Tag: Teenagers and Adolescence

Teens Are Rarely Hospitalized With Covid, but Cases Can Be Severe

Adolescents were hospitalized with Covid three times as often as with flu, researchers reported. Nearly one-third wound up in I.C.U.s.

Since the start of the pandemic, very few adolescents have become ill enough with Covid-19 to be hospitalized. But of those who did, about one-third were admitted to intensive care units, and 5 percent required ventilators, the Centers for Disease Control and Prevention reported on Friday.

These findings underscore the importance of vaccinating children against the coronavirus, experts said. “Much of this suffering can be prevented,” Dr. Rochelle P. Walensky, the C.D.C. director, said in a statement. “Vaccination is our way out of this pandemic.”

The data also run counter to claims that influenza is more threatening to children than Covid-19, an argument that has been used to reopen schools and to question the value of coronavirus vaccines for children.

The number of hospitalizations related to Covid-19 among adolescents in the United States was about three times as high as hospitalizations linked to influenza over three recent flu seasons, the study found.

“There’s a very strong case to be made for preventing a disease that causes hospitalizations and deaths, not to mention contributing to community transmission,” said Dr. Yvonne Maldonado, chair of the committee on infectious diseases at the American Academy of Pediatrics.

Children have a much lower likelihood overall of becoming severely ill or dying from Covid-19, compared with adults, but the risks are thought to increase with age. According to the most recent data collected by the academy, nearly four million children have tested positive for the coronavirus since the pandemic began, compared with about 30 million cases among adults.

Still, about 16,500 children have been hospitalized for Covid-19 since the pandemic began, and at least 322 have died, making it one of the leading causes of death among children, Dr. Maldonado noted.

“It sounds like it’s not a lot of deaths,” especially compared with 600,000 dead in the United States, she said. But “it should still be horrifying that 300 to 600 kids are dying because of something that is preventable.”

The new C.D.C. report focused on hospitalizations from Covid-19 among children ages 12 to 17. The rate of hospitalizations in that group was 12.5 times lower than among adults. But the rate was higher than that seen in children ages 5 to 11, the report found.

The researchers also tallied Covid-19 hospitalizations among children ages 12 to 17 from March 1, 2020, to April 24, 2021. The data came from Covid-Net, a population-based surveillance system in 14 states, covering about 10 percent of Americans.

The number of adolescents hospitalized with Covid-19 declined in January and February of this year, but rose again in March and April. From Jan. 1, 2021, to March 31, 204 adolescents were likely hospitalized primarily for Covid-19. Most of the children had at least one underlying medical condition, such as obesity, asthma or a neurological disorder.

The rate may have increased this spring because of the more contagious variants of the coronavirus in circulation, as well as school reopenings that brought children together indoors, and looser adherence to precautions like wearing masks and social distancing, the researchers said.

None of the children died, but about one-third were admitted to the intensive care unit, and 5 percent required invasive mechanical ventilation. Roughly two-thirds of the hospitalized adolescents were Black or Hispanic, reflecting the greater risk posed by the virus to these populations.

The researchers compared the numbers for Covid-19 with hospitalizations for flu in the same age group during the 2017-18, 2018-19 and 2019-20 flu seasons. From Oct. 1, 2020, to April 24, 2021, hospitalization rates for Covid-19 among adolescents were 2.5 to 3 times the rate for seasonal flu in previous years.

The data lend urgency to the drive to get more teenagers vaccinated, said Dr. Walensky, who added that she was “deeply concerned” by the numbers.

The Food and Drug Administration approved the Pfizer-BioNTech coronavirus vaccine for children ages 12 to 15 on May 12. The vaccine was approved for anyone older in December.

Of the 24 million children ages 12 to 17 in the United States, about 6.4 million have received at least one dose of the vaccine, and only 2.3 million are fully vaccinated.

Why Teens Need a Break This Summer

The pandemic has been the psychological workout of their lives. The next few months can be a time of recovery.

In the more than two decades I’ve spent as a psychologist working with adolescents, I have never seen teenagers so worn down at the end of an academic year as they are right now. Whether classes have been online, in-person or hybrid, young people are dragging themselves to the finish line of a frustrating, depressing and, for some, unbearably isolating year of school.

But now, with the number of new infections headed down and vaccinations widely available to ages 12 and up, most teenagers in the United States can anticipate a truly post-Covid summer. What should they look to make of it? For me, the answer is not “recover lost ground,” or even “put the past year behind them.” With the stress and constant adaptation of the pandemic now largely in the past, young people can enjoy the payoff of converting that experience into increased maturity and psychological strength.

To that end, it’s important to remember that building psychological muscle is a lot like building physical muscle. Any kid who has spent time in a gym knows that you gain strength when a period of exertion is followed by an interval of sufficient recovery.

For most teenagers, the pandemic has been the psychological workout of their lives. To put that workout to use, they need time for recovery so that they can enjoy increased emotional resilience by fall. For adults on board with that plan, here are a few guidelines to help.

Give teenagers room to process what they’ve been through.

For adolescents, as for many of us, the pandemic has been characterized by deep feelings of loss. They’ve missed sports seasons, holidays with grandparents, milestone birthday parties and other plans that are beyond rescheduling. Some have stepped back from friendships that won’t be rekindled. Many have had to experience the deaths of people dear to them.

As adults, our loving instinct might be to steer our teenagers away from dwelling on the anguish of the pandemic and toward taking advantage of the now brightening future and expanding opportunities. But we should remember that grieving, though a painful process, ultimately helps us move forward when allowed to run its course.

Teenagers may do some of their most productive grieving in the company of their friends. Colin Mooney, 15, of Highland Heights, Ohio, recently got together with several peers whom he hadn’t seen in person since their eighth grade year was derailed by lockdown in March, 2020. Sitting in a circle in one friend’s backyard, they talked about what they lost, including “our field day, our graduation and a special Mass where each eighth grader passes a candle to a seventh grader to make them eighth graders.” Talking through what they’d all missed offered much needed closure. “Sharing as a group,” he said, “really helped ease our minds and remember that everyone was going through the same thing.”

Other adolescents may mourn in a more private fashion. Arielle Green, 15, of Brooklyn, N.Y., writes poems to make sense of her feelings. Her recent poetry has centered on “how the pandemic sucks, and how things are still going on in the world that are really horrible.” She said that her poems offer a way “to let it all out.”

However your teenager goes about it, expect grief to be part of the summer. Give adolescents time and space to come to terms with the impact of Covid-19 on their lives so that they can, over time, savor what remains and embrace what lies ahead.

Be open to negotiating the “must dos.”

As with any summer, there will be some non-negotiables when it comes to how young people spend their days. Teenagers may need to get jobs, take over chores or brush up academically. Required activities can certainly be part of a recovery-focused summer, but when possible, let teens have some say in the details.

Ava Vestergaard, a 17-year-old senior at Sunset High School in Portland, Ore., needs to earn money for college, but she’s really hoping for the kind of job that will help her fill her emotional tank after a draining academic year. “When there’s a job I like, I enjoy the work and getting to know my co-workers.” For her, a job that’s gratifying might be worth much more in the long run than one that pays a few dollars per hour more but offers little of what she finds restoring.

And, of course, ambitious, self-improving pursuits can also fit the bill, so long as they’re more wanted than mandated. Ezekiel Salama, 17, of Shelbyville, Ky., can’t wait to attend the Governor’s School for Entrepreneurs, a selective summer program for teenagers in Kentucky. He’s expecting his constructive summer plans to leave him fresher than ever for the coming school year.

That said, everyone has different emotional settings. What energizes one person might leave another spent. Should an adolescent be fortunate enough to have some choices about how she spends her summer, adults may be able to help by tuning in to how much, and what, she wants to do. If you can tell that your teenager is genuinely eager to learn a new language, start a business or write a novel, stay out of her way. But if you get the sense that she’s crafting a punishing improvement regimen in an anxious attempt to compensate for a stripped-down school year, you might invite her to reconsider this approach so as not to risk returning to school feeling more depleted than she left it.

In a similar vein, parents may have their own concerns that their teenager has fallen behind academically this year. But if the school hasn’t called for an intervention, it may be best to let it go.

Don’t let guilt ruin restoration.

Given how much the pandemic upended expectations for what adolescents were supposed to be achieving, teenagers themselves might feel uneasy about the idea of making recovery a priority this summer. “Covid was a lot of doing nothing,” said Kari Robinson, age 14, of Evanston, Ill. “I think I might feel a little guilty if I use my summer freedom to relax.” Help your young people see past this way of thinking. The point of recovery is not to relax, but to grow. And if downtime is soaked in guilt, that growth is going to suffer.

Don’t underestimate the value of whatever they turn to — even if it’s “just hanging out” — as they go through the quiet work of rebuilding themselves.

There aren’t many upsides to having a virus wreak havoc with one’s adolescence, but on that very short list might be coming to appreciate the growth-giving practice of following stressful periods with deliberate recovery. This may be especially true at this moment in time, and it’s also how we want young people to be thinking about stress, recovery and growth long after the pandemic is over.


Moderna Vaccine Highly Effective in Adolescents, Company Says

The U.S., which has a surplus of vaccines, could soon have two options for teens while many countries face shortages.

Moderna said on Tuesday that its coronavirus vaccine, authorized only for use in adults, was powerfully effective in 12- to 17-year-olds. In a clinical trial of the vaccine in adolescents, there were no cases of symptomatic Covid-19 among fully vaccinated teens, the company reported in a news release.

Moderna plans to apply to the Food and Drug Administration in June for authorization to use the vaccine in adolescents. If approved, its vaccine would become the second Covid-19 vaccine available to U.S. adolescents, after federal regulators authorized the Pfizer-BioNTech vaccine for 12- to 15-year-olds earlier this month.

The Pfizer shot was initially authorized for use in people 16 and older, while Moderna’s has been available for those 18 and up.

The Moderna results are not a surprise and match what Pfizer reported in its trial of young adolescents. But they add to a growing body of evidence that the vaccines are safe and effective in children.

“We were pretty excited to see the data, and we’re excited to see that the numbers look very good,” said Dr. Yvonne Maldonado, a pediatric infectious disease specialist at Stanford Medicine and chair of the American Academy of Pediatrics Committee on Infectious Diseases.

She added, “People are going to be more comfortable being able to go back to school. They’re going to be able to do more activities socially. I do think it’s going to make a big difference in opening our society back up.”

On Monday, Mayor Bill de Blasio said that all public school students in New York City, the largest school system in the United States, would return to in-person learning in the fall. Several other states, including Connecticut, Illinois, Massachusetts and New Jersey, have also indicated that they will restrict online learning.

The widespread availability of safe, effective vaccines for teenagers could allow middle and high schools to operate more safely and restore at least some sense of normalcy.

“Having adolescents vaccinated against the virus is really going to limit spread in school to a great degree,” said Dr. Sean O’Leary, a pediatrics infectious disease expert at the University of Colorado Anschutz Medical Campus. “It potentially could even change mask requirements for school, depending on the level of vaccination uptake. I’m looking forward to a much different school year next year, primarily because of vaccination.”

But Moderna’s announcement comes at a time when there is already a glut of vaccines in the U.S., and amid signs that demand for vaccination may be flagging. And the authorization of vaccines for American adolescents has already raised questions about the ethics of vaccinating children, who are at relatively low risk for serious disease, while many countries do not have enough doses for their health care workers.

“It’s a tough conversation, because we are glad to see vaccine distribution safely expand to children,” said Saskia Popescu, an infectious disease epidemiologist at George Mason University. “But frankly, it’s hard not to see this as privileged when a majority of the world’s essential workers are struggling to get access to vaccines.”

The Moderna results, which the company announced in a statement, are based on a clinical trial that enrolled 3,732 people ages 12 to 17, two-thirds of whom received two vaccine doses. There were no cases of symptomatic Covid-19 in fully vaccinated adolescents, the company reported. That translates to an efficacy of 100 percent, the same figure that Pfizer and BioNTech reported in a trial of their vaccine in 12- to 15-year-olds.

“It’s really great news,” said Akiko Iwasaki, an immunologist at Yale University. “These vaccines are working really well in all the age groups and potentially even better in the younger people.”

Moderna also reported that a single dose of its vaccine had 93 percent efficacy against symptomatic disease.

Doses of the Pfizer-BioNTech vaccine being administered to young people ages 12 to 15 in Minneapolis earlier this month. 
Doses of the Pfizer-BioNTech vaccine being administered to young people ages 12 to 15 in Minneapolis earlier this month. Aaron Nesheim for The New York Times

The side effects were consistent with what has been reported in adults: pain at the site of the injection, headache, fatigue, muscle pain and chills. “No significant safety concerns have been identified to date,” the company said. The adolescents in the study will be monitored for a year after their second dose.

The authorization of a second vaccine for adolescents could help convince more parents, some of whom have expressed reluctance about having their children vaccinated, that the shots are safe, experts said. “Most parents vaccinate their children,” Dr. O’Leary said. “With the Covid vaccines, we’ve seen a little bit more hesitancy, but the further along we get demonstrating safety and effectiveness, the more people we’re seeing wanting the vaccine.”

It would also give parents and teenagers a choice between vaccines, although experts noted that the Pfizer and Moderna vaccines appear to be equally safe and effective.

“This really give parents, I think, a little bit more confidence,” said Rupali Limaye, an expert on vaccine use and hesitancy at Johns Hopkins University. “If they’ve had personal experience, for example, with one of the mRNA products and not the other, they might feel more comfortable then saying, ‘You know, I had a great experience with Moderna, so I really want my child to get Moderna.’”

But because the Pfizer and Moderna vaccines both require two shots, spaced several weeks apart, ensuring that all teens have access to the vaccine may remain a challenge. “I think we’ll still unfortunately not be able to reach more underserved populations that are facing vaccine disparities, because it’s still the two-dose regimen,” Dr. Limaye said. Authorizing a one-dose vaccine, like the Johnson & Johnson shot, for use in adolescents may help close these gaps, she said.

The U.S. already has enough doses to vaccinate adolescents many times over. There are approximately 25 million American children between the ages of 12 and 17, according to estimates from the U.S. Census Bureau. That is roughly the same number of shots that Pfizer and Moderna are distributing, in total, per week in the U.S.

“Right now, we have more than enough supply to vaccinate our teens,” said Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center in New York. “So it’s not so much that the Moderna vaccine is critical for having supply for our population, but rather, having a second vaccine come online for that age group that could be available to the rest of the world — I think that is important.”

Many other countries, however, will not be ready to vaccinate their adolescents for quite some time. Although more than 1.7 billion vaccine doses have been administered globally, there are enormous inequities between countries; 84 percent of doses have gone to people in high- and upper-middle-income countries. Just 0.3 percent have gone to low-income countries.

“A huge proportion of the world’s population actually lives in countries that don’t have access to any doses right now at all,” said Andrea Taylor, assistant director of programs at Duke University’s Global Health Innovation Center. “In one country we are looking at covering children, and in more than 100 other countries we are desperately scrambling to try to inoculate the most vulnerable populations.”

Covax, a global initiative that aims to improve access to vaccines in low- and middle-income countries, has fallen far short of its distribution goal so far. Moderna and Pfizer have pledged to deliver tens of millions of doses to Covax by the end of 2021. Given the vaccine shortages — and dire case numbers — in many other countries, the companies should consider delivering those shots sooner, even if it means postponing the vaccination of adolescents, said Prashant Yadav, an expert in health care supply chains at the Center for Global Development in Washington, D.C.

“If they can upfront that and deliver that now, that will give Covax the option of vaccinating the high-risk individuals in a large number of low-income countries,” he said.

The World Health Organization has called on countries with ample vaccine supply to share their shots with the world. President Biden has pledged to send 80 million vaccine doses — including shots from Pfizer, Moderna, Johnson & Johnson and AstraZeneca — abroad, although many activists and global health experts have called on him to do more.

“It feels like, ‘OK, we are putting this behind us,” Ms. Taylor said. “We’re moving forward and starting to make summer vacation plans. It can be really hard to remember that much of the world actually is still in crisis.”

Noah Weiland contributed reporting.

How Do I Know if My Teen Is OK?

In the pandemic, many of the traditional measures that indicate a teen is thriving have been rendered irrelevant.

Alix McDonald is 17 years old, and the future weighs heavily on her mind. A high school senior in Chicago, she was “stressed a lot” in the fall about “whether or not to apply to college,” especially during a pandemic.

What comforted her was “talking through pros and cons with my mom and dad” — without feeling as if her parents had an agenda. “They didn’t push me,” said Alix, who has both attention deficit hyperactivity disorder and a lesser-known learning difference called slow processing speed, and has long grappled with school-based anxiety. “They asked questions about what I wanted.”

Alix, like young people across the country, is wrestling with feelings of apprehension and uncertainty about what the next year will bring, made all the more intense in the pandemic. For parents, it has become harder to assess if their teenagers are doing OK. “Alix spends a huge amount of time alone in her room,” said her mother, Veronique McDonald, a real estate broker. “We try to implement something fun to get her to join us.”

In the pandemic, many of the traditional measures that indicate whether a teen is thriving have been rendered irrelevant. Does my child attend school and stay engaged? Is my child participating in team sports or joining activities in our community? Is my child getting enough sleep with these early morning practices? Why is my child always alone?

Jennifer Hartstein, an adolescent psychologist in New York who specializes in anxiety and depression, said that in the absence of “age-old markers” of wellness, “we have to pivot and look at kids differently.” Slow down and ask kids how they are doing, Dr. Hartstein advised.

She added: “A parent’s biggest strength is knowing when you need to get help for your kids and for yourself.”

Focus on social and emotional skills.

As families prepare for post-pandemic life, there is an opportunity to reframe discussions of what it means to be doing well. Skills such as self-compassion, resilience and distress tolerance are strong indicators of how a kid is doing.

Rheeda Walker, a professor of psychology at the University of Houston and the author of “The Unapologetic Guide to Black Mental Health,” said that resilience “isn’t about how many times we get knocked down” but rather, finding the factors that help us get back up. “What allows someone to tap into their strength when they need it most?” she asked. “Is it their family? Their faith?”

Dr. Walker encourages people to assess how they feel each day. “I talk in the Black community about psychological fortitude,” she said, explaining that it means asking: “What is my rating on a zero to 10 basis to achieve my goals today and manage my life? If I am at a 2, what is keeping me from getting to a 6?” Parents can teach teens to practice this strategy when kids are struggling to meet their own daily challenges, even if the goal is merely to leave the house and interact with peers.

She also noted that it is important to look for shifts in behavior, shifts in mood, anything that indicates a change in your child’s patterns — this is a signal for parents to investigate what lies underneath.

Pay attention to mental health.

When I was growing up in the ’80s, my doctor listened to my heart and lungs, checked my blood counts and monitored my growth. I checked all the boxes for “healthy.” Yet I had an undiagnosed anxiety disorder throughout childhood that made my launch into college agonizing.

“We as pediatricians have come a long way in our awareness of mental health,” said Dr. Sharon Robinson, a pediatrician in Evanston, Ill., who is raising two teenagers, ages 14 and 17. Anxiety is the most common adolescent mental health disorder, she said, and in her practice, they routinely screen all patients for depression starting at age 12.

When a child’s survey triggers a positive response for depression, Dr. Robinson first meets privately with the patient to ask clarifying questions and assess their risk level for self harm and suicidal ideation before inviting parents back into the room. With mild to moderate depression, which account for the majority of cases, Dr. Robinson discusses therapeutic strategies with the family and provides a referral to talk therapy.

In severe situations, such as when a child indicates suicidal thoughts or has made a suicide plan, “we urgently refer those children to a psychiatrist or even to the emergency room for assessment,” she said, and they also create a safety plan and schedule a follow-up visit.

Help young people rebuild their independence.

Psychologists and pediatricians recommend that parents return to focusing on the milestones that they helped their kids develop in early childhood — eating, sleeping, separating from parents. Adults can scaffold the basics, providing support, structure and encouragement as young people rebuild in-person socialization into their lives, and then step back and allow them to stand on their own.

Research published in June of 2020 by the Centers for Disease Control and Prevention showed that 18- to 24-year-olds reported the highest rate of struggles with mental health, substance abuse and suicidal ideation, as compared to older adults.

According to Ali Mattu, a clinical psychologist in Northern California and creator of the popular YouTube channel The Psych Show, teens and young adults are having a harder time psychologically than older generations because Covid has represented a bigger proportion of their lifetimes, and “the effects are greater.”

He explained that the adolescent brain is wired to quickly make associations, and during the pandemic, some young people have learned to be hypervigilant, because we’ve trained them to associate going places with risk of a major disease. Since our brains don’t finish developing until our mid-20s, he said, young people are quick to act on their emotions. For some, that means “anxious avoidance,” which can manifest as a reluctance to leave home. For others, it means “overconfident approach,” which accounts for teens and young adults who throng to parties, unmasked.

Dr. Mattu said the best thing parents can do for teens and young adults who are withdrawing is to help them develop four key skills. The first is “the ability to do things alone, like run an errand or do what needs to be done to get through their day,” based on the expectations of their family and culture. Second is “the ability to ask for help, to be vulnerable and ask for support,” such as by emailing a teacher on their own or reaching out to a counselor or parent.

Third is “the ability to support their peers, because teens are really focused on their relationships with each other,” explained Dr. Mattu, and often, a peer is the first one to know when someone is struggling. And the fourth skill is “finding a connection to a larger community,” such as a club, an organization, a fandom, a religious group — anything that creates meaning and purpose.

As young people take steps to re-enter the world, sometimes things will go wrong. The growth happens when they navigate their distress and try again instead of avoiding similar situations. Recently, my teenager asked me to drive her to meet a friend in downtown Chicago. “You can do this on your own,” I said. When she never arrived, her friend called us. Our daughter had entered the right street address in Google Maps — in the wrong city.

By the time we contacted her, she was lost on the highway, hysterical and terrified. “I just want to come home,” she cried. Our best friends, who live close to where she was, offered to drive out to meet her. My daughter swallowed her pride and accepted their help.

A week later, my daughter took a deep breath and got back on the highway to meet another friend. “This is you, being resilient,” I told her, as she headed out alone. “I couldn’t be prouder.”

Carrie Goldman (@CarrieMGoldman) is an author, speaker and the social-emotional learning curriculum director for the Pop Culture Hero Coalition. She is currently working on a memoir.


What Are Puberty Blockers?

Recent conservative legislation has targeted a class of drugs used to treat transgender adolescents. But what do these drugs actually do?

When Sebastian Liafsha came out as transgender in middle school, his mother, Heather, jumped into research mode.

Ms. Liafsha, a registered nurse in Lexington, S.C., put together a three-inch-thick binder packed with printouts of various laws, medical guidelines, pharmaceutical records and more. It was there that she would record the dates and details of Sebastian’s puberty blocker injections every three months for two and a half years, starting at age 14.

As a child who had never truly understood himself to be a girl, female puberty felt like an obstacle on Mr. Liafsha’s journey to manhood.

For Mr. Liafsha, now 19, puberty blockers not only paused the development of unwanted secondary sexual characteristics like breasts and a menstrual cycle, they gave him and his family time to continue his social transition (the process of presenting and living as the desired gender) and prepare for any future medical interventions.

“Before he started his transition, there were just a few months where puberty hit him, and he was off the wall,” Ms. Liafsha recalled. “He became really depressed.”

Puberty blockers helped to increase Sebastian’s confidence and happiness as an adolescent, which Ms. Liafsha likes to illustrate by pointing to her son’s life in the theater. In middle school, she said, he had always hidden in the ensemble, but by 10th grade — after two years on puberty blockers — he had flourished into a leading man.

Lately, puberty blockers have become a subject of debate in state legislatures, as lawmakers across the country introduce bills to limit health care options for transgender youth. Legislators in Arkansas already passed such a law, although Gov. Asa Hutchinson vetoed it last month. Arkansas conservatives argued that “the risks of gender transition procedures far outweigh any benefit at this stage of clinical study on these procedures.” But medical experts say that’s not the case.

Among the significant benefits of puberty blockers are a reduction in suicidal tendencies, which are often high in transgender adolescents, and a reduced need for expensive gender-affirming operations as adults. But while puberty blockers are commonly referred to as “fully reversible,” more research is needed to fully understand the impact they may have on certain patients’ fertility. There is also little known about the drugs’ lasting effects on brain development and bone mineral density.

Transgender youth have been the focus of new laws in states including Mississippi and Idaho, and pending in many others, designed to restrict their participation in sports — but this debate is largely separate from the discussion of puberty blockers.

Because the use of puberty blockers in transgender kids is still relatively new, the information is developing.

Here is a roundup of what experts know so far.

What are puberty blockers?

Puberty blockers are medications that suppress puberty by halting the production of estrogen or testosterone. They can stop transgender kids from experiencing the effects of puberty that may not align with their gender identities. Medically, the class of medications are called gonadotropin-releasing hormone agonists, or GnRH agonists. They are approved by the Food and Drug Administration to treat precocious puberty — puberty occurring at an unusually early age — so when they are prescribed to treat transgender youth, it’s considered an off-label use.

“Off-label,” the American Academy of Pediatrics noted in a 2014 statement, “does not imply an improper, illegal, contraindicated or investigational use” — it merely refers to the process of F.D.A. approval.

Ms. Liafsha recorded details about Sebastian’s puberty blockers in her binder, including date and time of injection, site of injection on the body, dosage and type of needle used.
Ms. Liafsha recorded details about Sebastian’s puberty blockers in her binder, including date and time of injection, site of injection on the body, dosage and type of needle used.Leslie Ryann McKellar for The New York Times

The medications may be given as shots in a doctor’s office every one, three or six months, or as an implant which lasts for about a year. Dr. Jessica Kremen, a pediatric endocrinologist for Boston Children’s Hospital’s Gender Multispecialty Service, noted that patients and families may prefer the convenience of the implants or six-month shots.

“It depends a lot on what is obtainable through a patient’s insurance,” Dr. Kremen said. Insurance companies are reluctant to cover off-label drug treatments, and implants can run up to approximately $45,000 per implant out of pocket, while shots cost can cost thousands of dollars per dose.

“That often determines which form we ended up using,” Dr. Kremen said. “But they all work well, as long as you administer them on time.”

How do they work?

Typically, in puberty, gonadotropin-releasing hormone helps to produce follicle-stimulating hormone (FSH) and luteinizing hormone (L.H.). In people assigned female at birth, these hormones prompt the ovaries to make estrogen, which promotes processes like breast growth and menstruation. In people assigned male at birth, they prompt the testes to make testosterone, which promotes processes like facial hair growth and a deepening of the voice.

Puberty blockers disrupt the production of FSH and L.H., therefore blocking the production of estrogen or testosterone. As a result, transgender adolescents do not continue to develop unwanted secondary sexual characteristics — transgender boys do not develop breasts and transgender girls do not develop facial hair, for example.

Puberty blockers do not stop an early stage in sexual maturation called adrenarche, which can cause acne, the growth of underarm and pubic hair and body odor.

Who can get puberty blockers?

Although parents might think they should start puberty blockers very young, so that a child never has to experience any physical changes associated with the unwanted gender, experts say it’s better to wait at least until the early stages of puberty have started. Dr. Stephen Rosenthal, medical director of the child and adolescent gender center for U.C.S.F. Benioff Children’s Hospitals, was a co-author of the Endocrine Society’s 2017 guidelines for transgender health care. He recommended starting puberty blockers when breast budding or the enlargement of the testes has begun, at the earliest.

That’s because Dr. Rosenthal does not recommend puberty blockers for prolonged use outside of the normal window of puberty. They restrict the functioning of the gonads, which may lead to adverse health effects. The longer blockers are used past the typical start of puberty — generally age 14, at the latest — the greater the possible risk.

When blockers are initiated in the early stages of puberty, Dr. Rosenthal typically suggests that his patients stop using them by age 14. At that point, patients, with their families and their doctors, can determine whether to introduce hormones that help them develop according to their gender identity or resume puberty in the gender assigned at birth.

Dr. Rosenthal further recommended that before starting blockers, children be evaluated by a mental health professional and determined to have gender dysphoria. He said families should also undergo a thorough process of informed consent, during which they are educated about the potential effects of blocking puberty — including adverse ones.

The World Professional Association for Transgender Health’s guidelines for medical care suggest that “before any physical interventions are considered for adolescents, extensive exploration of psychological, family and social issues should be undertaken.” Professionals emphasized mental health care as an integral part of the process.

What are the benefits?

Treatment with puberty blockers may improve the mental health of transgender adolescents, who are at high risk for suicide. A 2020 study found lower odds of lifetime suicidal ideation in transgender adults who wanted to take puberty blockers and were able to access this treatment. Another recent study showed similarly positive effects: transgender adolescents receiving puberty blockers had less “emotional and behavioral problems” than transgender adolescents recently referred to care, and also reported rates of self-harm and suicidality similar to those of their non-transgender peers. A 2020 study of 50 transgender adolescents indicated that puberty blockers and gender-affirming hormone treatments, or both, could positively impact quality of life and decrease depression and suicidal ideation. A 2014 study found that 55 young transgender adults who used puberty blockers, took gender-affirming hormones and had gender confirmation surgeries were able to “resolve” their gender dysphoria and showed overall well-being “in many respects comparable to peers.”

When Mr. Liafsha was an adolescent, puberty blockers helped to increase his confidence. After years in his school’s ensemble theater casts, he became a leading man.Leslie Ryann McKellar for The New York Times

Because puberty blockers halt the development of secondary sexual characteristics, transgender adolescents who take them before gender-affirming hormones may also be able to avoid future gender-affirming procedures. For instance, transgender men who don’t develop breasts wouldn’t have reason to have mastectomies, while transgender women who don’t develop masculine facial features might no longer choose to have facial feminization surgery.

What are the risks?

Puberty blockers are largely considered safe for short-term use in transgender adolescents, with known side effects including hot flashes, fatigue and mood swings. But doctors do not yet know how the drugs could affect factors like bone mineral density, brain development and fertility in transgender patients.

The Endocrine Society recommends lab work be done regularly to measure height and weight, bone health and hormone and vitamin levels while adolescents are taking puberty blockers.

A handful of studies have underscored low bone mineral density as a potential issue, though a 2020 study posited that low bone mineral density may instead be a pre-existing condition in transgender youth. Treatment with gender-affirming hormones may theoretically reverse this effect, according to Endocrine Society guidelines.

The impact of puberty blockers on brain development is similarly hazy. The Endocrine Society guidelines point to two studies: A small one published in 2015 showed that the drugs did not seem to impact executive functioning (cognitive processes including self-control and working memory), while a 2017 study of rams treated with GnRH agonists suggested chronic use could harm long-term spatial memory. (Of course, rams are not humans.)

The effects of puberty blockers are often referred to as “fully reversible,” including in both the Endocrine Society and WPATH guidelines, because of evidence showing that girls treated for precocious puberty were still able to undergo normal puberty and have children later in life.

While much of the data gleaned from precocious puberty treatments are applicable to transgender patients, Dr. Kremen said, “you’re asking a different question for precocious puberty than you are for a transgender child” when it comes to fertility. Halting puberty at its onset and then later starting gender-affirming hormones — a typical course for some transgender adolescents — may affect the ability to have children, she said. The Endocrine Society advises clinicians to counsel patients on “options for fertility preservation prior to initiating puberty suppression in adolescents.”

It is also worth noting that Lupron, one of the drugs widely used as a puberty blocker, has been reported to have long-term adverse effects in women who used it to treat precocious puberty. Women have reported issues including depression, bone thinning and chronic pain.

Puberty blockers may also impact future gender-affirming surgeries for transgender women. A recent study showed that transgender women who began puberty blockers at the start of puberty were 84 times more likely to require abdominal surgery if they wanted to pursue gender-affirming surgery. Because tissue from the penis and testes is used to construct a neovagina, and puberty blockers prevent the growth of those organs, material from the colon or omentum may need to be used.

An in-depth conversation detailing puberty blocker treatment and all its potential effects is an essential part of any transgender adolescent’s care. Specialists are eager for more research, but for now, they say the apparent benefits outweigh the hypothetical risks.

“Medications are rarely without side effects,” Dr. Kremen said. “That is usually not enough of a reason to allow a child, who is telling you that they’re extremely distressed by the pubertal changes that they’re seeing, to continue going through puberty.”

“Knowing what we do know, these medications have enormous benefits for the population that we care for,” she added.


Teens Are in Crisis. So Are Their Parents.

The pandemic turned Tiffany Lee’s home into a battlefield.

Wary of illness, Ms. Lee started taking precautions back in March 2020. She asked her 15-year-old son, Bowen Deal, known as Bo, to practice social distancing. She insisted he wear masks. But that didn’t sit well with him, because many people in their rural town didn’t follow such rules, she said.

“He would see all of his classmates having pool parties and going bowling and he’s angry at me because I won’t let him go,” she said of Bo, a freshman in high school in Metter, Ga., outside of Savannah. “He thinks I’m the bad parent because Mom is standing between me and my friends.”

Normally, the teenage years are when children separate from their parents, but today’s teens have been spending more time at home than ever. Adolescents who yearn to rove in packs found themselves confined to their bedrooms, chatting with the pixelated images on their screens.

“The group that is suffering the most” in terms of isolation “is 13- to 24-year-olds,” said Harold S. Koplewicz, president and medical director of the Child Mind Institute in New York City. “They are losing out on being allowed to separate. They’re having trouble with their academic goals. Many of the things they have been working for are gone.”

But as hard as it is to be a teen today, it’s draining being the parent of one. A national poll of parents of teens, released in March by C.S. Mott Children’s Hospital, found parents toggling between different tactics, trying to keep their children’s mental health afloat. About half of those surveyed said their teen’s mental health had changed or worsened in the pandemic. In response, half of these parents tried relaxing family Covid-19 rules, or social media rules. One-third spoke to a teacher or school counselor about their child; nearly 30 percent reported seeking formal mental health help.

“There’s been no prep for this,” said Julie Lythcott-Haims, the former dean of freshmen at Stanford University and the author of “How to Raise an Adult: Break Free of the Overparenting Trap and Prepare Your Kid For Adulthood.”

“Most of us haven’t had anything remotely resembling practice” with a pandemic, she said, “so we’ve had to flail, while simultaneously performing the part of a parent who kids can rely on for emotional support.”

“It’s no wonder,” she said, “that we are at the end of our ropes.”

The availability of effective vaccines, while welcome, introduces new uncertainties, she said. Will normal return? When will it come? What even is normal now?

“We’re just in a state of suspended animation,” she said. “We are in limbo, quite literally. That really creates some existential worries: Am I going to be all right? Is my family going to be all right?”

Trust your kids.

For Ms. Lee, 43, conflict with her son came to a head in January. Ms. Lee had just spent a holiday season dodging profanities flung at her by customers who didn’t want to wear masks in her clothing boutique. Meanwhile, Bo demanded that he be allowed to return to school in person.

The Lees’ house rules requires Bo to plan dinner a few days a week.
The Lees’ house rules requires Bo to plan dinner a few days a week.Stephen B. Morton for The New York Times
The Lees restricted Bo’s use of electronic entertainment, except for his cellphone. Stephen B. Morton for The New York Times

“I was at my wits’ end, and I couldn’t fight him anymore,” she said. She said she told him that if he got Covid-19 and brought it home to the family, “this is on you. You understand this, right?”

A certain level of autonomy is important to teens, but in the pandemic they’ve had very little, said Jennifer Kolari, author of “Connected Parenting: How to Raise a Great Kidand a San Diego-based therapist and parenting coach who leads workshops on parenting. For some, during the pandemic, their own messy bedrooms may be the only place they feel they have control, she said.

She suggests making an appointment with your teen, for later in the day or during the week, to discuss whatever issue keeps drawing the two of you into a fight.

“You can say, ‘Later tonight, we’re going to have a sit-down, and I want to hear your plan,’” she said. “‘I trust that you have a plan, and if you could let me in on that plan, that would really help.’”

Grapple with racism.

Amid racial tension and hate crimes, including the wave of anti-Asian violence this spring, many parents of color have tried to help their children process racism and civic unrest.

Thea Monyeé, a therapist in Los Angeles, watched her three Black teenage daughters getting into social media battles while she and her husband struggled to figure out how to best support them. The couple “didn’t want to police that process,” she said. “They needed to be angry for a while.” On the other hand, if one of the girls needed a place to vent frustration or rage, “we had to provide that, and then when they were sad or disappointed or hurt, we had to have those conversations.”

Thea Monyeé, in red skirt, is a therapist, podcaster and mother of three teenage daughters, Talani Wilson, left, 16, Taya Wilson, second from right, 17, and Lexington Winkler, right, 13. Kendrick Brinson for The New York Times

Meanwhile, Ms. Monyeé juggled her own work — including starting a business and hosting a podcast — with her daughters’ issues with remote school, all while people close to her struggled with Covid-19 and loss of income. She and her husband had to constantly remind each other, she said, “to make space for ourselves.”

Ragin Johnson finds she’s more terrified than ever for her 17-year-old son, a tall young Black man who has autism. “He’s a very friendly kid,” said Ms. Johnson, 43, a fifth-grade teacher in Columbia, S.C., “and I don’t want anybody to get the wrong impression, thinking he’s aggressive when he’s just very playful.”

She worries constantly about what might happen when her son heads out into the world alone. Between his impaired understanding of social interactions and his limited grasp of racial politics, “he doesn’t really understand what’s going on,” Ms. Johnson said. “I try to make sure he doesn’t go anywhere without me, but I can’t keep doing that.”

As she and other parents have learned in the pandemic, there may not be perfect solutions to all the challenges that have come up. Even a question as simple as “when will this be over?” can feel unanswerable. But experts say there are ways to make this stressful time more manageable.

Create different paths for connection.

If every conversation ends in a fight — or if your sullen teen won’t even start a conversation with you — try a different tactic. Offer to go on a drive with your child, but under specific conditions. “Let them be the D.J.,” Ms. Kolari said. “And you, you zip it. Do not use this moment to lecture them. Let your kids talk.”

If they do open up, then or later, try not to fix their problems. “You listen, and listen hard,” Mr. Koplewicz said. “You validate what they’re saying. Then, when they’re ready, you say, ‘OK, what’s next?’”

Ask for help.

If your child seems unusually blue or emotionally fragile, don’t be afraid to reach out for help. Mr. Koplewicz was not a fan of teletherapy prepandemic, but the successes he’s seen with it over the last year have made him a convert, he said. Ms. Lee found an online therapist at BetterHelp.com, who helped her and Bo navigate this rocky time. “This past year,” she said, “therapy has kept me from going off the deep end.”

Taya Wilson outside the family’s home in Pasadena, Calif.Kendrick Brinson for The New York Times
Ms. Monyeé said she and her husband had to remind each other “to make space for ourselves.”Kendrick Brinson for The New York Times

But therapy is not the only kind of support. Ms. Johnson leaned on a tight-knit group of girlfriends. “As a society we are trained to worry and try to control things,” said Patrick Possel, director of Cardinal Success Program, which provides free mental health services for uninsured and underinsured people in Louisville, Ky. Many of the program’s clients are dealing with multiple crises, from job and housing insecurity to abuse and their own mental health struggles. When a teenager in the house starts to struggle, parents may say they are out of resources to tackle this problem as well. But Mr. Possel and his colleagues urge them to look around. They ask clients, “Is there a network, a friend, a professional, who can help you?” he said.

Take care of yourself.

Liz Lindholm supervises the remote schooling of her 12-year-old twin girls and 18-year-old son at their home in Federal Way, Wash., a suburb of Seattle, while working in health care administration.

What’s been most challenging this year “is the work-life balance,” she said, “where work doesn’t end and school doesn’t really end and everything just kind of blends together.”

A 41-year-old single mother, Ms. Lindholm doesn’t have much time for self-care or even treats, but occasionally, she steals a moment to pour herself a soda — ideally, a Coke. It’s a small balm, given the sizable strain on her life. But for now, it’s the best she can manage. In this, experts say, she’s not alone.

For at least 30 minutes — or as long as three hours, if she can — Ms. Monyeé meditates, writes in her journal, practices yoga, even dances. Kendrick Brinson for The New York Times

Ms. Monyeé depended on her “morning ritual” this past year. For at least 30 minutes — or as long as three hours, if she can — she meditates, writes in her journal, practices yoga, even dances. “We’re not just mothers,” she said. “We are people who have dreams, who have needs, who have desires. Giving myself permission to be a full person has been essential.”

When parents fall apart, Mr. Koplewicz said, everyone suffers. “Self care is child care,” he said. “Are you managing to sleep seven or eight hours a night? Are you doing something spiritual?”

Many of the parents who come to Cardinal Success lack both time and private space. But that doesn’t mean they lack all resources, Mr. Possel said. “We ask them, ‘What are you doing? What does not work? Where do you have the energy to try something new?’”

Trying something new — returning to school in January — turned out to be the key for Ms. Lee and her son.

To Ms. Lee’s happy surprise, Bo is one of very few students wearing a mask when she picks him up from school. One day, on the way home in the car, he told her he was startled to discover his friends didn’t understand how vaccines work. She’s since noticed a shift in his friend group, and she says that the tension at home has noticeably lessened.

“I think our relationship is stronger now, especially since I’ve had to trust him to go off and make his own decisions,” she said. “I’m not the evil mom he thought I was. And I’m gaining new respect for him.”


Teens Are in Crisis. So Are Their Parents.

The pandemic turned Tiffany Lee’s home into a battlefield.

Wary of illness, Ms. Lee started taking precautions back in March 2020. She asked her 15-year-old son, Bowen Deal, known as Bo, to practice social distancing. She insisted he wear masks. But that didn’t sit well with him, because many people in their rural town didn’t follow such rules, she said.

“He would see all of his classmates having pool parties and going bowling and he’s angry at me because I won’t let him go,” she said of Bo, a freshman in high school in Metter, Ga., outside of Savannah. “He thinks I’m the bad parent because Mom is standing between me and my friends.”

Normally, the teenage years are when children separate from their parents, but today’s teens have been spending more time at home than ever. Adolescents who yearn to rove in packs found themselves confined to their bedrooms, chatting with the pixelated images on their screens.

“The group that is suffering the most” in terms of isolation “is 13- to 24-year-olds,” said Harold S. Koplewicz, president and medical director of the Child Mind Institute in New York City. “They are losing out on being allowed to separate. They’re having trouble with their academic goals. Many of the things they have been working for are gone.”

But as hard as it is to be a teen today, it’s draining being the parent of one. A national poll of parents of teens, released in March by C.S. Mott Children’s Hospital, found parents toggling between different tactics, trying to keep their children’s mental health afloat. About half of those surveyed said their teen’s mental health had changed or worsened in the pandemic. In response, half of these parents tried relaxing family Covid-19 rules, or social media rules. One-third spoke to a teacher or school counselor about their child; nearly 30 percent reported seeking formal mental health help.

“There’s been no prep for this,” said Julie Lythcott-Haims, the former dean of freshmen at Stanford University and the author of “How to Raise an Adult: Break Free of the Overparenting Trap and Prepare Your Kid For Adulthood.”

“Most of us haven’t had anything remotely resembling practice” with a pandemic, she said, “so we’ve had to flail, while simultaneously performing the part of a parent who kids can rely on for emotional support.”

“It’s no wonder,” she said, “that we are at the end of our ropes.”

The availability of effective vaccines, while welcome, introduces new uncertainties, she said. Will normal return? When will it come? What even is normal now?

“We’re just in a state of suspended animation,” she said. “We are in limbo, quite literally. That really creates some existential worries: Am I going to be all right? Is my family going to be all right?”

Trust your kids.

For Ms. Lee, 43, conflict with her son came to a head in January. Ms. Lee had just spent a holiday season dodging profanities flung at her by customers who didn’t want to wear masks in her clothing boutique. Meanwhile, Bo demanded that he be allowed to return to school in person.

The Lees’ house rules requires Bo to plan dinner a few days a week.
The Lees’ house rules requires Bo to plan dinner a few days a week.Stephen B. Morton for The New York Times
The Lees restricted Bo’s use of electronic entertainment, except for his cellphone. Stephen B. Morton for The New York Times

“I was at my wits’ end, and I couldn’t fight him anymore,” she said. She said she told him that if he got Covid-19 and brought it home to the family, “this is on you. You understand this, right?”

A certain level of autonomy is important to teens, but in the pandemic they’ve had very little, said Jennifer Kolari, author of “Connected Parenting: How to Raise a Great Kidand a San Diego-based therapist and parenting coach who leads workshops on parenting. For some, during the pandemic, their own messy bedrooms may be the only place they feel they have control, she said.

She suggests making an appointment with your teen, for later in the day or during the week, to discuss whatever issue keeps drawing the two of you into a fight.

“You can say, ‘Later tonight, we’re going to have a sit-down, and I want to hear your plan,’” she said. “‘I trust that you have a plan, and if you could let me in on that plan, that would really help.’”

Grapple with racism.

Amid racial tension and hate crimes, including the wave of anti-Asian violence this spring, many parents of color have tried to help their children process racism and civic unrest.

Thea Monyeé, a therapist in Los Angeles, watched her three Black teenage daughters getting into social media battles while she and her husband struggled to figure out how to best support them. The couple “didn’t want to police that process,” she said. “They needed to be angry for a while.” On the other hand, if one of the girls needed a place to vent frustration or rage, “we had to provide that, and then when they were sad or disappointed or hurt, we had to have those conversations.”

Thea Monyeé, in red skirt, is a therapist, podcaster and mother of three teenage daughters, Talani Wilson, left, 16, Taya Wilson, second from right, 17, and Lexington Winkler, right, 13. Kendrick Brinson for The New York Times

Meanwhile, Ms. Monyeé juggled her own work — including starting a business and hosting a podcast — with her daughters’ issues with remote school, all while people close to her struggled with Covid-19 and loss of income. She and her husband had to constantly remind each other, she said, “to make space for ourselves.”

Ragin Johnson finds she’s more terrified than ever for her 17-year-old son, a tall young Black man who has autism. “He’s a very friendly kid,” said Ms. Johnson, 43, a fifth-grade teacher in Columbia, S.C., “and I don’t want anybody to get the wrong impression, thinking he’s aggressive when he’s just very playful.”

She worries constantly about what might happen when her son heads out into the world alone. Between his impaired understanding of social interactions and his limited grasp of racial politics, “he doesn’t really understand what’s going on,” Ms. Johnson said. “I try to make sure he doesn’t go anywhere without me, but I can’t keep doing that.”

As she and other parents have learned in the pandemic, there may not be perfect solutions to all the challenges that have come up. Even a question as simple as “when will this be over?” can feel unanswerable. But experts say there are ways to make this stressful time more manageable.

Create different paths for connection.

If every conversation ends in a fight — or if your sullen teen won’t even start a conversation with you — try a different tactic. Offer to go on a drive with your child, but under specific conditions. “Let them be the D.J.,” Ms. Kolari said. “And you, you zip it. Do not use this moment to lecture them. Let your kids talk.”

If they do open up, then or later, try not to fix their problems. “You listen, and listen hard,” Mr. Koplewicz said. “You validate what they’re saying. Then, when they’re ready, you say, ‘OK, what’s next?’”

Ask for help.

If your child seems unusually blue or emotionally fragile, don’t be afraid to reach out for help. Mr. Koplewicz was not a fan of teletherapy prepandemic, but the successes he’s seen with it over the last year have made him a convert, he said. Ms. Lee found an online therapist at BetterHelp.com, who helped her and Bo navigate this rocky time. “This past year,” she said, “therapy has kept me from going off the deep end.”

Taya Wilson outside the family’s home in Pasadena, Calif.Kendrick Brinson for The New York Times
Ms. Monyeé said she and her husband had to remind each other “to make space for ourselves.”Kendrick Brinson for The New York Times

But therapy is not the only kind of support. Ms. Johnson leaned on a tight-knit group of girlfriends. “As a society we are trained to worry and try to control things,” said Patrick Possel, director of Cardinal Success Program, which provides free mental health services for uninsured and underinsured people in Louisville, Ky. Many of the program’s clients are dealing with multiple crises, from job and housing insecurity to abuse and their own mental health struggles. When a teenager in the house starts to struggle, parents may say they are out of resources to tackle this problem as well. But Mr. Possel and his colleagues urge them to look around. They ask clients, “Is there a network, a friend, a professional, who can help you?” he said.

Take care of yourself.

Liz Lindholm supervises the remote schooling of her 12-year-old twin girls and 18-year-old son at their home in Federal Way, Wash., a suburb of Seattle, while working in health care administration.

What’s been most challenging this year “is the work-life balance,” she said, “where work doesn’t end and school doesn’t really end and everything just kind of blends together.”

A 41-year-old single mother, Ms. Lindholm doesn’t have much time for self-care or even treats, but occasionally, she steals a moment to pour herself a soda — ideally, a Coke. It’s a small balm, given the sizable strain on her life. But for now, it’s the best she can manage. In this, experts say, she’s not alone.

For at least 30 minutes — or as long as three hours, if she can — Ms. Monyeé meditates, writes in her journal, practices yoga, even dances. Kendrick Brinson for The New York Times

Ms. Monyeé depended on her “morning ritual” this past year. For at least 30 minutes — or as long as three hours, if she can — she meditates, writes in her journal, practices yoga, even dances. “We’re not just mothers,” she said. “We are people who have dreams, who have needs, who have desires. Giving myself permission to be a full person has been essential.”

When parents fall apart, Mr. Koplewicz said, everyone suffers. “Self care is child care,” he said. “Are you managing to sleep seven or eight hours a night? Are you doing something spiritual?”

Many of the parents who come to Cardinal Success lack both time and private space. But that doesn’t mean they lack all resources, Mr. Possel said. “We ask them, ‘What are you doing? What does not work? Where do you have the energy to try something new?’”

Trying something new — returning to school in January — turned out to be the key for Ms. Lee and her son.

To Ms. Lee’s happy surprise, Bo is one of very few students wearing a mask when she picks him up from school. One day, on the way home in the car, he told her he was startled to discover his friends didn’t understand how vaccines work. She’s since noticed a shift in his friend group, and she says that the tension at home has noticeably lessened.

“I think our relationship is stronger now, especially since I’ve had to trust him to go off and make his own decisions,” she said. “I’m not the evil mom he thought I was. And I’m gaining new respect for him.”


With Covid Vaccines for Teens and Kids, Timing Matters

There can be a seven- or eight-week window around Covid vaccines when other shots can’t be given, so those who need them for camp, school or sports have to plan ahead.

Greg Gold, a high school senior from Westchester County, N.Y., went to the doctor for a checkup last week. His pediatrician, Dr. Jane Guttenberg, had planned to give him his meningococcal B shot, which she wanted him to get before he goes to college this fall. But when Dr. Guttenberg heard that he had an appointment for his first Covid-19 vaccination the next day, she told him they would hold off on the meningococcal vaccine until after he was fully vaccinated against Covid-19.

According to current recommendations from the Centers for Disease Control and Prevention, you aren’t supposed to get any other vaccine for two weeks before or after a Covid vaccine. That means that Mr. Gold, 17, will wait until mid-June to start the meningococcal B sequence — two shots, a month apart. He’ll still have time to get it done before he heads to Vanderbilt University in the fall, but the scheduling and juggling came as something of a surprise to him and his mother.

Dr. Guttenberg, who practices in New York City and in Scarsdale, N.Y. (and at Bellevue Hospital where she is one of my colleagues), said, “I’m prioritizing the Covid vaccine for all these kids going to college.”

Anyone with a teenager who is up against a deadline to be vaccinated for fall — or for camp this summer — should remember that vaccines have to be spaced, which can mean a seven- or eight-week window around Covid vaccines when other shots can’t be given.

Dr. Lee Beers, a professor of pediatrics at Children’s National Hospital who is the president of the American Academy of Pediatrics, said, “We’re really trying to push the message, get in and see your pediatrician and get caught up on your routine vaccines now or you’re going to end up in this really tricky place and have to delay Covid vaccine or other vaccines.”

With the news Monday that the Food and Drug Administration is preparing to authorize use of the Pfizer-BioNTech Covid-19 vaccine in children 12 to 15 years old by early next week, parents will need to plan with their pediatricians how to coordinate those along with catching up on their other shots. And younger children who have other shots due might want to consider catching up right now, so that they’re fully up-to-date for sports, camp or school. That way, as soon as they are eligible for Covid vaccines, there won’t be so much juggling to be done.

And a lot of kids have catching up to do, said Dr. Bonnie Maldonado, a professor of global health and infectious diseases at Stanford who is the chair of the A.A.P. committee on infectious diseases. When it comes to immunization, she said, “We lost a lot of ground in the pandemic, and the biggest gaps are in the adolescent age group.”

The regular vaccination schedule is determined primarily by burden of disease, said Dr. James Campbell, a professor of pediatric infectious diseases at the University of Maryland School of Medicine who is the chairman of the American Academy of Pediatrics subcommittee on vaccinations. You want peak protection at the age of peak risk, he said.

Dr. Campbell pointed out that for all the stories about vaccine hesitancy, only 1 percent of the parents in the United States actually choose not to vaccinate their children at all — and that he believes the publicity drumbeat of the Covid vaccination campaign will ultimately leave parents more comfortable, not less.

“In the end, this will be very good for vaccines that so much emphasis has been put on the process and the safety and the review,” Dr. Campbell said.

“In the past, I think people didn’t realize just how much scrutiny there is,” of serious reactions to any vaccine, Dr. Campbell said, or how much attention is paid to schedule, dose, and immune response when a new vaccine is tested.

When it comes to the Covid vaccines, Dr. Maldonado said, “We’re not overly specifically concerned about anything with this vaccine, we’re just following the normal processes.”

Still, it’s possible that younger children, who typically have more robust immune systems than adults, may react more strongly to the Covid vaccines. That is why vaccine studies in children look carefully at dosage and immunologic reactivity, Dr. Beers said: “They often start with a smaller group, give a lower dose of vaccine, test the response, work their way up to the dose needed for adequate immunity.”

Dr. Campbell and his colleagues at Maryland are just starting their first study of Covid vaccine in children under 12. And no one, he said, should be trying to convince parents that the vaccines are safe and effective in this age group until the data are available: “I have no reason to believe they won’t be safe and effective, but the proof is in the pudding — I want to see the pudding.”

Getting children caught up on their regular vaccines makes sense because it will keep them well protected if other diseases flare up now that the pandemic has driven down the rates of the usual childhood immunizations. Doctors are worried about a whole list of vaccine-preventable diseases, including measles, whooping cough, meningitis, HPV and flu.

Will Covid vaccines eventually fit into the schedule of routine childhood immunizations, and if so, at what age? Because the new vaccines are still in an emergency use authorization phase, “Nobody has answers; we’ll have to see over time,” Dr. Maldonado said.

For some diseases, it’s possible to vaccinate children for lifelong protection. Sometimes you wait to vaccinate until you reach the age when risk is higher. For example, we give HPV vaccine to children sometime between 9 and 12, so they will be immune before they become sexually active. We time the meningococcal vaccine for that age because the disease is more common in teenagers and young adults than in elementary school children.

Other diseases are most dangerous to infants or young children, so you need to vaccinate in infancy — such as rotavirus, which can cause severe dehydrating diarrhea in infants and small children, or whooping cough. Covid-19 is a disease that tends to be less severe in children, but which has still caused a great deal of serious illness. “We appreciate the fact that children are less at risk, but take seriously that they can get quite ill, that they can have long-haul symptoms or MIS-C,” Dr. Beers said, referring to the rare but serious Covid-related inflammatory condition in children.

And in addition to protecting children, immunizing them against Covid-19 may protect the adults around them; Dr. Campbell said that having pneumococcal vaccine in the infant schedule had meant not only a major reduction in disease for children, but also a drop disease in older adults who have contact with kids who are immunized.

Many families are waiting eagerly for vaccines to be available for their under-16 children. And many 16- to 18-year-olds are as eager to be vaccinated as their pediatricians are to see them get their shots. Mr. Gold, who, along with his whole family, had Covid-19 in March, was happy to be able to keep his vaccine appointment, and to come back in June for his first meningococcal B shot, and happy that there was time to get it all done before the fall.

The New Teenage Milestones

As Sweet Sixteens, proms and graduation ceremonies were disrupted or canceled, kids turned their losses into opportunities for new traditions with friends.

Growing up, Carley Ebbenga was used to not having big birthday parties. Since her birthday falls right in the middle of winter break, most kids were out of town so she stuck to small celebrations. But for her Sweet Sixteen, Ms. Ebbenga, who lives in Romeoville, Ill., a suburb of Chicago, wanted to do something special. She envisioned a trip into the city with a few friends where they would eat a nice dinner and stay up late dancing in their hotel rooms.

The pandemic, of course, foiled her plans.

Ms. Ebbenga made the best of things. She invited two of her closest friends to a bonfire in her backyard. They ate chili made by Ms. Ebbenga’s mother and danced around the fire while drinking hot cocoa. The small group also had a “burning ceremony” where they had notebooks and pens to write down “the deepest, most saddest things,” read them out loud and then burn the slips of paper in the fire. Ms. Ebbenga had gotten the idea from watching one of her favorite YouTubers, The Purple Palace, who had made a video burning things she wanted to let go of.

A lot of what Ms. Ebbenga wrote down were those things she missed out on during the pandemic like a Sweet Sixteen or “the nights of laughter lost this year” and “attending my first art show.” “It feels really good to just straight-up watch the fire burn,” she said.

When pandemic lockdowns began last spring, high school students in the class of 2020 realized pretty quickly that they’d be missing their proms and started creating new ways to mark their graduations. But few younger teenagers could have imagined that their lives would still be so limited by the pandemic a year later. Indeed, with different rules across the country, kids have had wildly varied experiences: Some schools have been operating in person and holding proms as usual, while for others, the spring of 2021 is not all that different from last year. And as more classic teenage milestones like Sweet Sixteens, prom and graduation were disrupted or canceled entirely, these kids have had to turn their losses into opportunities, forging new traditions with friends.

When Senior Year Was Supposed To Be ‘Your’ Year

“It’s hard to come to terms with the fact that we were told for the past three years, ‘Oh, just get to your senior year; it’s going to be a blast. You’ll have so much fun and it’s way easier,’” said Julia Weber, a senior in Athens, Ohio. “Now we’re doing school from our bedrooms with none of the fun.”

The missed milestone she’s most disappointed about is not having the opportunity to visit college campuses in person. “It’s really hard to make such a significant decision with a Zoom tour or just literally pictures that you found on Google of the campus,” she said.

Amaya Wangeshi, 17, of Justin, Texas, part of the Dallas-Fort Worth metroplex, has noticed an existential sentiment among her friends. “We feel lost in time,” the high school junior said, waxing philosophical about their experience. “It seems like time is moving through us rather than us moving through time. It’s a weird limbo.”

Tommy Sinclair, 17, of Worthington, Ohio, had to wait several months to get his driver’s license.Rich-Joseph Facun for The New York Times
Ms. Weber’s prom dress hangs in her room. “I was lucky enough to go with an upperclassman my freshman year,” she said. “So I have been once, but a lot of my classmates have never been and might not ever go.”Rich-Joseph Facun for The New York Times

Like Ms. Ebbenga, she also missed out on having a special 16th birthday celebration last year.

“My 16th birthday passed and I didn’t do anything,” she said. “It was a shock because it’s just one of those things you think about when you’re little. Because of media, everyone is like, ‘Sixteen, sixteen, sixteen.’ It’s supposed to be such a big deal.”

Getting her driver’s license was another rite of passage that didn’t go as planned. DMV closures in Texas meant she had to wait nearly a year to take her test.

“It was really frustrating,” said Ms. Wangeshi. “It sounds childish but I think a lot of people look at their life by reaching certain milestones. It’s just a natural tendency in the way we sort time and also the way we also consider achievement.”

New Traditions — Despite the Disappointments

While his delay wasn’t as long as Ms. Wangeshi’s, Tommy Sinclair, 17, of Worthington, Ohio, had to wait several months to get his driver’s license. However, as a member of his school’s theater repertory program, reimagining a school musical was a greater hurdle. Instead of performing “Annie” in front of a live audience, Mr. Sinclair’s school opted to film the year’s productions and sell tickets online for virtual viewings on YouTube.

“It’s just so different to not be performing in front of an audience,” said Mr. Sinclair, who noted that wearing masks, while necessary, was a challenge because the actors couldn’t show facial expressions. “It takes away from some of the fun, but it’s also a lot better than not doing anything at all.”

Ms. Ebbenga had to adapt when it came to her (now virtual) spring musical as well. For many students like herself, keeping traditions alive in 2021 means finding creative workarounds.

Sarah Abdella, 17, left, and Julia Weber, 18, right, eat take-out food at a bonfires as a way to catch up with friends who she hasn’t seen “in months, if not a year.”Rich-Joseph Facun for The New York Times
One of Tommy Sinclair’s losses this year was performing in his school musical in front of live audiences. The show was virtual instead.Rich-Joseph Facun for The New York Times

In prepandemic times, the cast and crew of Ms. Ebbenga’s thespian club would link arms in a ritual called “circle” minutes before the start of each show. Individuals take turns speaking, whether it’s sharing words of encouragement or sentimental memories. This year, they’re planning to do “circle” over a Zoom call with everyone on camera.

“We have to keep that tradition alive because it’s the essence of our thespian club,” Ms. Ebbenga said.

Mr. Sinclair, who is part of his school’s student council, is currently hard at work to make his junior prom as “Covid-friendly” as possible, which includes separating attendees into groups and setting up activities in different parts of the school such as having dancing in the gym, photo booths in the hallways, a movie playing in one section and a cotton candy machine.

For other students, school dances and social events aren’t a possibility. But that hasn’t stopped them from wanting to create new memories during what has been a largely disappointing year. Some parents are taking prom into their own hands by planning unofficial ones that are not affiliated with their schools.

Because her senior prom was canceled, Ianne Salvosa, 18, of Lake St. Louis, Mo., is making her own version with friends.

“A lot of people are actually just buying dresses, taking pictures, and going out to dinner with their friends, which is something I’m trying to plan to do,” she said.

Goodbye Prom, Hello Picnics

For Ms. Weber, hosting small socially distanced bonfires has been a way to catch up with friends who she hasn’t seen “in months, if not a year.”

“Obviously, that’s not necessarily a milestone, but I do think in this incredibly uneventful — from a school perspective — year, this’ll be what I look back on and be like, ‘Oh, that was the biggest social event: sitting at a fire with three people in my backyard,’” Ms. Weber said.

Ms. Ebbenga plans to incorporate backyard bonfires into future hangouts with friends even after they are all vaccinated, which is quickly becoming a reality for teens as more states open up their eligibility requirements.

“It’s really sweet,” she said. “Everyone’s outside and cold, but we have blankets and we’re together and that’s what makes it the best.”

“It’s just so different to not be performing in front of an audience,” Mr. Sinclair said. “It takes away from some of the fun, but it’s also a lot better than not doing anything at all.”
“It’s just so different to not be performing in front of an audience,” Mr. Sinclair said. “It takes away from some of the fun, but it’s also a lot better than not doing anything at all.”Rich-Joseph Facun for The New York Times

Ms. Salvosa has been having outdoor sushi picnics with her friends so that they have more room to keep safe distance.

Another way she stays connected to friends, maintaining a sense of normalcy and forming new traditions is by watching movies together using Teleparties, a browser extension that lets people use streaming TV services together. Ms. Salvosa and her friends use the chat feature to add commentary in real time. And thanks to outdoor team sports like lacrosse and cross-country, many student athletes have still been able to safely compete and root for one another.

While it’s ultimately not the year these kids wanted, it is one nobody will forget.

“It’s just knowing that I had to go through something that’s going down in history books and that other kids are going to have to learn about in the future,” Mr. Sinclair said. “It’s just weird. This is definitely not the high school experience I expected.”

The New Teenage Milestones

As Sweet Sixteens, proms and graduation ceremonies were disrupted or canceled, kids turned their losses into opportunities for new traditions with friends.

Growing up, Carley Ebbenga was used to not having big birthday parties. Since her birthday falls right in the middle of winter break, most kids were out of town so she stuck to small celebrations. But for her Sweet Sixteen, Ms. Ebbenga, who lives in Romeoville, Ill., a suburb of Chicago, wanted to do something special. She envisioned a trip into the city with a few friends where they would eat a nice dinner and stay up late dancing in their hotel rooms.

The pandemic, of course, foiled her plans.

Ms. Ebbenga made the best of things. She invited two of her closest friends to a bonfire in her backyard. They ate chili made by Ms. Ebbenga’s mother and danced around the fire while drinking hot cocoa. The small group also had a “burning ceremony” where they had notebooks and pens to write down “the deepest, most saddest things,” read them out loud and then burn the slips of paper in the fire. Ms. Ebbenga had gotten the idea from watching one of her favorite YouTubers, The Purple Palace, who had made a video burning things she wanted to let go of.

A lot of what Ms. Ebbenga wrote down were those things she missed out on during the pandemic like a Sweet Sixteen or “the nights of laughter lost this year” and “attending my first art show.” “It feels really good to just straight-up watch the fire burn,” she said.

When pandemic lockdowns began last spring, high school students in the class of 2020 realized pretty quickly that they’d be missing their proms and started creating new ways to mark their graduations. But few younger teenagers could have imagined that their lives would still be so limited by the pandemic a year later. Indeed, with different rules across the country, kids have had wildly varied experiences: Some schools have been operating in person and holding proms as usual, while for others, the spring of 2021 is not all that different from last year. And as more classic teenage milestones like Sweet Sixteens, prom and graduation were disrupted or canceled entirely, these kids have had to turn their losses into opportunities, forging new traditions with friends.

When Senior Year Was Supposed To Be ‘Your’ Year

“It’s hard to come to terms with the fact that we were told for the past three years, ‘Oh, just get to your senior year; it’s going to be a blast. You’ll have so much fun and it’s way easier,’” said Julia Weber, a senior in Athens, Ohio. “Now we’re doing school from our bedrooms with none of the fun.”

The missed milestone she’s most disappointed about is not having the opportunity to visit college campuses in person. “It’s really hard to make such a significant decision with a Zoom tour or just literally pictures that you found on Google of the campus,” she said.

Amaya Wangeshi, 17, of Justin, Texas, part of the Dallas-Fort Worth metroplex, has noticed an existential sentiment among her friends. “We feel lost in time,” the high school junior said, waxing philosophical about their experience. “It seems like time is moving through us rather than us moving through time. It’s a weird limbo.”

Tommy Sinclair, 17, of Worthington, Ohio, had to wait several months to get his driver’s license.Rich-Joseph Facun for The New York Times
Ms. Weber’s prom dress hangs in her room. “I was lucky enough to go with an upperclassman my freshman year,” she said. “So I have been once, but a lot of my classmates have never been and might not ever go.”Rich-Joseph Facun for The New York Times

Like Ms. Ebbenga, she also missed out on having a special 16th birthday celebration last year.

“My 16th birthday passed and I didn’t do anything,” she said. “It was a shock because it’s just one of those things you think about when you’re little. Because of media, everyone is like, ‘Sixteen, sixteen, sixteen.’ It’s supposed to be such a big deal.”

Getting her driver’s license was another rite of passage that didn’t go as planned. DMV closures in Texas meant she had to wait nearly a year to take her test.

“It was really frustrating,” said Ms. Wangeshi. “It sounds childish but I think a lot of people look at their life by reaching certain milestones. It’s just a natural tendency in the way we sort time and also the way we also consider achievement.”

New Traditions — Despite the Disappointments

While his delay wasn’t as long as Ms. Wangeshi’s, Tommy Sinclair, 17, of Worthington, Ohio, had to wait several months to get his driver’s license. However, as a member of his school’s theater repertory program, reimagining a school musical was a greater hurdle. Instead of performing “Annie” in front of a live audience, Mr. Sinclair’s school opted to film the year’s productions and sell tickets online for virtual viewings on YouTube.

“It’s just so different to not be performing in front of an audience,” said Mr. Sinclair, who noted that wearing masks, while necessary, was a challenge because the actors couldn’t show facial expressions. “It takes away from some of the fun, but it’s also a lot better than not doing anything at all.”

Ms. Ebbenga had to adapt when it came to her (now virtual) spring musical as well. For many students like herself, keeping traditions alive in 2021 means finding creative workarounds.

Sarah Abdella, 17, left, and Julia Weber, 18, right, eat take-out food at a bonfires as a way to catch up with friends who she hasn’t seen “in months, if not a year.”Rich-Joseph Facun for The New York Times
One of Tommy Sinclair’s losses this year was performing in his school musical in front of live audiences. The show was virtual instead.Rich-Joseph Facun for The New York Times

In prepandemic times, the cast and crew of Ms. Ebbenga’s thespian club would link arms in a ritual called “circle” minutes before the start of each show. Individuals take turns speaking, whether it’s sharing words of encouragement or sentimental memories. This year, they’re planning to do “circle” over a Zoom call with everyone on camera.

“We have to keep that tradition alive because it’s the essence of our thespian club,” Ms. Ebbenga said.

Mr. Sinclair, who is part of his school’s student council, is currently hard at work to make his junior prom as “Covid-friendly” as possible, which includes separating attendees into groups and setting up activities in different parts of the school such as having dancing in the gym, photo booths in the hallways, a movie playing in one section and a cotton candy machine.

For other students, school dances and social events aren’t a possibility. But that hasn’t stopped them from wanting to create new memories during what has been a largely disappointing year. Some parents are taking prom into their own hands by planning unofficial ones that are not affiliated with their schools.

Because her senior prom was canceled, Ianne Salvosa, 18, of Lake St. Louis, Mo., is making her own version with friends.

“A lot of people are actually just buying dresses, taking pictures, and going out to dinner with their friends, which is something I’m trying to plan to do,” she said.

Goodbye Prom, Hello Picnics

For Ms. Weber, hosting small socially distanced bonfires has been a way to catch up with friends who she hasn’t seen “in months, if not a year.”

“Obviously, that’s not necessarily a milestone, but I do think in this incredibly uneventful — from a school perspective — year, this’ll be what I look back on and be like, ‘Oh, that was the biggest social event: sitting at a fire with three people in my backyard,’” Ms. Weber said.

Ms. Ebbenga plans to incorporate backyard bonfires into future hangouts with friends even after they are all vaccinated, which is quickly becoming a reality for teens as more states open up their eligibility requirements.

“It’s really sweet,” she said. “Everyone’s outside and cold, but we have blankets and we’re together and that’s what makes it the best.”

“It’s just so different to not be performing in front of an audience,” Mr. Sinclair said. “It takes away from some of the fun, but it’s also a lot better than not doing anything at all.”
“It’s just so different to not be performing in front of an audience,” Mr. Sinclair said. “It takes away from some of the fun, but it’s also a lot better than not doing anything at all.”Rich-Joseph Facun for The New York Times

Ms. Salvosa has been having outdoor sushi picnics with her friends so that they have more room to keep safe distance.

Another way she stays connected to friends, maintaining a sense of normalcy and forming new traditions is by watching movies together using Teleparties, a browser extension that lets people use streaming TV services together. Ms. Salvosa and her friends use the chat feature to add commentary in real time. And thanks to outdoor team sports like lacrosse and cross-country, many student athletes have still been able to safely compete and root for one another.

While it’s ultimately not the year these kids wanted, it is one nobody will forget.

“It’s just knowing that I had to go through something that’s going down in history books and that other kids are going to have to learn about in the future,” Mr. Sinclair said. “It’s just weird. This is definitely not the high school experience I expected.”

Eating Disorders in Teens Have ‘Exploded’ in the Pandemic

Here’s what parents need to know.

As a psychologist who cares for adolescents I am well aware of the prevalence of eating disorders among teenagers. Even still, I am stunned by how much worse the situation has become in the pandemic.

According to the psychologist Erin Accurso, the clinical director of the eating disorders program at University of California, San Francisco, “our inpatient unit has exploded in the past year,” taking in more than twice as many adolescent patients as it did before the pandemic. Dr. Accurso explained that outpatient services are similarly overwhelmed: “Providers aren’t taking new clients, or have wait-lists up to six months.”

The demand for eating disorder treatment “is way outstretching the capacity to address it,” said the epidemiologist S. Bryn Austin, a professor at the T.H. Chan School of Public Health and research scientist in the Division of Adolescent and Young Adult Medicine at Boston Children’s Hospital. “I’m hearing this from colleagues all across the country.” Even hotlines are swamped. The National Eating Disorders Association helpline has had a 40 percent jump in overall call volume since March 2020. Among callers who shared their age over the last year, 35 percent were 13 to 17 years old, up from 30 percent in the year before the pandemic.

What has changed in the pandemic?

There are several possible explanations for this tsunami of eating concerns in teenagers. When adolescents lost the familiar rhythm of the school day and were distanced from the support of their friends, “many of the things that structured a teenager’s life evaporated in one fell swoop,” said Dr. Walter Kaye, a psychiatrist and the founder and executive director of the eating disorders program at University of California, San Diego. “People who end up with eating disorders tend to be anxious and stress sensitive — they don’t do well with uncertainty.”

Further, eating disorders have long been linked with high achievement. Driven adolescents who might have normally poured their energy into their academic, athletic or extracurricular pursuits suddenly had too much time on their hands. “Some kids turned their attention toward physical health or appearance as a way to cope with anxiety or feel productive,” Dr. Accurso said. “Their goals around ‘healthy’ eating or getting ‘in shape’ got out of hand” and quickly caused significant weight loss.

For some, an increase in emotional eating in the pandemic has been part of the problem. Attending school from a home where food is constantly available may lead some young people to eat more than usual as a way to manage pandemic-related boredom or stress. “Being at school presents a barrier to using food as a coping mechanism; at home, we don’t have that barrier,” noted Kelly Bhatnagar, psychologist and co-founder of the Center for Emotional Wellness in Beachwood, Ohio, a practice specializing in the treatment of eating disorders.

In many households the pandemic has heightened food insecurity and its attendant anxieties, which can increase the risk of eating disorders. Research shows that, compared to teenagers whose families have enough food, those in homes where food is scarce are more likely to fast, to skip meals, and to abuse laxatives and diuretics with the aim of controlling their weight.

The Instagram influence

What teens see on their screens is also a factor. During the pandemic, teenagers have spent more time than usual on social media. While that can be a source of much needed connection and comfort, scrutinizing images of peers and influencers on highly visual social media has been implicated in body dissatisfaction and disordered eating. Dr. Austin noted that teenagers can be prone to comparing their own bodies to the images they see online. “That comparison creates a downward spiral in terms of body image and self-esteem. It makes them more likely to adopt unhealthy weight control behaviors.”

When adolescents take an interest in managing their weight, they often go looking for guidance online. Indeed, a new Common Sense Media survey found that among teenagers who sought health information online between September and November of 2020, searches on fitness and exercise information came second only to searches for content related to Covid-19 — and ahead of searches on anxiety, stress and depression.

What young people find when they go looking for fitness information can be highly problematic. They are likely to come across harmful “thinspiration” and “fitspiration” posts celebrating slim or sculpted bodies, or even sites that encourage eating disordered behavior. Worse, algorithms record online search information and are “deliberately designed to feed harmful weight loss content to users who are already struggling with body image,” such as advertisements for dangerous diet supplements, Dr. Austin said.

When to worry

With so many forces contributing to teenagers’ body dissatisfaction and eating disordered behavior, how do parents know when to worry?

Parents should be alarmed, Dr. Kaye said, “if your child suddenly loses 10 to 20 pounds, becomes secretive about eating, or if you are seeing food disappear,” as becoming furtive about what, how and when one eats is a common occurrence in anorexia, bulimia and other eating disorders.

Experts agree that adults should be on the lookout for behaviors that veer from previous norms, such as suddenly skipping family meals or refusing to eat food from entire categories, such as carbohydrates or processed foods. Worth concern, too, is the teenager who develops fixations such as carefully counting calories, exercising obsessively or hoarding food, which may be a sign of a binge eating disorder. Parents should also pay close attention, said Dr. Accurso, if adolescents express a lot of guilt or anxiety around food or eating, or feel unhappy or uncomfortable with their bodies.

According to Dr. Bhatnagar, the view of eating disorders as a “white girls’ illness” can keep teens who are not white girls from seeking help or being properly screened for eating disorders by health professionals, even though eating disorders regularly occur across both sexes and all ethnic groups.

“Boys are having the same troubles,” said Dr. Bhatnagar, “but heterosexual boys may talk about body image a little differently. They tend to talk in terms of getting fit, getting lean or being muscular.”

Dr. Austin also noted that it is common to see elevated rates of eating disorders in lesbian, gay and bisexual youth of all genders as well as transgender and gender diverse young people.

“Eating disorders,” Dr. Accurso said, “don’t discriminate.”

How to help

Research shows that early identification and intervention play a key role in the successful treatment of eating disorders. Accordingly, parents who have questions about their teen’s relationship with eating, weight or exercise should not hesitate to seek an evaluation from their pediatrician or family health provider. Trustworthy eating disorder information, screening tools and support can also be found online. And when necessary, online resources can provide guidance and support to those on treatment waiting lists. “It may not be ideal for many,” Dr. Kaye said, “but it’s the reality of the situation we’re in.”

Parents can also take steps to reduce the likelihood that an eating disorder will take hold in the first place. Experts encourage adults to model a balanced approach to eating and to create enjoyable opportunities for being physically active while steering clear of negative comments about their teenager’s body or their own. Parents should also openly address the dangers of a ubiquitous diet culture that emphasizes appearance over well-being, creates stigma and shame around weight and links body size to character and worth. As Dr. Accurso noted, “We are not defined by a number on a scale.”


Where to find help

The National Eating Disorders Association, or NEDA, is a good starting place. It supports individuals and families affected by eating disorders.

F.E.A.S.T. is an international nonprofit organization run by caregivers of those suffering from eating disorders, meant to help others.

Maudsley Parents was created by parents who helped their children recover with family-based treatment, to offer hope and help to other families confronting eating disorders.

The Academy for Eating Disorders offers many resources, as do the Eating Disorders Center for Treatment and Research at University of California, San Diego, and the Eating Disorders Program at Boston Children’s Hospital.


Anti Asian Hate Books

Books make great educational resources to combat discrimination and xenophobia, and to foster activism.

After a year with a marked increase in discrimination and harassment aimed at Asian-Americans across the country, the past few months have been particularly shocking, in both the frequency and violence of attacks.

A powerful way to fight racism is education. Conversations about prejudice with your children starting at a young age go a long way toward building empathy and acceptance, and books can be a great tool for sending important messages. This list of 10 fiction, nonfiction and comic books will help kids of all backgrounds understand and combat this wave of anti-Asian hate and bullying, and provide more context to America’s history of discrimination.

Children’s Books

“My Footprints,” by Bao Phi; illustrated by Basia Tran
In this snowy yet colorful picture book, little Thuy uses her imagination to recover from a bullying incident at school, with help from her two mothers. Ages 4 to 7.

“My Name is Bilal,” by Asma Mobin-Uddin; illustrated by Barbara Kiwak
Bilal tries to hide his Muslim identity at his new school while his sister, Ayesha, is harassed for wearing a head scarf. A book, persuades Bilal to embrace his faith publicly and gives him the courage to stand up to the school bully. Ages 6 to 9.

“Inside Out & Back Again,” by Thanhha Lai
This novel in verse spends a year with 10-year-old Ha and her family as they flee war-torn Saigon and start a new life in Alabama. Ha weathers bullying from classmates for her appearance and limited English skills until she pushes back. Ages 9 to 12.

“Count Me In,” by Varsha Bajaj
Karina and Chris have been neighbors for years, yet their families have never spoken until Karina’s Indian-American grandfather volunteers to tutor Chris in math. When the grandfather is attacked by a stranger while walking, the students work together to heal and overcome the hate. Ages 9 to 12.

“Fred Korematsu Speaks Up,” by Laura Atkins and Stan Yogi; illustrated by Yutaka Houlette
The story of the civil rights activist Fred Korematsu is told in poems chronicling his experiences of racism as a child and his long fight for justice. This biography includes passages about the country’s history of discrimination, the impact it had on Japanese-Americans and resources for young activists. Ages 9 to 12.

Teenage Nonfiction Books

“They Called Us Enemy,” by George Takei, Justin Eisinger and Steven Scott; illustrated by Harmony Becker
In this graphic memoir, the “Star Trek” actor and activist George Takei recounts his harrowing childhood and his family’s traumatic experience being uprooted from Los Angeles and being taken to three World War II internment camps. Ages 12 and up.

“From a Whisper to a Rallying Cry: The Killing of Vincent Chin and the Trial that Galvanized the Asian American Movement,” by Paula Yoo
In 1982, Vincent Chin was celebrating his bachelor party at a bar when an argument with two white men turned fatal. Chin’s death and the light criminal sentences his killers received incited national protests and a federal trial. Yoo’s comprehensive account sheds new light on the tragedy and its legacy. Ages 13 and up.

Teenage Graphic Novels

“Displacement,” by Kiku Hughes

In this science-fiction story inspired by her family, the teenage Kiku Hughes time-travels to the 1940s and finds herself trapped in the same World War II internment camp as her grandmother. There, Kiku gets a life-altering history lesson. Ages 12 and up.

“Superman Smashes the Klan,” by Gene Luen Yang, art by Gurihiru

Based on a 1946 Superman radio series, two Metropolis teenagers experience racism and attacks from the Ku Klux Klan when their family moves from Chinatown to the suburbs. Ages 12 and up.

“Flamer,” by Mike Curato

Boy Scout summer camp is fraught with anxiety for the teenager Aiden Navarro when he is bullied for his Filipino heritage, while questioning his religion and sexuality. This graphic novel is a moving story about self-discovery and survival. Ages 14 and up.

Emerging From the Pandemic With Acne, Facial Hair and Body Odor

Young people experiencing the body changes of puberty without being in school are facing a unique set of challenges. Here’s how parents can support them.

A pediatrician friend saw a 10-year-old girl recently, for her yearly checkup. Like so many children (and so many adults) among us, she had gained a little extra weight over the past year, but she was fundamentally healthy. “The mom says to me, ‘You know, she’s very self-conscious, she’s developed over this last year, and none of her friends have, and it makes her so uncomfortable and it makes her sad,’” said the pediatrician, Dr. Terri McFadden, a professor of pediatrics at Emory University School of Medicine.

The child had been attending virtual classes, and she was worried about going back into the classroom looking different; her mother had tried to explain to her that different people develop at different rates, Dr. McFadden said, but “she just felt she wasn’t normal, she wasn’t like her friends.”

Most of the children in Dr. McFadden’s practice have been out of school for a full year, she said, and while many are eager to return to their friends, some are anxious about going back. Many have gained a significant amount of weight, which alone can make them worried about how they may be received by their peers. “School can be cruel,” Dr. McFadden said.

While some schools have already gone back to in-person classes, circumstances vary across the country. Many children in the public school system in Atlanta, where Dr. McFadden practices, have been at home for more than a year. Some may be returning to school in bodies that have morphed over months at home, and while classmates may have noticed certain developments like a cracking voice, acne or facial hair on Zoom screens, other changes will be much more evident in person.

“I definitely have seen a lot of people with a lot of weight gain and worry about going back,” said Dr. Holly Gooding, the head of adolescent medicine at Emory University School of Medicine. She always asks teenagers how school is going, she said, and nowadays, many of them say they’ll be going back in the fall. That presents an opportunity to ask more specifically about re-entry, she said, and open up the subject of body image.

Dr. Chanelle Coble, an adolescent medicine specialist at N.Y.U. Grossman School of Medicine, said that young people are experiencing the body changes of puberty without the supports they would usually get from their peer group, and that is part of the general stress of the pandemic year. In her New York City practice, Dr. Coble said that she has seen higher than usual rates of severe anxiety and depression, as well as disordered eating, including among 11-, 12- and 13-year-olds.

Some of these were children who gained weight early in the pandemic, and then, perhaps in reaction, started restricting their eating. In some, the weight loss has been so severe that they have stopped growing, or stopped menstruating.

“Puberty is a general time of angst for people,” said Dr. Jennifer Miller, a pediatric endocrinologist at the Ann & Robert H. Lurie Children’s Hospital of Chicago, and an assistant professor of pediatrics at the Northwestern University Feinberg School of Medicine. It’s a stage when adolescents tend to be sensitive about changes in their bodies and how others perceive those changes, and the anxieties of returning to school — or more generally to life after lockdown — make that more pronounced.

Dr. Jami Josefson, a pediatric endocrinologist at Lurie Children’s Hospital and an associate professor at Northwestern, said that going back to school after being out may be like seeing a relative you haven’t seen in a long time — there will always be comments about how the child has grown and changed.

Some children will be taller, some will be more developed, some boys will have changing voices while others won’t. “This is all a normal part of going through adolescence, but it might seem a little more sudden,” Dr. Josefson said.

Families should talk with children about how these changes are normal, about how everyone’s body changes, but not in unison. Dr. Coble suggested, “start with the basics, how are you eating, how are you sleeping?”

If your children have been truly isolated, think about helping them ease back in — perhaps by encouraging them to spend socially distanced time outside with one good friend. Pandemic or no pandemic, children and families need reliable information about puberty. Dr. Adiaha Spinks-Franklin, a developmental behavioral pediatrician at Texas Children’s Hospital and an associate professor at Baylor College of Medicine, sends families to Amaze.org, which has videos aimed at kids, and to the Healthy Bodies Toolkit site developed by Vanderbilt University.

Even in nonpandemic times, life is often harder for early developers, who remain emotionally and intellectually the same age as their peers, but who may look significantly older. Dr. Carol Ford, a professor of pediatrics and division chief of adolescent medicine at the Children’s Hospital of Philadelphia, said that the children who develop early always need more support, and that may be particularly true now, when the changes may be starker after an interval away. Parents need to be ready to have concrete and detailed conversations about issues like personal hygiene (yes, your sweat starts to smell different) and the developments still to come (menstruation, wet dreams).

Some adolescent specialists have raised questions about whether the emotional intensity of lockdown and the pandemic year may actually have contributed to early puberty; Dr. Spinks-Franklin said, “I’ve had quite a few of my girls start their periods during the pandemic.” She has wondered whether stress has had something to do with that, or whether it is just regular development.

One preliminary analysis out of Italy that was published in March suggested that referrals for early puberty in girls were significantly increased during the first six months of the pandemic, compared to the same six-month period of 2019. From March to September of 2020, 246 children, almost all girls, were referred to Bambino Gesù Children’s Hospital in Rome to be evaluated for suspected precocious puberty, compared to 118 during the same months of 2019. The authors raised questions about the possible links to stress, higher caloric intake and increased screen use, to be addressed with further research.

If you think your child might be developing too early, schedule an appointment for an in-person checkup, and ask their pediatrician to discuss issues of puberty and body image. After the 10-year-old’s mother brought up the subject, Dr. McFadden talked with her patient, reinforcing the message that the body changes of puberty are normal and healthy. She talked with the mother about speaking with the child’s teachers, “so there will be a cadre of folks looking out for her as she re-emerges into in-person school.” And she and the mother discussed the risks that can attend early development in girls, who may be taken for older than they are, or preyed upon.

Make sure that your child has clothes that fit her changing body and doesn’t seem to be popping out of too-short pants or too-tight shirts, which will draw attention to the changes. Talk about whether a child developing breasts wants to wear a camisole or bra. Talk through the logistics of getting your period at school, and make sure she knows where to go if she needs help or supplies.

Though Dr. Miller sees patients for puberty-related questions and problems, her own sense of puberty during the pandemic also reflects her experience as a parent. “We have an 11-year-old daughter who is emotionally a roller coaster,” she said. Her daughter’s school recently had the “puberty talk,” in person, and her daughter reported, “The best part was being in one room with all the girls.”

Her daughter then asked her pediatric endocrinologist mother why anyone needed to be a doctor focusing on puberty, Dr. Miller said, “Since all I do is talk about how it’s a completely normal thing for your body to go through.”

Tools to Help Teens Talk About Sexual Assault and Harassment

A sex ed teacher talks about how young people can try to keep themselves safe from sexual assault and be allies to others.

I was making lunch when my 17-year-old son sat down at the kitchen table. “Hey Mom, is this real?” he asked, and showed me an Instagram post that read: “97% of young women have experienced sexual harassment. If you are surprised, then you’re probably not listening.”

I asked to take a closer look and he handed me his phone. The statistic wasn’t completely accurate but it was close. It was pulled from a British study that found that among women aged 18 to 24, 86 percent had been harassed in public spaces, 3 percent didn’t recall ever having experienced sexually harassing behavior, and 11 percent chose not to answer the question. There was more to the post; when I swiped left, it demanded: “Boys do better.”

“What do I do with that?,” my son asked. “What does that mean?”

It was a good question.

Posts like the one my son showed me have been all over social media since the death of Sarah Everard, the young British woman who was kidnapped and killed several weeks ago (a police officer has been charged).

As a high school sex educator, working both in person and remotely as a national consultant, I talk to young people all over the country. The posts they see include statistics about sexual harassment, sexual assault and rape that my students describe as “devastating” and “terrifying.”

When I asked some of my students and other teens I know about the statement “Boys do better,” several boys said they felt “attacked” or “hopeless” because it feels as if they are being accused of perpetrating crimes they haven’t committed. Many say they consider themselves a “good guy” and want to help, but don’t know how.

According to another survey, this one done in the United States, 87 percent of 18- to 25-year-old women reported having experienced sexual harassment. The report found that 76 percent of respondents (72 percent male, 80 percent female) had never had a conversation about how not to harass, or express other forms of misogyny. The National Violence Resource Center concluded that one in four girls and one in six boys is sexually abused by the age of 18. We also know that boys experience sexual abuse not only at the hands of men, but in some cases, girls and women. And a large number of those who experience sexual assault are gay, lesbian, bisexual or transgender.

So, yes, sexual violence is a significant problem. Chalina Morgan-Lopez, 17, from Raleigh, N.C., who told me she had been repeatedly harassed and grabbed at school, said: “It made me feel powerless and like an object. I felt uncomfortable and unsafe in my classes with my harassers.”

When I teach, there are certain questions about sexual assault that teenagers always ask. They want to know, “How do I keep myself safe?” “How can I be a supportive friend and ally?” They also want to know, “What’s the deal with drunk sex?” Here are some answers to those questions.

Promote respect

Speak up about objectifying and dehumanizing language, whether in the media or in school hallways. During Donald Trump’s presidential campaign in 2016, he dismissed his vulgar comments about grabbing women as “locker room banter.” The incident heightened awareness of the way that talking about women as sex objects normalizes sexual harassment and may contribute to sexual assault.

Amanda Ehrenhalt, a 16-year-old who lives in Philadelphia and plays field hockey and track and field, said, “Locker room talk isn’t made up. It’s for real. As an athlete who is around other athletes, I hear it all of the time.” If you hear someone talking about sex in a demeaning way, you might say, “Hey, let’s keep it respectful,” or “What do you mean by that?”

Take care of yourself

As you go through adolescence, it’s important to understand consent. Your body and sexuality belong to you. Just because you say yes to one form of sexual activity, doesn’t mean you’ve said yes to another. You and your partner have to agree about what you’re doing together and whether to take things to a new level. You also have the right to change your mind at any time and choose not to move on or even to stop the activity altogether.

If you choose to be sexual with someone else, know how to manage what’s going on. You can say “No,” “This is making me uncomfortable,” or “Let’s go back to what we were doing before.” If you don’t feel you can say something directly, you can make up an excuse: “I forgot that I’m supposed to be home early — I have to go.” If the person you are with continues to try and persuade you or is just not listening, you can say, “If you continue you will be assaulting/raping me.”

We all deserve to be treated with dignity and enjoy our romantic and sexual relationships with others. If you are sexually active, you have to ask the person you’re with to make sure your interactions are welcome, and keep on asking. It can be as simple as, “you good?” or “this OK?” Pressuring, manipulating, pushing or talking someone into saying yes to sexual activity is not a “yes” or consent. It is coercion and potentially illegal.

Remember that federal law recognizes that someone who is incapacitated by alcohol or drugs is legally incapable of giving consent. Each state has its own laws, as well.

Put simply, getting someone drunk so they will have sex with you could land you with a criminal charge or in jail.

And, if you are the one who is assaulted, no matter what choices you make, what you are wearing or consuming, it is not your fault.

Step in to help others

There are several ways to be a supportive friend or an ally to someone who has experienced sexual harassment or assault. They include raising awareness, speaking up when you see or hear suspicious, risky or dangerous behavior and being compassionate to survivors.

Ramis Banuri, 19, of Salt Lake City, Utah, said he speaks up whenever he can, and tries to get others to do the same. “People don’t necessarily want to intervene because there’s this notion that it’s not your business and they don’t want to embarrass themselves if they misread a situation, he said. “I tell them ‘would you rather be embarrassed for a moment about a small situation that nobody will really remember, or be sorry because you were right and could have prevented someone from getting hurt?’”

Bystander intervention is a strategy for preventing harassment and assault from happening or continuing. The goal is to disrupt what feels like a loaded moment before things can escalate. Every situation is different and there is no single way to intervene, but here are some guidelines from the Green Dot program, a widely used bystander intervention training system, which encourages people to act using what are called the Three Ds.

Direct intervention is straightforward. If someone uses sexist language or makes someone uncomfortable with sexual comments or jokes, you could say, “Hey, that’s making people uncomfortable — that’s harassment. Stop.” Or “You’ve had way too much to drink. You’re in no shape to even think about hooking up — let’s get you home.”

You can also interrupt a risky dynamic with a distraction. If someone is making another person uncomfortable with their attention, you could say, “Hey, the guys are looking for you downstairs. Let’s go see what’s up.”

In other situations, you may delegate to someone else who has more training, authority or social leverage and may be more effective at intervening.

If you see someone you don’t know well acting inappropriately, tell the people they came with and encourage them to intervene. If you witness a couple fighting and it seems to be getting physical, find a trusted adult or authority figure, or call the police.

If you or a friend are harassed or assaulted, the National Sexual Assault Hotline can provide information and guidance.

Ms. Morgan-Lopez took steps to be proactive: “I began by forming a small group of students at my school who were also passionate about targeting this issue, and we connected with local organizations who offered us trainings in sexual assault.”

Mr. Banuri also had training through a peer-led sex education program. He said what inspires him is knowing that “I am doing the right thing — that reaffirms my values: community, connection, family and friendship. That’s affirming and strong — helping people stay safe.”

Shafia Zaloom is the author of “Sex, Teens and Everything in Between.”

Teenage Brains May Be Especially Vulnerable to Marijuana and Other Drugs

Teenagers are more likely to get hooked on marijuana, stimulants and other recreational drugs than college-aged or older adults.

Adolescents and teenagers who experiment with marijuana and prescription drugs are more likely to get hooked on them than young people who try these drugs for the first time when they are college-aged or older, according to a new analysis of federal data.

The research suggests that young people may be particularly vulnerable to the intoxicating effects of certain drugs, and that early exposure might prime their brains to desire them. The findings have implications for public health policymakers, who in recent years have called for increased screening and preventive measures to reverse a sharp rise in marijuana vaping among teenagers.

The new study, published in JAMA Pediatrics and led by a team of scientists at the National Institute on Drug Abuse, sought to gain a better understanding of how adolescent brains respond to a variety of recreational drugs. Previous research suggested that early exposure to marijuana, nicotine and alcohol might lead to faster development of substance use disorders. But the new analysis cast a wider net, looking at the effects of nine different drugs, including opioid painkillers, stimulants, marijuana, alcohol, cigarettes, cocaine, heroin, methamphetamine and tranquilizers.

The researchers used data from the government’s National Survey on Drug Use and Health, a closely watched annual study that tracks substance use and mental health issues among Americans. The new research focused on two age groups: adolescents between the ages of 12 and 17, and young adults aged 18 to 25. Alcohol was by far the most commonly used substance in both groups: A quarter of adolescents and 80 percent of young adults said they had used it. About half of young adults said they had tried cannabis or tobacco. But among adolescents, that number was smaller: Roughly 15 percent said they had experimented with cannabis, and 13 percent said they had tried tobacco.

Most troubling to the authors of the new study was how many people went on to develop a substance use disorder, indicating that their experimentation had spiraled into an addiction. The researchers found that within a year of first trying marijuana, 11 percent of adolescents had become addicted to it, compared to 6.4 percent of young adults. Even more striking was that within three years of first trying the drug, 20 percent of adolescents became dependent on it, almost double the number of young adults.

Adolescents who tried prescription drugs were also more likely to become addicted. About 14 percent of adolescents who took prescription stimulants for recreational use went on to develop a substance use disorder within one year, compared to just 4 percent of young adults. And while 7 percent of young adults who tried opioid painkillers became addicted soon after taking them, that figure rose to 11.2 percent among younger users.

For alcohol and tobacco, however, there was not much of a difference between the two age groups: Both older and younger youth had a similar rate of developing a substance use disorder. And for illicit drugs such as cocaine and heroin, the number of adolescents using them was too small for the researchers to draw any meaningful conclusions.

One possible explanation for the findings is that young people who have a greater predisposition to developing an addiction may be more likely to seek out illicit drugs at an earlier age. But Dr. Nora Volkow, a senior author of the new study and the director of NIDA, said it is known that cannabis and other drugs can have a potent effect on adolescent brains because they are still developing. Younger brains exhibit greater plasticity, or ability to change, than the relatively static brains of older individuals. As a result, drugs like cannabis are more likely to alter synaptic connections in younger brains, leading to stronger memories of pleasure and reward.

“It’s a learning process when you become addicted,” said Dr. Volkow. “It’s a type of memory that gets hard-wired into your brain. That occurs much faster in an adolescent brain.”

Studies show that regularly using marijuana can affect cognition in adolescents, leading to impairments in parts of the brain that are involved in learning, reasoning and paying attention. Yet in recent years the booming popularity of e-cigarettes has led to a sharp increase in the number of adolescents who vape nicotine and marijuana, a trend that has alarmed public health officials. Some studies suggest that adolescents may also be more likely to try marijuana as more and more states legalize its recreational use.

Dr. Volkow said that as states implement new marijuana regulations, policymakers should work on measures aimed at protecting adolescents. She stressed that pediatricians and dentists should screen for drug use in their young patients by asking them about it. And she cautioned parents not to dismiss marijuana use in teens and adolescents as something that is harmless.

“As it relates to marijuana, the drugs that were available when parents today were teenagers are very different from the drugs that are available now,” she said. “The content of THC is much higher, and the higher the THC content, the greater the risk of adverse effects.”

Teenagers, Anxiety Can Be Your Friend

Think of it as a personal warning system that will help you notice when things are on the wrong track.

For many teenagers, anxiety is riding high these days.

A new report from the University of Michigan’s C.S. Mott Children’s Hospital National Poll on Children’s Health found that one in three teen girls and one in five teen boys have experienced new or worsening anxiety since March 2020.

And a year into the pandemic, there’s certainly plenty to worry about. Maybe you’re feeling nervous about catching or spreading Covid-19, or about returning to in-person school. You might be feeling tense about where things stand with your friends or perhaps you’re on edge about something else altogether: your family, your schoolwork, your future, the health of the planet.

While I wish there were fewer reasons to be anxious right now, I do have good news for keeping yourself steady. Psychologists actually understand a lot about anxiety — both the mechanisms that drive it and interventions that get it under control — and what we know is quite reassuring. So if you’re looking to feel more at ease, start by letting go of these common myths.

Myth: I’d be better off if I never felt anxious.

Without question, anxiety feels bad — it’s no fun to have a pounding heart, sweaty palms and tightness in your chest — and for that reason, it’s easy to assume that it must be bad. But the discomfort of anxiety has a basic evolutionary function: to get us to tune into the fact that something’s not right.

You can think of anxiety as the emotional equivalent of the physical pain response. If you accidentally touch a hot burner, the pain makes you pull your hand away. In the same way, if your friends want to take a Covid-safe outdoor event and move it into a cramped indoor space, you should feel a surge of discomfort. That odd feeling in the pit of your stomach will help you to consider the situation carefully and be cautious about your next step.

Try to view anxiety as your own personal warning system. It’s more often a friend than a foe, one that will help you notice when things are on the wrong track.

Given this, when is anxiety unhelpful? While most of the anxiety you feel is likely to be healthy and protective, psychologists agree that anxiety becomes a problem if its alarm makes no sense — either going off for no reason or blaring when a chime would do.

In other words, you should not feel anxious when all is well, and when you do feel anxious, the intensity of your nerves should match the scale of the problem before you. Feeling a little tense before a big game is appropriate and may even improve your performance. Having a panic attack on the sidelines means your anxiety has gone too far. It may be worth talking to a mental health care provider for advice on how to manage it, but first you can try the proven techniques below.

Myth: There’s not much I can do about anxiety.

You do not need to feel helpless when your anxiety alarm goes off, and even when anxious feelings cross the line from healthy to unhealthy, there’s a lot you can do to settle your nerves. Keep in mind that anxiety has both physical and mental components. At the physical level, the amygdala, a primitive structure in the brain, detects a threat and sends the heart and lungs into overdrive getting your body ready to fight or flee that threat. This is helpful if you’re dealing with a problem that calls for attacking or running — you’re about to miss the school bus and need to break into a sprint to catch it — but bothersome if your one-note-Johnny amygdala gets your heart pounding and your lungs hyperventilating while you’re trying to take a test.

A really good way to curb the physical symptoms of anxiety? Controlled breathing. Though it can sound like a daffy approach to managing tension, breathing deeply and slowly activates a powerful part of the nervous system responsible for resetting the body to its pre-anxiety state. There are many good breathing techniques. Find one that you like. Practice it when you’re feeling calm. Put it to work when your amygdala overreacts.

For the mental component of anxiety, watch out for thoughts that are extremely negative. Are you thinking, “I’ll probably get sick if I go to school,” or “I’ll never find someone to sit with at lunch”? Such intense pessimism will almost certainly set you on edge. Counter your own catastrophic thoughts by asking yourself two questions: Am I overestimating the severity of the problem I’m facing? Am I underestimating my power to manage it? Weighing these questions will help you keep your concerns at healthy levels.

Myth: If something makes me anxious, I should avoid it.

Understandably, if we’re scared of something, we’re inclined to stay far away from it. Avoidance alleviates anxiety in the short term, but here’s the rub: In the long term, avoidance entrenches it. There are two separate factors at work here. The first is that it feels great when we steer clear of the things we dread. If you’ve been doing school remotely this year and get nervous when you picture your return to in-person learning, resolving to stay home will cause your worries to instantly drain away. It’s human nature to want to repeat any behavior that leads to feelings of pleasure or comfort, but every boost of avoidance-related relief increases the likelihood that you’ll want to continue to avoid what you fear.

The second factor in the avoidance-feeds-anxiety double whammy is that you rob yourself of the chance to find out that your worries are exaggerated. For example, the realities of in-person school are sure to be more manageable than the harrowing scenarios your imagination can create. Going to school would likely bring your worries down to size.

Facing our fears can reduce anxiety. But you don’t have to dive into nerve-racking experiences when wading in is an option. If social distancing has left you feeling unsure about the status of your friendships, you might be tempted to isolate yourself. Instead, come up with a small first step, such as making a plan to hang out with just one or two buddies before returning to the broader social scene. Get your feet wet and then take it from there.

With the world beginning to open up, it makes sense that you might feel nervous about easing back into it. Knowing what’s true about anxiety — and not — will make it easier to navigate the uncertain times ahead.


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.