort and safety. Which parenting philosophy would inform how I raised my newly teenage daughter?

My own preteen years were intense. On my 10th birthday, my mother, whom I called “Mama,” gave me a private birthday celebration. She’d started her period at 10, so she expected mine any day. She told me that as soon as I started bleeding, I’d go on the pill. She’d had the traumatic experience of getting pregnant as a teenager, and then being whisked away by her mother to a town where no one knew them, giving birth and putting the baby up for adoption with Catholic charities. She’d insisted that the pill would give me freedom.

Not only was Mama my mother, she was also my best friend. I felt fortunate to be positioned as her confidante, even though that meant, according to her, that I was “too old” to hold her hand in public. In the months leading up to my 10th birthday, I heard all about her newfound dating life. This included a one-night stand with a 19-year-old bartender. Since she was 36 and he 19, she said, “we were both at our sexual primes.”

On my birthday, Mama served pink champagne and she-crabs — the egg-bearing females — and dared me to eat the roe. She played Helen Reddy’s “You and Me Against the World,” and when Helen sang “when one of us is gone / and one of us is left to carry on,” we cried in each other’s arms. I felt aching nausea at the fear of losing my mother; it started in my stomach and spread up across my chest.

When my period finally came, I was 13, but by then Mama no longer needed my friendship and confidences; she’d met the man who would become my stepfather. I became part of the wallpaper. Mama moved miles away to their new house. And I moved in with my grandmother and started drinking.

When Mama was 13, Grandma had left her with her mother for nearly a year so that she could try to find her husband who had run off with another woman.

By the time Grandma was 80, she was ready to make up for how she’d abandoned my mother, by providing the safest, warmest, most loving home possible for me. I hid my drinking as best I could, so I wouldn’t disappoint her. That limitation most likely saved my life, because I was, shall we say, wild.

Grandma doted on me. As soon as I got out of my bed, she’d make it. She woke up at 3 every morning to do my laundry, press my clothes for school, and make my meals. Living through the Depression made her a workhorse for ensuring everyone was properly clothed and fed. She was the opposite of my mother, who’d insisted that I cook for the family and do the dishes, but didn’t care if I made my bed or not. In return for everything she did for me, however, Grandma made sure I knew it: She’d show me the bones visible through the soles of her feet after she’d stood on them all day. I hated when she did that, almost as much as she hated it when I unmade my bed right after she made it, just to spite her.

By the time my daughter and I squeezed into the festival, pulsating with bass and throngs of leather- and spike-clad metal fans, my wild days were long gone. This was her heaven and my hell, but I was happy she had found something she felt passionate about. My wife and I have tried to bring our daughter up in such a way that she knows she is loved, and that we are happy when she is happy.

As we made our way toward our eventual meeting spot, I surveyed the landscape of the three stages and thought about what kind of parent I wanted to be. Should I nurture her independence to ensure she can survive this often-cruel world, or should I protect her for as long as I can to show her that I am always there? The truth is that although my mother was selfish and irresponsible, she cared that I would grow up to take care of myself, and I have. And although my grandmother martyred herself with her overabundance of attention and selflessness, she cared that I would be safe in the world, and I am. My parenting can be informed by both of my “mothers.” I can nurture my daughter’s independence and give her boundaries to make sure she is safe.

“Can I go now?” she asked impatiently.

I looked into her eyes. “Yes,” I replied. I’ll be right here.

I found the “parent tent,” also known as “reverse day care” — a cool, comfortable lounge perched atop a hill with a vantage point that allowed me to see all three of the stages, with the audience pumping heads and tattooed fists to the various screaming guitars. I was afraid. I wanted her to hold my hand. I wanted her to need me. But I reveled in her sense of freedom. The joy of her budding independence rippled through my heart and cracked it wide open. At one point, I caught a glimpse of her running through the crowd to make it to the next show. She was smiling and laughing. “There’s my daughter,” I told the mom next to me.

“They grow up so fast,” she said.

“I know,” I said. But still.

Susannah Bell is a teacher and writer who lives with her wife and teenage daughter in the San Francisco Bay Area.

Modern Love: The Day His Journal Went Blank

Modern Love

The Day His Journal Went Blank

A daughter races to collect her father’s memories before Alzheimer’s can steal them away.

Credit…Brian Rea

  • Feb. 5, 2021, 12:00 a.m. ET

My father stood in the kitchen eating refried beans from the can with a fork as Paul Simon sang “Graceland” on repeat for 20 minutes.

“Hey Alexa, why don’t we take a break, huh?” he finally said, as if the speaker were a child who had taken too many turns on the slide. “Yeah, let’s give it a rest for a little bit.”

I watched him pet the device and gently shush it.

“Alexa, turn off,” I said, and the kitchen fell silent.

My father gave me a look, the same look he used to give me when I was 10 and didn’t want to call my grandmother or send thank-you cards after my birthday party. A look of a lesson to impart.

“Yes?” I said.

“Next time,” he said, “say please.”

My father has always been the type of person who likes listening to birds and picking up litter. I grew up admiring the way he would walk into a room full of friends watching TV and ask, “Who wants to talk?” He wanted to know what people were thinking about, and when phones lit up at the dinner table, he would sit and watch as the rest of us hunched and stared at our laps like phone-addicted zombies.

I try to be more like my father and make these values my own. But these characteristics of his are fading along with his memory, and the means through which I connect with him feel less like bonding and more like desperation.

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Almost five years ago, when my father was 62, he learned he had Alzheimer’s disease. Over this time, my mother and I have watched his decline. He forgets his friends’ names and can no longer read. Every morning, he sits in a baby blue polka-dot towel and waits for one of us to prompt him to start his day.

My mother will say: “Come in here and get dressed, honey.” “Brush your teeth, honey.” “Come drink some orange juice, honey.”

I look at other fathers who make money and pancakes and kiss their wives, and I feel depressed for how small my father’s world has become. I see how my mother is nervous to socialize with him or take him to dinner parties where the other husbands talk about work and politics, while hers asks, over and over, if Frank Sinatra is alive.

Since graduating from college two years ago, I have split my time between my apartment in Brooklyn and my parents’ house in Hastings-on-Hudson. Every week, I pack a bag and take the train 30 miles north to help with the caregiving. I joke about how it’s confusing to live in two places. “It’s like I have divorced parents,” I say as I hug my roommates goodbye.

I struggle to understand myself as a 23-year-old who is also taking care of a parent. I feel stiff when my roommates get dressed for work and ask which shoes I like best, or when they talk about their goals: what they want to do, where they want to live. I marvel at the ease with which they can sound so sure of their freedom and choices.

It’s not that I don’t have plans for myself, or that I dislike shoes. There’s just something about when my father calls me “Mommy” in front of the neighbors that morning, and then says he’s sorry, that makes my mouth feel tight when it comes to offering style advice or talking about my dreams.

I often wish I could ask my father who he was at 23. I wish I could ask what his bad habits were, or how he treated his mother, or what he did on Saturdays. But his ability to recall his past has disappeared, so I have come to terms with not knowing. I spend a lot of time asking him other questions instead, but my queries have surpassed casual curiosity.

Every week I ask: “Dad, what do you love about Mom?” “Dad, what is your favorite thing about yourself?” “Dad, do you like to cry?”

I shake him up like a Magic 8-Ball and throw him as many questions as I can. But just like the toy, his answers are random lines I have heard before. I’m patient as he searches for words and pronunciations, but we often end up playing charades as I guess at the words he has lost.

Last September, my parents and I were organizing our storage bin in the basement of our apartment building when I uncovered a chest of my father’s old journals. Under yellowed Superman comics and water-damaged concert tickets were 15 or so composition notebooks, dating from 1978 to 2002.

My mother said journals are private and attempted to hide them from me, but she soon realized I would keep coming back. Morals and privacy seemed unimportant if these journals could give me access to the person my father used to be. So I began to read them. And they have been a gift.

In his journals, my father wrote about self-doubt and fear and all the things that brought him joy. I copied his sentences into my own journal and cited his wisdom when I spoke to my friends. He also wrote about riding his bike around Brooklyn, reporting for small newspapers and exiting the subway at Seventh Avenue to walk home through the park.

Until I read those journals, I had no idea he’d done those things, and the similarities between us stunned me. I have spent the last two years working as a reporter for small Brooklyn papers, and every Sunday, heading home from the train that carries me back to the city from Hastings, I too take that walk home from Seventh Avenue.

When I read my father’s entries, I feel less lost. I not only recognize the person my father used to be, but I recognize myself.

My mother gave me permission to quote a few of them.

On Sept. 9, 1991, he wrote: “I want to stand up outside between the cars, head blowing in the wind, and scream, scream until I nearly start living … start living my dream. I need something. Too much time and too little touch in my life lately. Loneliness can kill, I believe.”

A few months later, on Feb. 10, 1992: “I feel giddy, like a kid. I want to dance! She called. Suzanne from Brooklyn. Yes, she’d love to go out again. So it’s brunch and watching the playoffs at her place Sunday. God I feel happy.”

“Later last night after 11:00, spurred by the phone call, I danced in the kitchen in the dark. A Stones song, I danced alongside old ghosts and laughed at them. Whether trying to shake demons or embrace a new dream, dancing in the dark always felt good.”

Suzanne is my mother, and it was through these journals that I learned how much my father loves her. His journals also showed me how much he loves his friends, and how much he loves me. Every entry from 1997 to 2002 mentions “little Annabelle.”

What I wasn’t prepared for, however, was the moment the entries stopped. On April 28, 2002, my father wrote about my bathtub performance of “Tomorrow” from the musical “Annie,” and then the next page is blank. And so is the next, and the one after that. I flipped through wide-eyed, in denial. I didn’t want this version of my father to be over.

As I read that last entry, he and I were sitting beside each other on the couch with “Ellen” on TV. She was playing Burning Questions with Bradley Cooper, but their exchanges were too quick for him, so he stared at the rug instead.

I thought about the scenes I’d just read: my father calling his friends at midnight to tell them a joke, riding the subway and reading the paper, asking my mother to dance. Watching him now as he gazed at the rug, I felt uneasy about all the time he spends in silence. I felt afraid of how much he had lost and would continue to lose.

“Dad,” I said.

“Yes?”

“Do you love Mom?”

He laughed. “Of course.”

I took a breath and turned off the TV. I did my best to join him in the moment, as that is all we have.

“How much do you love her?”

“What do you mean, how much?” He laughed again. “One quart.”

“And you love me a gallon?”

“Yes,” he said. This much he understood. “Very many gallons.”

Annabelle Allen is a freelance journalist in New York City.

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An Invisible Cost of College: Parental Guilt

An Invisible Cost of College: Parental Guilt

Is it any wonder that plenty of people are tempted to borrow a whole lot of money to send their kids to college?

Credit…Ana Galvañ
Ron Lieber

  • Feb. 3, 2021, 9:47 a.m. ET

Many of us put our heads in the sand when it comes to confronting the cost of college for our kids, and I’ve spent the last several years trying to figure out why.

Sorting it out is a personal finance challenge of the highest order, given that the retail price of a four-year degree from many selective, private institutions has sailed past the $300,000 mark. Even at some state schools, the bill for four years of tuition, room and board can run to more than $100,000. And while it is tempting to throw up our hands and bet on financial aid or free college for all by 2030, doing so (and saving nothing) would be pretty risky.

To get more clarity on what to pay and how, we need to focus more on the personal and less on the finance. These are our kids after all, so there will be feelings.

Last week, I wrote about fear. This week, I want to bring you back from the guilt trip you may be on, perhaps without even knowing it.

Many of us seem to go through life with little voices in our heads that repeat the following, softly or maybe emphatically: It is my solemn duty to make sure my offspring get to and through college, and I should pay for it, come what may.

So how can these feelings of obligation lead to guilt if we’re not careful? Let’s start with the government. If you apply for financial aid, you fill out the Free Application for Federal Student Aid (FAFSA), and it spits out what is called an “Expected Family Contribution” — the amount of money the government has determined that a family should be able to pay toward the student’s bill.

Those words are hateful — the great expectations, the presumptuousness around family composition, the notion that this is a gift. Thankfully, they will go away in the 2022-23 school year, when the government will replace them with the less loaded phrase, “student aid index.”

Good riddance to all of it, though the federal dictate that families, not governments (as is the case in many other countries), should bear the costs of higher education will remain.

Next come the prices that schools quote to you — discounted, perhaps, but not enough to feel affordable. Yes, people with lower incomes who apply to extremely well-endowed schools may get generous aid packages, but most schools can’t offer grants to cover everything that families with below-average earnings might need.

Then, there is the upper middle class. Cue the small violins, sure, but many of these families are stretching to buy homes in the good public school districts and to pay for ongoing after-school enrichment and summer activities.

It may be hard to save much for college if you’re investing in offspring on an ongoing basis (and trying to mind your own retirement and perhaps your own remaining student loans, too). Then even some of the most generous colleges believe you should be able to pay $40,000 per year or more.

Sometimes our guilt comes from what we see and hear around us. Our friends and neighbors tick off lists of schools their kids are applying to, often with no mention of whether or how they can afford them. We can’t know what kind of debt they are taking on, whether there are wealthy grandparents in the background or what kinds of discounts they may have received.

But it’s hard not to feel inadequate when we learn that some of the schools they view as candidates are impossibly unaffordable for us. What must our own children think about that? It is probably best to address the question directly before they even wonder, perhaps before high school starts. This is especially true if you do not want to end up among the group of parents that, as Kevin Carey recently reported in The Upshot, now owes around $100 billion in outstanding federal Parent PLUS loans.

But there is more. We are, after all, the product of our own parents. And whatever they did for us, we may at least want to match for our kids. Whatever they did not or could not do for us, well, we may want to do a whole lot better.

Is it any wonder that plenty of people are still quite tempted to borrow a whole lot of money to send their kids to college?

Sure, we have trained for trade-offs. We made them, or not, when we purchased the first stroller; the first athletic gear; the first and third and fifth musical instrument. No matter what, our children probably found their passions and excelled where they were meant to.

But college may seem different. It is the launching pad for life. Here, trading off — or planning to — feels as if it will matter more than whether a child makes all state orchestra or the soccer travel team. And so we worry that if we can’t pay for what might be best for our child, we will be taking something away that will matter forever.

One way to begin your return from the guilt trip is to have an honest conversation with your own parents, if possible. There is no shame in telling them that you are scared and feel overwhelmed about what you’re up against when it comes to paying for college. It is possible that some of them may want to help.

Putting $100 per month into a 529 plan for their new grandbaby can add up to nearly $35,000 over 18 years if the investments grow at a 5 percent annual rate. The gift of child care matters, too: If grandparents can help, it may enable parents to save a bit more, or focus better on their jobs so that they may eventually step up to better-paying positions. It’s worth asking.

If the grandparents are gone or cannot help, we should have gentler conversations with ourselves. Our financial lives are quite different from what theirs were like.

Real wages, adjusted for inflation, haven’t gone up much in a generation unless you’re affluent. Unions have less power, and employers push white-collar workers out of companies much more frequently than they once did. And then there’s the unknown, long-term impact that the pandemic may have on many industries.

If you’re lucky enough to have and keep a job, the majority of your retirement savings will probably need to come out of your paycheck via your discipline and good investing luck, not a pension contribution from a benevolent employer.

This may sound like a laundry list of financial sadness, but it’s actually a script for a conversation with yourself. Given what you are up against, you are under no obligation to make the same financial decisions your parents did, or that your neighbors do, or that the statisticians behind some government formula think you must.

Every family has its own particular balance sheet and budget, and each one comes with a slightly different set of feelings. So there is no algorithm that can ingest variables and spit out a formula for wonder, hope and the perfect college sweatshirt. But if you can ask yourself, directly, why you’re feeling guilty about this, it’s a good first step toward answering in a way that could make you feel better.

This article is adapted from “The Price You Pay for College: An Entirely New Road Map for the Biggest Financial Decision Your Family Will Ever Make,” by Ron Lieber.

I’m a Disabled Parent. It Took a Pandemic to Let Me Join the P.T.A.

I’m a Disabled Parent. It Took a Pandemic to Let Me Join the P.T.A.

My chronic illness made it hard to volunteer at my kids’ school. Now I can serve on the executive board of the P.T.A. without leaving my bed.

Credit…Jialun Deng

  • Feb. 2, 2021, 5:00 a.m. ET

In a year of intense isolation, I’ve never felt more connection to my children’s school.

I have a chronic illness that has kept me from volunteering in the highly engaged P.T.A. at my children’s New York City public school. In a strange paradox, for many chronically ill parents like me, the pandemic has brought new opportunities to become substantially involved in our children’s lives and schools.

With a background in teaching and educational reform, I’d spent most of my life in classrooms. I’d always assumed I’d be an active participant in my two children’s learning. Initially, I was — when my first child was 2, I created a cooperative playgroup and later joined a more established group, where I served on the admissions committee. Then, when my older child entered pre-K, I got sick.

I went from a vibrant, engaged woman to a person who clung to her home, and often her bed, as if it were a life raft. Some mornings, despite 10 hours of sleep, I’d wake plagued by dizziness, feeling like I’d been hit by a truck. Eventually I was diagnosed with myalgic encephalomyelitis (M.E.), more commonly known as chronic fatigue syndrome, a disease that impacts between 836,000 and 2.5 million Americans, with women being afflicted at four times the rate of men, leaving the most severely ill completely bed-bound.

The first few years of my illness were the most challenging. On good days, I could muddle through short family events in my children’s classrooms, but on bad days it took everything in me to drag myself one block to after-school pickup, timing the trek so I’d have to wait a minimal time at the gate. Volunteering was out of the question.

In addition to frequent meetings, the P.T.A. at my kids’ school holds numerous social and fund-raising events. I couldn’t even muster the energy to attend these as a participant, let alone assist in organizing. The annual P.T.A. board elections were a difficult reminder that though I had much to contribute, my illness kept me from getting involved.

Last spring, when the world went online in the pandemic, my children’s school, like so many, did its best to pivot. But even with the commitment and energy of the school community, I’d be hard pressed to say it thrived. I knew the P.T.A. was going to be heavily involved in plans for the fall, so I reached out to see if I could help. There were conversations about everything from the flipped classroom model to improving the feedback loop between frustrated parents and overwhelmed teachers. Brainstorming solutions lit me up.

In the fall, the P.T.A. presidents asked if I’d consider joining the executive board as co-vice president of publicity and communications, teaming up with another parent I liked and respected. The P.T.A. leaders told me they had a new vision for the organization. In addition to the ubiquitous fund-raising, they wanted a major push toward improving communications and building community in a landscape that made both challenging. The new mission, the role and working with the other parent appealed to me. Still, I wavered.

One of the cardinal symptoms of M.E. is post-exertional malaise, where physical and cognitive effort leads to a flare-up. Pacing, or monitoring energy expenditure, is a critical part of symptom management. While the severity of my illness had decreased through a combination of treatment, pacing and luck (that summer I’d even been swimming with my kids and on a few short hikes), I worried that overcommitting could catapult me back. But because I could do everything virtually from my house, even from my bed if need be, I took a chance and said yes.

Since October my co-vice president and I have collaborated on our school newsletter, planned a social-justice movie night, and after the chat in one P.T.A. meeting became problematic, helped develop procedures for more effective communication during virtual meetings. In addition, we’re serving as liaisons between a parent-led advocacy group, school administration, and an external group that will be providing training to teachers and parents on how to more effectively address issues of race and racism both at home and at school.

I am not alone in appreciating this unexpected silver lining of the pandemic. In an online group for parents with M.E., run by the #ME Action Network, I encountered several other parents who also credit Zoom for allowing them access to their children’s school in a new way. For Holly Latham, from Jackson, Tenn., who self-describes as “barely hanging on by my fingernails,” it was as basic as being able to attend a meeting virtually to discuss an individualized education program, or I.E.P., for her child who has special needs, instead of struggling to get there physically.

Before the pandemic, Marthe Schmitt, a 51-year-old mother of one from St. Louis, Mo., wished to be more involved in her 8-year-old daughter’s school, but couldn’t: “I was always hesitant to commit to something and then not be able to physically show up.” This year though, she dove in, serving as social-media coordinator and working with her husband to update the school’s bylaws and make them more inclusive. “M.E.’s a very isolating disease, but being on the board has made me feel more connected and less disenfranchised,” Ms. Schmitt said.

Elin Daniel, a 42-year-old mother of one from Bothell, Wash., has moderately severe M.E. and is able to leave the house only a few times a week. “When school was in-person, just getting ready to attend an event would exhaust me and I’d always have a flare-up a day or two after,” she said. But since her children’s school went virtual, she’s joined her P.T.A. board as fund-raising chair, which has improved her mood and self-esteem. “I so rarely feel useful,” Ms. Daniel said. “It feels nice to contribute to the community and set an example for my daughter.”

For parents with chronic illnesses, the ability to be involved in our children’s lives isn’t something we take for granted. Mary Wu, a 41-year-old former teacher from Los Angeles and mother of three, only recently became ill but feels this deeply. Before her diagnosis, she and her 15-year-old daughter had been involved with National Charity League, an organization dedicated to leadership development and philanthropic work such as volunteering at food banks, cleaning up beaches and providing healthy snacks to underfunded schools.

“It was a great way to spend time with my daughter while teaching her to give back,” Ms. Wu said. “But after the onset of my illness, there’s no way I could have done it in person anymore.” Luckily, the charity league’s pivot to online meetings and virtual service has allowed the Wus to continue, fulfilling some of their service hours by sewing face masks for a local organization dedicated to helping women with breast cancer.

“I want something positive to come from all this,” Ms. Wu said. “I hope in the future, organizations still provide access to parents that can’t be there physically.”


Heather Osterman-Davis is a writer, filmmaker and mother of two in New York City.

Evidence Builds That Pregnant Women Pass Covid Antibodies to Newborns

Evidence Builds That Pregnant Women Pass Covid Antibodies to Newborns

A new study suggests that protective antibodies can be transferred through the placenta, and the baby may receive more of them if a mother is infected with Covid earlier in her pregnancy.

A woman  in McAllen, Tex., who tested positive for Covid-19 while she was pregnant. Studies suggest that pregnant women infected with the coronavirus can pass antibodies to their babies. 
A woman in McAllen, Tex., who tested positive for Covid-19 while she was pregnant. Studies suggest that pregnant women infected with the coronavirus can pass antibodies to their babies. Credit…Carolyn Cole/Getty Images
Christina Caron

  • Jan. 29, 2021, 9:04 p.m. ET

One of the many big questions scientists are trying to untangle is whether people who get Covid-19 during pregnancy will pass on some natural immunity to their newborns.

Recent studies have hinted that they might. And new findings, published Friday in the journal JAMA Pediatrics, provide another piece of the puzzle, offering more evidence that Covid-19 antibodies can cross the placenta.

“What we have found is fairly consistent with what we have learned from studies of other viruses,” said Scott E. Hensley, an associate professor of microbiology at the Perelman School of Medicine at the University of Pennsylvania and one of the senior authors of the study.

Additionally, he added, the study suggests that women are not only transferring antibodies to their fetuses, but also transferring more antibodies to their babies if they are infected earlier in their pregnancies. This might have implications for when women should be vaccinated against Covid-19, Dr. Hensley said, adding that vaccinating women earlier in pregnancy might offer more protective benefits, “but studies actually analyzing vaccination among pregnant women need to be completed.”

In the study, researchers from Pennsylvania tested more than 1,500 women who gave birth at Pennsylvania Hospital in Philadelphia between April and August of last year. Of those, 83 women were found to have Covid-19 antibodies — and after they gave birth, 72 of those babies tested positive for Covid-19 antibodies via their cord blood, regardless of whether their mothers had symptoms.

According to Dr. Karen Puopolo, an associate professor of pediatrics at the University of Pennsylvania and one of the senior authors of the study, about half of those babies had antibody levels that were as high or higher than those found in their mother’s blood, and in about a quarter of the cases, the antibody levels in the cord blood was 1.5 to 2 times higher than the mother’s concentrations.

“That’s fairly efficient,” Dr. Puopolo said.

The researchers also observed that the longer the time period between the start of a pregnant woman’s Covid-19 infection and her delivery, the more antibodies were transferred, a finding that has been noted elsewhere.

The antibodies that crossed the placenta were immunoglobulin G, or IgG, antibodies, the type that are made days after getting infected and are thought to offer long-term protection against the coronavirus.

None of the babies in this study were found to have immunoglobulin M, or IgM, antibodies, which are typically only detected soon after an infection, suggesting that the babies hadn’t been infected with the coronavirus.

Experts don’t yet know if the amount of antibodies that passed on to the babies were enough to prevent newborns from getting Covid-19. And because only a few of the babies in the study were born prematurely, the researchers can’t say whether babies who are born early might miss out on those protective antibodies. The study authors also noted that because their results were from just one facility, the findings would need to be further replicated.

The placenta is a complex organ, and one that has been understudied, said Dr. Denise Jamieson, an obstetrician at Emory University in Atlanta and a member of the Covid expert group at the American College of Obstetricians and Gynecologists, who was not involved with the study.

And more research is needed to better understand whether vaccine-generated antibodies behave comparably to antibodies from Covid-19 infection, said Dr. Andrea G. Edlow, an assistant professor of obstetrics, gynecology and reproductive biology at Harvard Medical School.

In a study published in the journal Cell in December, for instance, Dr. Edlow and her colleagues found that Covid-19 antibodies from a natural infection might cross the placenta less efficiently than the antibodies produced after vaccination for flu and whooping cough (pertussis).

“What we really want to know is, do antibodies from the vaccine efficiently cross the placenta and protect the baby, the way we know happens in influenza and pertussis,” Dr. Jamieson said.

Experts do not know whether the Covid vaccine will work in this way, in part because pregnant women were excluded from the initial clinical trials.

“It’s plausible that the Covid vaccine will offer protection to both pregnant mothers and their infants,” said Dr. Mark Turrentine, a member of the Covid expert group at A.C.O.G. “To me,” he added, “this study highlights that inclusion of pregnant women in clinical trials such as the Covid-19 vaccine is essential, particularly when the benefit of vaccination is greater than the potential risk of a life-threatening disease.”

Am I Too Old to Keep the Bargain With My Kids?

Ties

Am I Too Old to Keep the Bargain With My Kids?

As an older parent of young children, I feel that I am holding a big secret — my own mortality.

Credit…Lucy Jones

  • Jan. 29, 2021, 5:00 a.m. ET

“I’m rea—dy!” At 2:45 a.m., our 3-year-old, Nathaniel, yells out like an excited rooster heralding the day. My wife, Lisa, and I take turns attending to these middle-of-the-night greetings. Tonight, it’s my turn.

As my 56-year-old body oozes out of bed and stumbles to the kids’ bedroom, I step on a Lego brick that has been lying in wait like a spiny crustacean. A searing pain rips through my right foot.

Cheerful Nathaniel again yells, “I’m rea—dy!” By this time, Nathaniel’s 6-year-old brother, Theo, is awake. As I finally arrive, limping and in pain, both boys welcome me through the darkness with, “Oh, hi Dad!”

It’s a perfect storm. Both kids are awake, it’s the middle of the night, and my dented Lego foot is throbbing. All I can think at this moment is, “Am I too old for this?”

I get them back into their beds, and collapse onto a lumpy red bean bag to “stay for a few minutes,” as Nathaniel requests. At this point, I will do anything to get them back to sleep.

All of this is a labor of love, of course. I wouldn’t want to be anywhere else but here, making sure that these kids feel safe — even at 2:45 a.m. Most of all, I want them to be reassured that I will be there when they need me.

But as I stare at the ceiling, the anxiety starts to build. Sure, I’m here now, but what about 15 years from now when one calls me at 2:45 a.m. despondent after a bad breakup, or 25 years from now after getting laid off from a dream job?

This night, like dozens before it, I feel the tug of haunting questions: Will I be there for them when they need me? Can I keep my side of the bargain even as I head into the carnival fun house of aging?

Lisa and I met a few years after my first marriage ended. At the time, I was in the midst of raising my two young children, Hana and Noah, in shared custody with their mom. I grew to love being a dad because of these two beautiful kids. And with Lisa 14 years younger than me, I was excited that we would have the chance for more kids together. We decided to wait a few years as Hana and Noah grew up and we established our blended family.

Less than a month after my 50th birthday, my second wave of parenthood began. Theo was born. And three years after that, Nathaniel arrived. In no time, we were a family of six. The brain-numbing, body-punishing months of middle-of-the-night infant wake-up calls arrived too. I quickly realized that I no longer felt like the 35-year-old energetic dad I once was. This was different.

I have run the numbers in my mind over and over again. I will be 71 when Nathaniel graduates from high school, and approaching my 80s when he starts to settle into his adult life. And then?

When I was growing up, my mom would tell us about older friends in their 50s (and beyond) who had passed away, saying that they had “dropped dead.” In my kid mind, the visual of someone suddenly falling to the floor dead, or shockingly sprawled over some potted plant in an office lobby, was horrifying. It stuck with me.

And now in my mid-50s, I am surely knee-deep in the “drop dead” zone.

Believe me, I am preparing for the long haul. I exercise regularly and eat a heathful diet. I have even run three marathons. I also continue the self-work of clearing my head of the triggers and boogeymen that have tied me up in knots over the years.

But this night, as the lumpy red bean bag starts to swallow me up like quicksand, and the clock approaches 3:30 a.m., I’m tired. Nathaniel and Theo have finally fallen back to sleep. I can go.

I get on my hands and knees to begin the stealth crawl out of their room, a technique that has taken me 25 years and four children to perfect. Nathaniel stirs and says, groggily, “Dad! Stay for a few minutes.” I’ve been caught.

I stroke his soft, post-toddler hair and whisper, “What does Daddy say to you?” He answers, “I love you.”

It’s a well-rehearsed routine we practiced when I dropped him at preschool. I created similar rituals with Hana, Noah and Theo. Wherever they were, I wanted them to know I was right there with them.

I tell Nathaniel that I have to go back to bed. He sleepily and slowly explains, “Dad, you love me. You love me, Dad.” He drifts back to sleep.

As I make it out into the dark hallway, Nathaniel’s words glow like dancing fireflies in my heart.

The ritual carries an echo of my mom’s last day of life, now almost a decade ago. In her 80s and succumbing to cancer, she had fallen into a deep coma and was near death.

Mom had always been there for me. While my dad often set conditions on our relationship (Did I go to the right college? Did I pursue the right career? Was I making enough money?), my mom never did. She stuck with me through all of my choices — some OK, some great, some disastrous. She had the intuition to know that providing the safety of her love and support would allow me to find my own way and grow.

As she struggled to breathe, I stroked her soft, gray hair. She seemed to be laboring to hang on. I leaned in to speak to her directly for what would be the last time, whispering, “It’s OK, Mom. We will all be OK. You have done so much. You can let go. Your love will always be right here with me. I love you.”

Now, climbing back into my bed, I imagine the strong, brightly colored thread of her love woven through my exchange with Nathaniel. It feels like a sacred filament, one that travels from her heart, through mine and to all of my kids, connecting us in a radiant circle that sits above space and time.

Yes, I will try my best to keep going, supporting these kids through the many challenges and joys of their lives. But my most important job will be to strengthen and reinforce this thread, weaving it deeply into their souls on a daily basis so that they can grab onto it like a lifeline at any moment, even when I am not here.

I wake up a few hours later, stressing about a Zoom work call just an hour away. Nathaniel and Theo suddenly burst into my room and jump on the bed. “Hi, Dad!” Of course, one of them lands on my still-dented Lego foot. Another shot of pain.

But it’s also a beautiful reminder: I am still alive.

Matthew Stodder is a writer, business and personal coach, and father of four. He lives in the Los Angeles area.

When Grandparents Want a Say in Naming Their Grandchildren

Generation Grandparent

When Grandparents Want a Say in Naming Their Grandchildren

The expectant parents spend weeks deciding on their new baby’s name. Then the grandparents weigh in.

Credit…Luke Wohlgemuth

  • Jan. 19, 2021, 5:00 a.m. ET

Rachel Templeton felt honored when her father-in-law invited her out to dinner on Long Island, just six weeks after the birth of her first child. Expecting a celebratory event, she dressed with care for what would be her first real postpartum outing.

The restaurant was lovely, but “the light banter quickly turned serious,” Ms. Templeton recalled. Her father-in-law announced that she and her husband should change the name they had carefully chosen for their son, Isaiah.

Growing up in Philadelphia, he explained, he had encountered anti-Semitic sneers and discrimination; now he feared that a biblical name would make his new grandson a target. To protect the child, the family should use his middle name instead.

Startled and hurt, Ms. Templeton coolly replied, “If I ever feel he’s being harmed by his name, I’ll consider it. But in exchange, I never want to hear about this again.” Isaiah is 9 now, and she and her father-in-law had not discussed the matter in all those years, until they told me the story.

But Ms. Templeton, 45, a radio reporter in San Juan, P.R., clearly hadn’t forgotten the conversation. And her father-in-law, who asked to remain anonymous, insisted, “I still agree with my original premise,” reasoning that “there was a lot of anti-Semitism when I grew up and there’s a lot now.”

Other parents remember tangling with grandparents over baby names, too. An accountant in suburban Phoenix, a newlywed when she met her husband’s maternal grandmother, warmed to her instantly and vowed to name her first daughter in the grandmother’s honor: Colleen. “We didn’t think there would be any drama,” she said.

Wrong. Her in-laws had divorced years before her marriage, and her father-in-law was upset that they wanted to name the baby after his ex-wife’s side of the family.

The new parents felt whipsawed, wanting to keep everyone happy while also defending their independence. “Telling someone what you can or can’t name your child is so controlling,” the accountant said. She told her husband, “I didn’t marry your dad.” After considerable back and forth, they went with Colleen.

What’s in a name? Maybe more than we think or anticipate when our expectant children are kicking around the possibilities.

“Names are all about identity,” said Pamela Redmond, chief executive of the giant Nameberry baby-naming site and co-author of 10 books on baby names. “The name the parents choose is central to who the child is and will be, and grandparents feel very invested in that.”

Maybe we grandparents want a family name carried on, or one that reflects our religious or ethnic identity. If our children have other ideas — these days, they often do — “the link to their ancestry is broken,” Ms. Redmond pointed out.

Plus, we have our own notions of appropriateness and a probably misguided sense that our grandchildren’s names reflect on us. So when our children creatively come up with Nevaeh (it’s “heaven,” backward) or use the city where the baby was conceived (like Nashua), we bridle.

“If you’re the conservative who named your kids Tom and Emily, and they’re naming their daughter Miles and their son Freedom, it’s like showing up at the country club with blue hair and tattoos,” Ms. Redmond said.

Being different is often the point, though. Young parents face a vastly wider assortment of choices than older generations ever considered. New parents may gravitate toward gender-neutral names, for instance. Older generations’ notions about playground taunts have become outdated when kids have such diverse names that a plain vanilla Linda or a mundane Mike may yearn for something more distinctive.

But that doesn’t prevent some grandparents from wading into the fray. Sometimes, since more spouses now keep their own names when they marry, differences arise not over the newcomer’s first name but the surname.

A personal example: My then-husband and I gave our daughter my last name, with his as a middle name. It caused no discernible problems.

My feminist hopes for a matrilineal naming tradition lasted one generation; my daughter’s daughter has her father’s last name, with her mother’s in the middle. I felt mildly disappointed, but not argumentative.

On the other hand, Mary Lou Ciolfi got an earful from her mother about her children’s last names. Ms. Ciolfi kept her name when she married in 1984, and she and her husband reflexively gave their son his father’s last name. Four years later, pregnant with a daughter, Ms. Ciolfi thought, “Why should he get all the names?” Her whole family is Italian and “very ethnic in our traditions.”

When she told her mother that her daughter would have her last name, “she was annoyed and angry with me and tried to talk me out of it,” said Ms. Ciolfi, 60, who teaches public health at the University of New England. “She said silly things like, my children wouldn’t know they were siblings. I was just rolling my eyes.”

As it happens, Ms. Ciolfi’s two sons (surnamed Vorhees) and her daughter (named Ciolfi) know perfectly well that they’re siblings. As for her late mother, “she was totally in love with all her grandchildren and moved past it.”

That tends to happen, said Sally Tannen, who has directed parenting workshops at the 92nd Street Y in Manhattan for nearly 20 years, and grandparenting workshops for four.

The discussions can get intense, said Ms. Tannen, whose youngest grandchildren are twins named Cedar and Shepard. “This is the first stage in grandparents’ realizing that this is not their kid and they don’t have control,” she continued. “They have to step back, and some are good at that and some are terrible.”

Sometimes, parents find face-saving solutions, like giving children middle names they will never use to placate one grandparent or another.

But clashes over names can backfire, Ms. Tannen pointed out, if they make new parents angry enough to withdraw. Parents serve as the gatekeepers to their children and, as I learned from my conversations, they remember feeling pummeled, even decades later.

Fortunately, as Ms. Ciolfi discovered, these conflicts tend to fade after the grandchildren actually arrive. “As soon as you’re pregnant, everyone has an opinion” about names, Ms. Tannen has observed. “Once there’s a baby, it would be pretty silly to hold onto that.”

Even Ellen Robin, a math teacher in Sebastopol, Calif., and her late father-in-law got past their antagonism.

She still keeps a file of enraged letters he sent after she and her husband somewhat impulsively decided to call their new son Ivan. “He completely flipped out over naming our child after ‘the worst anti-Semite ever,’” she recalled 36 years later, referring to the terrorizing Russian czar, Ivan the Terrible. “He said, ‘You have cursed this baby.’ He went completely berserk.” Her mother-in-law helpfully sent a list of names they deemed acceptable.

“I had never been bullied like that,” said Ms. Robin, 69. As a compromise, she and her husband renamed their son Jesse Ivan. But they always called him Ivan and, to her surprise, her in-laws soon did, too. “After a few months, it was as if nothing had happened,” she said. She and her three sons all developed warm relationships with her father-in-law.

Rachel Templeton’s two boys are also close to their paternal grandfather.

But she has noticed this: She and her husband initially nicknamed her elder son Zay, until he said that he preferred his proper name. Then, everyone knew him as Isaiah — except his grandfather who, in nine years, never used his grandson’s full name.

He will now, though. It’s taken a while but, he told me, “I’m happy to call him whatever he wants to be called.”

The Grizzly in the Purple Pants

Ties

The Grizzly in the Purple Pants

My mom and stepdad wanted me to be more manly. In Cub Scouts, I just wanted to make the troop cupcakes.

Credit…Lucy Jones

  • Jan. 15, 2021, 5:00 a.m. ET

Russell Lee spat a wad of snuff into a Planters peanuts can. We sat at a picnic table in his backyard, next to the railroad tracks. He jackhammered the ground with his right leg.

“Your mom’s having an affair,” said Russ, my mother’s husband.

“What’re you talking about?” I stared at his face — grayed muttonchops against skin bronzed from working under the Texas sun. Hummingbirds buzzed past us, sucking sugar water from the cherry-red feeder. I wanted to crush them.

Russ struggled against tears. “And she has AIDS. I have proof.”

His accusation rang false, but adults held secrets. Then 21, I had mine.

I had met Russell Lee even before my mom did. When I was 5, my uncle took me to visit one of his ailing relatives. In walked a brawny guy carrying a motorcycle helmet and wearing purple pants. His thinning black hair was long and curly.

I wondered if he was a hippie. I’d seen ones on TV but never in real life.

When I was 6, my father, a suit-and-tie-wearing principal, descended into psychosis from abusing alcohol and speed. My mother, Nelda, a petite blonde schoolteacher, escaped with me when the death threats became body blows and a brandished .38.

Mom filed for divorce. The court forbade my father from future contact. We never saw him again.

Three months later, my mom’s sister arranged a blind date with one of her in-laws. He turned out to be Russell Lee, the man in the purple pants.

Mom loved that Russ had overcome life obstacles. One-quarter Cherokee, he was the last of 12 kids in an evangelical family of sharecroppers in the Ozarks. His mother died when he was 7. At 14, Russ quit middle school. He married four years later, had two kids, and by 45 had been divorced for a decade.

Within six weeks, he and my mom married. We moved from a middle-class life in conservative San Antonio to a duplex covered in psychedelic posters in liberal Austin.

My mother told me that Russ was my father now, so I should call him Dad.

I was a first grader and did as told but felt like a liar. Russell and I had met only four times.

He was an avid outdoorsman. I loved books and music. Scrawny, blond and asthmatic, I embodied my stepfather’s opposite, an albino salamander next to a grizzly bear.

Mom wanted me to be more like normal boys. She and her husband decided to remold me.

Cub Scouts was first. I kept offering to make the troop cupcakes.

They redoubled their efforts.

Every boy should know how to hunt and fish, Russ said. I wanted to play Scrabble, but he took me fishing. I threw the pole into the water. He had me shoot a rifle at a coffee can. I missed. “The only ones who’ll be safe are the deer,” he said, shaking his head.

Over time, the relationship with my stepdad became more contentious. Russ grew irate when I was elected student council president my junior year, saying the position interfered with my J.C. Penney janitor job.

He wanted me to quit, but I argued that the position might help me with college scholarships. Nelda and Russ had no money. I negotiated a compromise. “I won’t run again next year.”

But my plan was to run for senior class officer.

The next fall, we went to dinner at a relative’s house. Our hostess hugged me. “The ladies at church say you were elected class president. Congratulations!”

My stepdad smacked his fist against his thigh. “You promised me!” He didn’t look at me during the meal.

“You lied! Now you gotta quit,” he yelled, later in the car.

I startled myself when I said “no.”

He wanted me to move out, but my mother begged for me to be able to stay. I avoided him, going into their home just to sleep.

Each semester of high school, Russ insisted I take an auto repair class. I always stalled, promising “later.”

Every man should know how to work on his car, he said.

Before my last semester, Russell brought up the mechanics’ course again.

The only way I could fit it into my schedule was by dropping calculus, physics and AP English, so I refused.

“Don’t you disrespect—”

“I’m not meant for manual labor, like you!” I shouted. “I have a brain!”

“Get out.”

I stuffed my backpack.

“School ends soon. Let him stay until then,” mom pleaded.

Russ acquiesced, but skipped my graduation.

I moved out. When Russell and I saw each other at family events, we’d shake hands for show but keep our distance.

In my junior year of college, Russ was diagnosed with lung cancer. After he’d recovered from surgery, Nelda moved into a motel. My stepfather stayed at the house by the railroad tracks.

When my mom asked me to go see him, I agreed — as a favor to her.

It was during that visit he announced that my mother had AIDS, and that she had been cheating on him with the train engineers.

“When the horn blows, it’s a signal.” He believed my mother was meeting the railroad staff for trysts in a nearby abandoned shack.

“The tracks bend there,” I said, pointing. “The horns are warnings.”

He didn’t believe me. “There’s proof she has AIDS in the shack,” he said.

I crossed the tracks and went inside. “Nelda has AIDS” was spray-painted on a wall. But I recognized Russ’s handwriting. His capital “I” looked like a tadpole swallowing its tail.

When I called my mom, she cried. “He kept accusing me of grotesque sexual infidelity. I couldn’t take it.”

Because of our history of emotional distance, I wasn’t wounded by Russ’s break with reality. He’d been diagnosed with paranoid schizophrenia when I was in my teens. But mom hid the depth of his mental illness from me.

After his lung surgery, he’d stopped taking his meds. Mental illness made his greatest fear appear true: Nelda didn’t love him.

Witnessing the extent of his disorder made me kinder. I started visiting my stepdad on weekends. We convinced him to visit his psychiatrist, who recalibrated his medications. Nelda and Russ reconciled.

Though I’d come to understand him, it took me the better part of a decade to allow myself to trust him — and my mother — with my secret. At 30, I told them I was gay.

“Never made any difference to me,” Russ said.

My jaw hit the floor.

“He’s known since you were 16,” Nelda said. “A boy telephoned. Russ went to get you. You fainted.” I remembered the phone call, but hadn’t realized they did, too. A guy from Nebraska I had a crush on had called long-distance. We’d met at student council camp and I’d been desperate for him to like me.

She paused. “It was hard for me, but he says you were born this way.”

So, Russell Lee had been my secret ally all along.

When I was 45, he fractured a hip, had a heart attack and went into a coma. That night, the nurses told Nelda she had to leave. She hugged Russ. Though he was unconscious, his arm pulled her closer.

I flew back to Texas from New York. “There’s little chance for recovery,” a doctor said. We signed the papers to unplug the respirator.

The morning of his funeral, I walked outside. A hummingbird hovered near my face.

“If I could choose anyone in the world as my dad, I’d choose you,” I whispered. The tiny creature floated a moment longer. Then, it darted away.


Court Stroud lives in New York City, where he’s working on a book.

Kids and Covid Tests: What You Need to Know

So You Think Your Kid Needs a Covid Test

Here’s everything you need to know about when to get it and what to expect.

Credit…Sonia Pulido
Christina Caron

  • Jan. 13, 2021, 6:00 a.m. ET

My 4-year-old daughter is pretty tough when it comes to medical procedures. The flu shot? Not even a flinch. Stitches in her forehead? No big deal. Years earlier, she calmly watched as a nurse pricked her finger and squeezed the blood, drop by drop, into a tiny vial to test it for lead.

But the Covid test was different.

In early September, just before her preschool reopened, she began sneezing and had a sore throat. When her congestion worsened, we knew that she needed to get a coronavirus test. But as the nurse approached her, holding a long stick with a brush on the end resembling a pipe cleaner, she covered her face and backed away. In the end, two people had to hold her down. She screamed as the swab activated her lacrimal reflex, bringing tears to her eyes. It was over quickly, but she cried for half an hour afterward and insisted that she would never visit another doctor again. She now refers to that probe as “the needle.”

In late December she needed another test for her preschool, but this time she wasn’t sick. With the memory of her last experience still fresh in my mind, I immediately started researching. Were there less invasive tests to consider? If so, how would we find one? Would it be accurate enough? And was there an ideal way to prepare a squeamish young child who was averse to getting tested?

As it turned out, none of these questions had simple answers. So I consulted with five doctors and two of the largest urgent care providers in the United States to learn more.

How do I know if my child needs a test?

There are four main reasons a child might need to be tested:

  • They have symptoms

  • They have been exposed to someone infected with the virus

  • Their school, day care or a hospital requires it

  • They need it as a precaution before and after traveling

If your child has any symptoms of Covid — even mild ones like a runny nose or a sore throat — it’s a good idea for them to get tested and stay home, said Dr. Stanley Spinner, chief medical officer and vice president of Texas Children’s Pediatrics, the largest pediatric primary care group in the country, and Texas Children’s Urgent Care.

“We have seen, time and time again, kids with very mild symptoms with no known exposures who get tested with our very accurate PCR and sure enough, they come back positive,” Dr. Spinner said.

If your child has been in close contact with someone who tested positive for Covid-19 — even if your child does not have any symptoms — they should get tested, the experts said. The Centers for Disease Control and Prevention define close contact as spending at least 15 minutes within six feet of someone who has the coronavirus, or having any type of direct physical contact with an infected person, including kissing or hugging.

If your child is in school or day care, those institutions may have rules on when they must be tested, and how.

It’s safest to stay home, but if you and your children must travel, the C.D.C. recommends getting tested one to three days before your trip and then again three to five days after your trip.

If you’re still unsure if your child needs a test, call their pediatrician, said Dr. Kristin Moffitt, an infectious disease specialist at Boston Children’s Hospital. You can also take the C.D.C.’s clinical assessment tool, which can be used for any family member, including children.

Which types of tests are available for kids?

Virus testing for children is, for the most part, the same as it is for adults. The Food and Drug Administration has authorized the emergency use of two basic categories of diagnostic test. The most sensitive ones are the molecular PCR tests, which detect the genetic material of the virus and can take days to deliver results (some locations offer results in as little as a day). The second type of test, the antigen test, hunts for fragments of proteins that are found on or within the coronavirus. Antigen tests typically yield results quickly, within 15 minutes, but can be less sensitive than the molecular tests.

The way your provider collects your sample can vary. For instance, regardless of whether you get a PCR test or an antigen test, the collection method could be any of the following: nasopharyngeal swab (the long swab with a brush at the end that reaches all the way up the nose toward the throat); a shorter swab that is inserted about an inch into the nostrils; a long swab of the tonsils at the back of the throat; or a short swab swizzled on the gums and cheeks. The new saliva tests, which are still being vetted, require you to drool into a sterilized container, which could be difficult for young children.

FastMed Urgent Care, which has a network of more than 100 clinics in Arizona, North Carolina and Texas, currently uses a long swab to perform the rapid antigen test and a short swab for the PCR test, said Dr. Lane Tassin, one of the company’s chief medical officers. But MedExpress, a different urgent care group with clinics in 16 states, tests all patients with the shorter nasal swab when doing either PCR or antigen tests at its nearly 200 urgent care centers, said Jane Trombetta, the company’s chief clinical officer.

Which diagnostic test should my child get?

The type of test that your child gets will largely depend on what is available in your area, how long it takes to get the results back and why the child needs it, the experts said.

Some day care centers and schools will only accept PCR results for clearance to return to school, so it is best to double check their rules beforehand.

The long-swab molecular test is considered the “gold standard,” but other less-invasive testing methods are also reliable. For routine testing, Dr. Jay K. Varma, senior advisor for public health at the Office of the Mayor of New York City, said the shorter swab “performs basically as well as the longer, deeper swab does. That’s true in both adults and children.” In fact, he added, New York City’s public hospital testing sites began switching from the long swab to the short swab during the summer.

Dr. Jennifer Lighter, a pediatric infectious disease specialist at NYU Langone Health, said she likes the antigen tests because they can quickly identify Covid-positive kids when they are contagious. Antigen tests are most accurate when the amount of virus in the sample is highest — typically around the day that symptoms start.

If you have a preference on which test you’d like your child to get, call your pediatrician’s office first and ask what kinds of tests they perform and how they collect the samples. Clarify whether they use the shallow (anterior) swab or the long (nasopharyngeal) swab. If you want the more comfortable, shallow PCR test but your pediatrician’s office does not offer it, try other testing centers in your area, including pediatric urgent care centers.

Some tests are now available for home use. But if you’re using a home test, check the label. Some aren’t indicated for children.

Are there any downsides to getting my kid tested? Is it safe?

Many testing sites offer drive-through services where you don’t need to leave your car. But if you must walk into a clinic, the experts I spoke with said that the risk of getting Covid while you’re there is low.

“In my experience, everyone that is delivering health care now is being incredibly careful with infection control,” said Dr. Sean O’Leary, the vice chairman of the American Academy of Pediatrics’ committee on infectious diseases. “The risk of going into a health care facility is probably pretty low relative to a lot of the other things people are currently engaging in in the U.S.”

Testing facilities require people to wear masks and to maintain physical distancing, he added.

The experts also said that the tests themselves are not harmful for young children, including infants, even if done repeatedly. The long swab may produce discomfort for a brief period — Dr. O’Leary jokingly calls it the “brain biopsy” — but he is not aware of any long-term risk to the nose or throat.

How can I prepare my child for the test?

To avoid any surprises, ask your provider about which types of tests they offer and how they collect the samples ahead of time.

It’s usually best to be straightforward with your kid about what to expect. For short nasal swabs, explain that a doctor will tickle the inside of their nose with a cotton swab to collect their boogers, and that it won’t hurt.

For the long swab, you may want to prepare your child by explaining that the swab might feel a little uncomfortable, but that it will be over quickly. You can also share that kids of all ages are getting the test, even babies.

Over all, convey that it’s no big deal and it’s something that simply needs to get done, Dr. Lighter said.

“Kids are only as anxious as the information that’s coming to them,” she added.

If your child might be intimidated by the protective gowns, masks and face shields that health providers wear, explain that they wear that clothing to stay safe — kind of like how people wear cloth masks when they go outside.

Some hospitals have created videos like this one from the Children’s Hospital Colorado that show how the Covid test works and what families can expect. If your child is old enough to understand, it might be helpful to watch a video like this together and then talk about it afterward.

Try to find out how long you might need to wait. Many areas have long lines at testing sites, so consider bringing water, snacks and entertainment (crayons, storybooks) for your kids.

If your child’s pediatrician is administering Covid tests, it might be reassuring for your child to have the test performed by someone they are already familiar with. But if not, “try and go somewhere that has experience working with children,” Dr. O’Leary said. Doctors and nurses who test children regularly will most likely know what to do if your child is nervous or scared.

When I Was Labeled a ‘Troubled’ Teen, I Obliged

The author in the Adirondack Mountains of upstate New York in 2007, during his second stay in a wilderness therapy program. 
The author in the Adirondack Mountains of upstate New York in 2007, during his second stay in a wilderness therapy program. Credit…via Kenneth R. Rosen

Voices

When I Was Labeled a ‘Troubled’ Teen, I Obliged

I was sent to three “tough love” programs meant to redirect me. Trying to run away from one made me feel that I had no choice but to become what I had been told I was.

The author in the Adirondack Mountains of upstate New York in 2007, during his second stay in a wilderness therapy program. Credit…via Kenneth R. Rosen

Kenneth R. Rosen

  • Jan. 12, 2021, 5:00 a.m. ET

All I heard was rain, my thumping heart harmonizing with the tempo of the tempest outside. I waited for the night watchman’s light to sweep over my bunk. He disappeared into the hallway, into the next room of clients who he noted to himself were present and asleep and so moved to the next room.

When he entered another room, I hurried behind him, crouching, to the central alcove, from where I made my escape. My plan included a list — backpack, peanut butter, headlight, rain gear, stolen MapQuest printouts, knife — and a destination, Boston. I’d run to an unfamiliar city, across a state to which I’d been taken against my will, to meet a future I could not be certain was any better. The rain seemed less like a portent, more an encouragement, as if each wind gust carried with its rivulets the words, It’s your time. They’ll never find you. Go now.

They were the escorts. Transporters. Redirection specialists. They, usually two men who take unsuspecting teenagers in the middle of the night to therapeutic programs across the country, went by different names. I was certain they were coming for me. They had come for me several months before the night of my escape, in late winter 2007, at the request of my parents who saw no other way to set me straight. My mom and dad hired the men, after consulting with school officials, psychologists and an education consultant, to take me from my bed and to deliver me like a wasted soul to an experiential therapy program in the Adirondack Mountains in upstate New York. They believed they were practicing “tough love,” making the difficult choice to send their child away to forge a better future away from home.

Some of the gear the group carried through remote stretches of New York State. 
Some of the gear the group carried through remote stretches of New York State. Credit…Kenneth R. Rosen

From New York I’d go on to a program in Massachusetts. I did not know it then, but I’d become one of the tens of thousands of “troubled” or “at-risk” teenagers carted off to these unregulated, private industries each year.

The years leading up to my being taken and the eventual break out is now a blur of misanthropy. I was reckless, taking my mom’s car out for joy rides without permission, skipping class, distrusting authority figures like the high school principal and local municipal authorities sent to curb my behavior, to put me back on a path more, how should we say, normal.

In the nearly 12 months I’d spend between the experiential wilderness therapy program (twice), a therapeutic boarding school in Massachusetts and a residential treatment center on a ranch in Utah, I lived up to the designation of a troubled teen. The programs were what the media called part of a tough love movement, which flourished in the early aughts but still exists today.

The Academy at Swift River, a former therapeutic boarding school for troubled children, in Cummington, Mass., in spring 2007. The author spent months here before trying to escape, after which he was sent to a remote ranch in Southern Utah.Credit…Kenneth R. Rosen

I’d return that type of love to my parents, ignoring their written letters, our only form of communication, vetted and censored by my “therapists.” I felt betrayed and discarded. They pleaded with me to accept the programs and to do my best to succeed in them. It felt like they wanted me gone. Really, I was being groomed for institutionalization. The juvenile and criminal justice systems the programs ventured to save me from instead prepared me for adult incarceration. By the end of my time away I recognized a bliss associated with handcuffs. Lockup and lockdown meant the familiarity of strip searches, drug tests, isolation cells and men who handled me like I was worthless: hallmarks of the programs that became synonymous with the word homebound.

But losing any self-actualization and inner-direction came later. On the night of my escape, I still believed I held some agency over my future, shrouded in uncertainty though it was. What would I do in Boston? I didn’t care. How would I earn money? Where would I stay? I would figure it out once I was far away from this place.

My parents were no longer trustworthy. They were part of the growing number of my adversaries working to keep me from personal liberties. At the program I was restricted access to food. I was allowed only communication with my parents, not my friends back home. If I chose not to respond to my parents, I would also be cut off from my peers in the programs. Either way, I’d lose.

The night the author tried to run away from the Academy at Swift River, he started from this alcove.Credit…Kenneth R. Rosen

I was given prescription medication to ease my anxiety and depression, which left me hollow and numb. I was made to answer questions about my life and emotions until, I was told, I got them right, framing things in a way the program and therapists felt more accurately told a story about my deviance that I then internalized. My journals were confiscated, their private contents used against me in “therapy sessions.”

I wasn’t troubled or bad. I was alone, all the angst and hormonal shifts of adolescence compounded and weaponized against me. I was backed into a corner and told to change, made to think I’d become reproachable and unwanted. What they wanted from me — to be happy, well-adjusted, open to therapy and the mind-numbing boredom I associated with schooling — seemed a betrayal of the very thing they wanted me to be: myself.

Meanwhile, I had broken a number of rules at the school — “cheeking” medication, drinking hand sanitizer, fraternizing with girls. I was certain then, by the fourth month at the program, that I was doomed for another “transport.” Then one night they came.

I’d been waiting, staring deep into the white ceiling overhead, my inability to sleep soundly forever cemented. Before I could jump down from the top bunk bed, the escorts announced that they were there for a different boy, my roommate. He stood from his bed, his head hanging. He pulled a pre-packed suitcase from underneath his bed (we all had our own type of go-bag), gave a weak smile, shrugged, told me he’d see me again, however unlikely, and left with the men flanking him out the door, choosing to go, as they called it, the “easy way.” He had already gone the “hard way.”

Picked off. Kidnapped. Taken. Call it what you wish, but trying to sleep each night with the notion that a pair of strangers could come to lift you from your bed, whether your actions were deserving of this treatment or not, haunts me, haunts thousands. Having watched my roommate get taken was surreal. It made real for the first time what had happened to me, brought into context that it was happening to others, and eventually sold me on my own desire to flee. I would not wait to be taken. I had to get out. No one would take me. I would lead myself away.

Now, standing outside the central alcove with my back to the doorways of the program, I stared into the fields of the Berkshire mountains, another expanse of seclusion and remove, the rain washing over me in blinding sheets. I bent into the storm, leaning into the wind that soon turned, pushed at my back, leading me away from this place into the deep, heaving thicket at the far end of the program’s property.

The author’s room at the academy in spring 2007. Sometimes the boys played Monopoly at night in the bathroom, seeking a rare opportunity for unsupervised recreation. Credit…Kenneth R. Rosen

I vaulted a fence and tore my rain pants. Water and a cold breeze swept into the tear. I began to shiver. Boston seemed farther than ever, the return to my previous life an impossibility. My mother once told me “to strive, to seek, to find, and never to yield,” cribbed from the Tennyson poem. But yield I would, turning around and greeting my future and any hope I had for making it my own. I was told I was troubled and believed it and ran because that’s what bad kids did.

I unceremoniously turned myself in to the night watchman because I had lost all strength to continue being bad. I wanted to be good, loved. It was as much a desire to get away that drove me from the program as it was a display of disapprobation and the final displacement of my waning emotional strength. I would fold into the programs, accepting that if I were to change it would be by a force better accepted than rejected, one that had overpowered and broken me into a shell of my former self.

Those programs are now a distant memory, but the contours of those inescapable feelings of rejection and dismissal, of living up to the expectations held by others and not myself, follow me. When I find the energy to keep those memories from chaining me to a different person, a different time, I do my best never to yield.

Kenneth R. Rosen is the author, most recently, of “Troubled: The Failed Promise of America’s Behavioral Treatment Programs.”

Juggling My Children, Their Alcoholic Sitter and My Own Sobriety

Ties

Juggling My Children, Their Alcoholic Sitter and My Own Sobriety

The babysitter says she has nine days sober, but we all lie, every addict, every alcoholic.

Credit…Lucy Jones

  • Jan. 8, 2021, 5:00 a.m. ET

Tonight I left my children with our longtime babysitter, who claims she is nine days sober, but is possibly drunk or high.

At the very least, she is exhausted — the kind of exhausted that seeps into your bones and calcifies. I am leaving my children with her because I trust her. Four years, she has cared for my children. She has made them paper crowns and cardboard castles, bathed them and sung them to sleep. She and I have lunched and sipped tea. Together, we have summited mountains of paperwork to secure her health insurance, a new car, a new apartment.

I know her, I trust her. This is the mantra I repeat to myself from my office upstairs, where I am listening to every thump and bump and giggle below.

I am in the house. I didn’t leave. It’s the middle of a pandemic; no one leaves anymore. That’s how I know my children will be alive when I finish working. But as the night goes on, I start checking the baby monitor, because my children are not in bed and it is after 8 o’clock, after bedtime, late and getting later. When they finally appear — my 5-year-old daughter doing a cartwheel, my 3-year-old son dragging his blankies, the babysitter, alert and smiling — I release a breath I had not realized I was holding.

How many days of sobriety do you need to babysit? To be trustworthy? Seven days? Thirty days? Ninety days? Conventional wisdom holds that the physical symptoms of alcohol withdrawal — the nausea and sweating, the shaking and disorientation — usually subside in three to five days.

The babysitter says she has nine days sober, but we all lie, every addict, every alcoholic. I detoxed in the hospital’s drunk tank. On day two of sobriety, I had a seizure. On day six, I had a panic attack. On day nine, I could put on my own pants, barely.

But the struggle doesn’t end with the physical. It’s mental. The misery of protracted withdrawal — dysphoria, depression, irritability — can drag on for weeks. Twelve-step programs refer to this as “the monkey on your back,” because the cravings weigh on you, pick at you, natter in your ear about how much more bearable this conference call, this meal, this round of hide-and-seek might be with a drink. My first sponsor insisted I find a job and keep busy, which I did, and I stayed sober.

Tonight, I’m paying it forward. I am giving the babysitter a job. I am keeping her busy. I am hoping she stays sober.

But what if I weren’t an alcoholic? Would I have asked her to leave? Would I have said I’m not comfortable, and sent her away? This babysitter has become something more akin to family. She has told me stories of being dragged through her childhood like a fiberglass boat through the shallows: a father who left, a mother who did her best, a grim foster care placement, and the briny scrape of countless other dangers, both visible and not. This babysitter — whose heart is miraculously intact despite the damage it has endured, including a recent brush with death and viral cardiomyopathy — could I have asked her to leave?

The Big Book of Alcoholics Anonymous says she should stay. Being of use is important, it says. The fellowship of another alcoholic is crucial, it says. Still, I wish she hadn’t confessed. I wish she hadn’t told me over the kitchen island, in front of the children as they were eating spaghetti, as they were eating her every word, saving their questions for the morning when I know they will ask me, What is drinking? What is sober? Why is her face so fluffy?

They do not know what it is to be bloated. They do not understand edema or addiction. They have never seen me drink alcohol, not once, not ever. I will have to explain it to them. They share my blood, so it’s possible that this thing, this alcoholic affliction may be metastasizing in them, even now, as they lie in their beds, chattering back and forth. I will have to explain at least part of it to them in the morning.

Someday they will want to know all of it. How I stopped drinking. How I writhed as the alcohol and dope leached out of my system. How I was dry. For years I was dry, like a desert, like the air in winter, like a pile of ash. Angry. Pimpled. Thirsty. That first year, I locked myself away in a halfway house where I learned how to shower, how to clean a toilet, how to cook spaghetti, how to wash a dish, how to make a bed, why you should care about making your bed. And AA meetings every day. For three years, every day. I had the Big Book nearly memorized — the acceptance passage, the serenity prayer, How It Works, the steps and traditions. I remember so little now.

I’ve been sober 18 years, so long I don’t even think about drinking and drugs anymore. Not really, anyway. Not often. Definitely not every day. But once in a while, maybe out at dinner with friends, when someone orders a red wine, or a beer, or a vodka tonic.

Vodka. I’d like seven vodka tonics. I’d like to slip inside a bottle of vodka, to bathe in it, to slosh, just for the night, just for a little while.

That’s how I know my addiction is still there, still lurking, still hungry. After 18 years it’s probably ravenous, but it’s not starving. Starvation is something you die of, and addiction cannot be killed. You can’t excise or eradicate it. You have to contain it. Dam it. Barricade it. Even then, it whispers. Through whatever levees you erect, it gurgles. It splashes out a Morse code of desire. You become a certain kind of deaf, a certain level of numb, all the time, every day. That’s the work. That is how you progress from drunk, to dry drunk, to sober human. You’ll never be just human. You’ll always be a sober human — a person almost, but not quite.

My babysitter has nine days sober. When she tells me, she says how proud she is. I have given her my children for the night. When I go downstairs, they will be asleep, or will be in bed contemplating going to sleep. She and I will talk. I will tell her what it was like, what happened, what it’s like today. I will tell her half-truths — not even. She will tell me what it is like for her right now, today, with her nine days sober. I will believe half of what she says — not even.

Tomorrow night, she will watch my children again. She will hold them, and her soon-to-be 10 days, as tightly as she is able. I know her, I trust her. She will keep the children as safe as she knows how. I pray their laughter and shrieks and glee will keep her safe in return. These are the things alcoholics do for each other. These are the things that keep us sober. These are the things I hope someone would do for my children, should they need it.


Sarah Twombly is a writer and mother to two young children.

The Challenge of Parenting While Watching a Mob Storm the Capitol

Parenting While Shocked

As the local grown-up, I don’t need to be responsible for fixing everything; helping my girls process their sense that everything seems broken is enough.

Credit…Jason Andrew for The New York Times
Lisa Damour

  • Jan. 7, 2021, 4:58 p.m. ET

Like many of us, I stood speechless yesterday as I watched rioters storm the nation’s Capitol. My daughters, ages 10 and 17, watched alongside me and were shocked, too. Feeling rattled and helpless, I wanted someone to look after me much more than I wanted to do any parenting myself.

As a psychologist, I’m used to staying levelheaded in chaotic situations. Last night was different; I was pretty much useless. I left my girls in the care of my calm and capable spouse, and spent the evening on the phone and then Twitter seeking assurance that order would be restored. I wanted the sense that there was, or would soon be, a grown-up in the room.

Today, I remembered: I am a grown-up in the room, at least around here. And focusing on that sphere is making it possible for me to join my husband in being the parent my daughters need and deserve.

I don’t need to be responsible for fixing everything; helping my girls process their sense that everything seems broken is enough. Over breakfast, I asked my 10-year-old what she was thinking about yesterday’s events and reassured her that, even though things got out of control, calmer heads have prevailed and I now feel hopeful that things might be moving in the right direction.

Being the grown-up in the room means making space for my girls’ confusion and their questions. Tonight, I will ask both of them what they heard from their teachers and classmates at school, what they wonder, what they think. I know that I won’t have all the answers to their questions, so I’ll just be honest about what I do and don’t know and everything I am still struggling to understand.

It means I have apologized for checking out last night. Had I alarmed them by reacting to yesterday’s chaos strongly or loudly, I would have apologized for that as well.

Being a grown-up means setting aside my misguided belief that compulsively checking social media or broadcast news reports will help me feel better. I have reminded myself that doing so only unsettles me and pulls me away from what I want to be present for: my kids, my spouse, my own work, myself.

It means that I need to be mindful of what media my daughters are taking in as events continue to unfold. My younger daughter gets most of her news from us or with us. We can and will limit her exposure to graphic images and frightening information. If there is something upsetting she needs to know, we should be the ones to tell her so that we can choose the right moment, share the news in age-appropriate language and be prepared to address her reaction.

My older daughter gets her news from us, with us, and also from a vast, complex and largely opaque-to-adults adolescent discourse that unfolds over social media. With her, we will do more listening than talking, seeking to make sure that she’s a critical consumer of what she’s taking in, that she’s working with facts and that she’s thinking for herself.

Yesterday, we watched TV news together as a family, pausing at one point to ask my younger daughter if the reports felt like too much. She insisted that they weren’t, and that she wanted to see what was happening. We deferred to what she knows about herself, and what we know about her and continued to watch together until we switched the television off to have dinner.

Trying to be an up-to-the-job parent as historical events unfold can leave us feeling doubly overwhelmed. Our own sense of, “Oh my God, what is happening?” quickly gives way to other worrisome questions: “How can I possibly explain all of this and fix it for my kids?”

Well, we can’t — at least not today. But to be good parents, we don’t need to. We just have to remind ourselves of the territory we control right now and be the grown-ups there.

Family Geocaching

Take Your Family on a Treasure Hunt With Geocaching

A game of hide-and-seek using GPS technology is a joyful distraction for many.

Credit…Ka Young Lee

  • Jan. 2, 2021, 11:43 p.m. ET

If it feels as if you’ve already explored every last nook and cranny of your cramped lockdown life know this: Right under your nose, there’s a hidden world operating entirely out of view.

That world is geocaching, a no-contact game of hide-and-seek between hundreds of thousands of strangers. Players hide caches — waterproof containers, usually small plastic boxes — in out-of-sight spots for others to discover using GPS technology.

How has this world remained totally hidden from you? The first rule of geocaching is to try to keep your searching a secret. If a runner jogs by, players may pretend to be deeply engrossed in plant identification. (Once you know about geocaching, you may realize just how many other folks are pretending to be fascinated by that patch of ivy.)

Geocaching began in earnest in 2000, when the U.S. military adjusted its GPS satellites to improve accuracy for recreational GPS users. An enthusiast in Oregon hid the first cache, said Bryan Roth, president and co-founder of Geocaching HQ, which runs Geocaching.com. Since then, the community has grown steadily, with the pandemic spurring a considerable increase in participation.

“At a time when people are looking for some distraction, getting outside really works well,” said Mr. Roth, who noted that sign-ups for the Geocaching app are up 70 percent compared with last year.

To get started, download an app on your phone, like Geocaching HQ (free download and some free caches, but the $30 annual membership unlocks more); Cachly ($4.99 and free caches, iPhone only); or c:geo (free download and free caches, Android only). You can also geocache with a hand-held GPS device, using online databases like NaviCache.com to find cache coordinates.

Caches are rated 1 to 5 by their difficulty; beginners may want to start with a 1 and work up from there. GPS will usually get you within 30 feet of the cache, and instructions like “look to the north of the roadway” can clue you in on exactly where you should be searching.

Then the real hunt begins.

When you find the cache — be it hidden under a tree, tucked into a log pile or taped to the back of a sign — you can check it off on the app. Most caches have a logbook tucked inside which shows everyone who was there before you, while others will contain a trinket as a treasure. (Putting a few tiny objects in your pocket before you head out gives you options if you think you might want to swap with the trinkets inside.)

One particularly nice benefit of geocaching is that it gets screen-addicted kids outside. And even though geocaching happens outdoors, you needn’t be outdoorsy.

When a friend first suggested that Katie Sweeney and her husband try geocaching in 2007, “I was like, I don’t really like hiking,” she remembered. Ms. Sweeney, a copywriter based in the Netherlands, soon found many caches within a few blocks of her home, in Philadelphia at the time. Today, she takes her 6-year-old daughter out to geocache on their way to or from the grocery store or other errands.

“We’re always discovering new places near where we live,” Ms. Sweeney said, adding that children can really be an asset. Their different vantage points often helps them see things adults might overlook.

Nick Geidner, a University of Tennessee journalism professor, doesn’t mind if a hunt is a bust.

“We don’t always find them,” he said. “But if we fail, we can come back and we can try again.” Henry, his 7-year-old son, wasn’t quite so sure. When asked how he felt after giving up on a recent hunt, he said, “I’m not like angry, but I’m not like happy.”

The thrill of finding a tricky or unique cache, though, far outweighs those not-happy moments. In September, Ms. Sweeney and her daughter found a once-in-a-lifetime cache, which had a gamelike opening with a maze, magnetic ball and secret code.

“It was this little joy,” said Ms. Sweeney, recalling opening the cache. “We’re all just looking for little moments of joy.”