Supporting children in the struggle against COVID-19

In the United States and abroad, Coronavirus Disease 2019 (COVID-19) threatens our health, disrupts our routines, and undermines our financial and economic well-being. Diagnoses of anxiety in children were at a peak even before the coronavirus provided more cause for alarm. Watch (or read the transcript below!) this EmbraceRace conversation with Bay Area child psychologist Dr. Allison Briscoe-Smith, and Houston-based developmental behavioral pediatrician Dr. Adiaha Spinks-Franklin, about how parents, guardians, and other caregivers can best protect children in these difficult times. This conversation was recorded on 3/24/20.

EmbraceRace: We're so pleased to have two of our favorite doctors in the race and kids space with us tonight in conversation along with all of you joining us from all around the country.

Dr. Allison Briscoe-Smith is a child clinical psychologist who specializes in trauma and issues of race. She combines her love of teaching and advocacy by serving as a professor and by directing mental health programs for children experiencing trauma, homelessness or foster care. An adjunct professor at the Wright Institute, much of her work is with Bay Area schools and nonprofits as a clinician, consultant and trainer.

Dr. Adiaha Spinks-Franklin is a developmental behavioral pediatrician in the Meyer Center for Developmental Pediatrics at Texas Children's Hospital and an Associate Professor of Pediatrics for Baylor College of Medicine. Since 2018, she has led a team of multi-disciplinary, multi-ethnic pediatric professionals to conduct anti-racism workshops across the country. The workshops focus on racism as an Adverse Childhood Experience, training healthcare professionals to become “anti-racists,” and addressing the effects of racism during clinical encounters with patients.

EmbraceRace: You're in different parts of the country, I know things are changing really quickly. Adiaha, from where you are in Houston, what are you seeing? What's the COVID-19, or the corona virus situation, and especially how it's being experienced, not only by you, but the people you serve?

Dr. Adiaha Spinks-Franklin: Well, thank you for having me on as a guest. I've been a big fan of EmbraceRace for quite some time.

The Houston area, as the state of Texas, has been rather delayed in the public health response to the COVID-19 pandemic. And as a result, we haven't had the type of systemic closures that you see in other parts of the country. We're getting there now. This week has been a pivotal week, in various cities, encouraging people to remain home. It's been done step-by-step. First we had school closures, then restaurants went from in-dining to to-go-dining, grocery stores are trying to remain stocked, because people are shopping and collecting toilet paper, we don't know why.

And then today, the City of Houston, and the surrounding county that Houston is in, gave a stay at home order starting at midnight tonight. With families that I've spoken with, they've all had very different experiences. We have a large oil industry here, so because of the international conflicts regarding oil, I've had parents be furloughed from their jobs due to the oil industry. But then another parent, even in the same family, will lose their job, or be laid-off because of COVID-19. So we're already seeing economic effects. We've been seeing those for about two weeks, at least among my patient population.

Some of the children have had worries, concerns, a lot of questions. Parents have been pretty good at fielding their children's questions appropriately, and trying to seek evidence-based information with scientific facts from the CDC website. And I've been encouraging families to do that. Finally, schools locally are closed and they have started online schooling programs this week in the Houston area.

And so now families are having to adapt to having online learning. In some schools, the children face-to-face video conference with their teachers, at a specific time every day. And then there are other schools where children are receiving assignments just once a week, to turn in at their own pace. So everyone's trying to figure out what to do.

EmbraceRace: What are you seeing Allison?

Dr. Allison Briscoe-Smith: I'm calling from the Bay Area, from Oakland [California] in particular. We are a couple of weeks ahead, with this being our second full week of school closure, and actually it was last week Monday that, the Bay area went under shelter-in-place. So we're about two weeks, a week and a half ahead, and also have been having our kids out of school for two weeks now.

In [the mental health] sphere of work, we've been really having a challenge about how we are reaching out to folks. We've got a number of logistical challenges, making sure that we can engage in therapy and outreach. And that's namely about privacy over the phone or how to do telehealth.

So I'm part of communities that are trying to figure out how to make that work, and people are figuring out how to make it work. I'm finding clinically that a lot of our clients, that they're not necessarily finding the time for therapy right now, that there's more and other immediate needs that are more pressing. And that's not to say there aren't mental health needs, but showing up for a therapy appointment, even via Zoom, is falling to the bottom of the list, and other kinds of things, we're seeing a whole range of stuff happening clinically.

I think as Adiaha also spoke about, just the range of the economic impact, and our schools have not, at least in the Bay area, systematically moved to online, in terms of the public schools. We have a large population of kids that don't have online access. So I just got off a family-school call, where we're trying to figure out how to deliver hotspots and Chromebooks to families, and to try to make that work. And as such, we really haven't started online.

So a lot of our families, at least in the public-school arena, are hodgepodging it, and trying to figure out how to do this together, with some big challenges around kids that already have underlying anxiety, learning disorders, learning disability type of issues. That's a challenge. And I'm also now working with a lot of parents, and parents who are managing their own anxiety - or not! - in this moment. That's also what showing up.

EmbraceRace: You're both touching on a number of things already that we can identify. So there's the need to protect ourselves, and our children, and each other, and others from possibly contracting the disease. There are a different set of issues for parents, for children, for educators.

Number one, what are some of the basic guidelines you're offering your clients, and then the folks who you're interacting with, that we should all know? And what are some of the misunderstandings you're finding to be prevalent among the people that you're dealing with, if any? Adiaha, let me start with you. What are you seeing?

Make sure you're getting medically accurate, evidence-based information about COVID-19.

Dr. Adiaha Spinks-Franklin: I'm a developmental behavioral pediatrician in the Houston area, and I care for children with a variety of developmental disabilities and behavior disorders. And, what we're hearing from parents are a variety of levels of understanding. There are some parents that are getting information from social media that is not accurate. [See the World Health Organization's list of COVID-19 Myth Busters.] And so it's good for us to talk about that, and refer them to sources, where they can receive medically accurate, scientifically updated information [as from the CDC website.]

Dr. Allison Briscoe-Smith: There was one misconception that came out, that I think it's really important to disabuse, which is, I heard a number of people saying, "Well, I'm not hugging my kids anymore, because I don't want them to get infected." And I really want to challenge that. I know that that's a worry and concern, but actually especially for our little ones, we need to do what we can to make sure that we're safe. Of course, if you're in direct risk, you want to be thoughtful of that, but we need to be hugging our kids in our homes. We need to be providing with them with lots of extra love right now in this kind of moment. So, I'm worried about that [misconception]. I don't want that message to kind of spread.

Maintain a routine with your child(ren).

Dr. Adiaha Spinks-Franklin: One of the things I've asked parents to do, is to set up a schedule for their children and a routine. Because children do better when they have structure and routine. Children with developmental disabilities or behavior disorders, really struggle with adapting to changes, and having a day where there is no order and structure. When it's unpredictable, it really stresses them out. And one of the ways that children respond to stress, is through disruptive behaviors. Behavior is a form of communication, it has a meaning, and children are trying to tell us something. So when their behaviors escalate it's often a sign that the child is stressed, and it is up to the adults to figure out, how to reduce the child's stress. One easy way of doing it, is just having a simple schedule. Try to have consistent wake-up times, and bed-times, schedules for morning activities, schedules for meal times, and routine bedtime activities.

Dr. Adiaha Spinks-Franklin: I'm also recommending pairing up indoor, and outdoor activities, as long as they are engaging in social distancing, and remaining at least 6 to 10 feet away from other people. What I explained to folks is the reason we're recommending 6 to 10 feet is because that's how far a cough or sneeze can travel. And the COVID-19 virus is transmitted through those respiratory droplets that we expel when we cough and when we sneeze.

The other thing we talk about, or resources for hands-on activities that are really fun for families, I mentioned a website called Education.com. And they've got a wealth of hands-on activities, that are designed for children from preschool to fifth grade, and there are things like simple science projects, writing projects, reading projects, math activities, and they're literally hands-on things that families can do together.

Allow time for free play indoors and outdoors.

Dr. Adiaha Spinks-Franklin: I suggest pulling out the old game boxes, and dusting them off, and the card games, and sit on the floor, and actually play with your kids. If you give them 10 minutes of free play time, you're likely to see a lot less behavior problems down the road. And then I suggest simple walks. It could be a nature walk in the backyard, it can be anything that allows them to get some sunshine. It actually isn't good for children to spend a lot of time on screens, or in their rooms by themselves and not engaging in other activities. One of the things we are concerned about, as developmentalists, is the risk for anxiety and depression, when there is a prolonged disruption in the child's routine, and we don't want this stressful event, that is stressful for the entire country, to actually turn into a toxic stress. It doesn't have to become a toxic, dangerous stressor. It can be something that is tolerable, and manageable when your family supports you.

Take time for yourself.

Dr. Adiaha Spinks-Franklin: Finally, I asked parents to have a little, "Me time." Last week. I literally assigned coloring, to a mom who is caring for her aging parents, and her children who have disabilities. I had an extra coloring book, one of those really fancy mindful coloring books for adults. I got it at the dollar store. It was in my clinic room. I gave it to her, she said she had matte pencils at the house, I assigned her five minutes of coloring when everybody goes to bed and she put it in her phone. I said, "Put it in your phone now, otherwise you won't do it." Those little things.

EmbraceRace: Adiaha, Thank you for that. And Allison, I saw you nodding away. What are you telling folks?

Dr. Allison Briscoe-Smith: I think that the message that Adiaha is providing is really, really sound, and could bare repeating, but really, really listening to those.

I think the other kind of challenge is that we're really overwhelmed with a lot of resources. That's a blessing. But if I get another email with the 300 websites that I have to look out to improve my homeschooling, I might lose my mind. I don't know if anyone else is feeling that. I think you've got to pick a source. Pick a person that you really trust. Pick one thing that feels really good. Pick something. Because I think there's another kind of overwhelmed that a lot of folks are manifesting, if they become overwhelmed with information. That is something I get to come and speak about, from a place of economic privilege, but I'm also hearing about this in terms of folks that are really struggling. So listen to Adiaha, she's the medical professional here to listen to. Pick a person, to really, focus in on.

And then I think the last point, to really raise up, is that this is the time to reach for our oxygen mask as parents, that we really have to do that. And it's really easy for that to go out the window now. You were full-time working, and now you're full-time working and full-time parenting, at home and taking care of other folks. We moved my mother in. So now we've got a a 73-year-old, a 2-year-old, a 11-year-old, a 9-year-old, some other folks. All of that's kind of happening, so you have to do something. And I really like the idea of something small. Five minutes a day. But you have to have something that's five minutes that's yours. Reading an old book, putting on a pair of socks that you really like, taking a shower, whatever it is.

Dr. Allison Briscoe-Smith: But this is the time to reach for our oxygen mask, and as we both believe, we understand that our children are really thriving when we do well. And this is such a huge stressor that impacts us as parents, that we really have to work hard to be, well - not perfect, but well. That would be the piece that I would really like to emphasize. Any small, tiny thing, that we can do, that helps us is really important.

EmbraceRace, Melissa: I want to say that we did our first puzzle. As a family first ever, and it was good. And then Andrew stayed up late, finishing. I thought it was for the kids and then he was up 'till 1:00.

EmbraceRace, Andrew: I need more than five minutes Allison.

Dr. Allison Briscoe-Smith: Five minutes is just a reminder for us to try that. But if we can do more, even better.

But also I think it's just the conversation about, what's actually necessary for us to be of service. If you can feel like, "Oh, I can't possibly make a time for myself in this moment." Then chances are that our stress responses are up. Our ability to actually attend, to provide, and we're also talking about doing this in the context of really, all being in the same four walls together. Some of you all have big four walls, some of us have small four walls, but that's really important for us to think about... that we have to manage our stress as much as possible. Again, not perfectly, but attend to, and some graciousness with ourselves around it.

EmbraceRace: You both work in two of the most diverse parts of the country, and your population is quite diverse, but maybe majority are people of color, I'm not sure, kids of color. But I'm wondering what you're seeing, and if there's any difference you're seeing, and how families of color are being affected? And of course that would be true for families of East Asian descent as well.

Attend to our resilience as communities of color.

Dr. Allison Briscoe-Smith: The way that I'm seeing patients right now is really via telephone. I have to say, and I see some questions around that, our teens are uniquely adapted for that. In fact, my teen clients have been like, "Finally I get to talk to you by phone." So we're FaceTiming, we're doing all that kind of stuff. So I think there's a way that the teens have really moved to that. It's been much more complicated in the context of doing play therapy with an 8, 9-year-old or a 7-year-old. But you know what, we're figuring this out. A lot more of my work at this moment to be supporting parents, and parents of color.

In terms of the question about how this is impacting populations of color, when we talk about our disproportionate over representation amongst poverty, that's where it shows up, in terms of access to resources. The community that I really serve in, and live in, is predominantly Latinx, and migrant, and undocumented. And so the ability to get help from those checks from Trump, aren't going to come into my community in the same kind of way. So those economic pieces are really particularly challenging, for a lot of the families, but then there's also a piece, and this is my big drive, which is I think, we really need to attend to our resilience as communities of color. We've been through hard things before, we've been through, maybe not this, but as say it's the only reason I'm here as a black person, is because one of my ancestors survived the Middle Passage.

So an opportunity for us to really pay attention to our resilience, our strength. Our bodies are meant to handle extraordinary stress, so that's really a place that I'm trying to emphasize that. You also mentioned something I think is important, which is for us to pay attention to the ways in which our Asian brothers and sisters and folks are being impacted, by xenophobia and by racism. And to understand that it's coming out of fear, and that there are ways that we can stop it, by joining in, and being supportive, and explicitly addressing, common misperceptions, poor use of language, as evidenced by some of our administration.

Dr. Allison Briscoe-Smith: There are ways that we can do this that don't actually incite fear, because what none of our kids need right now is to be afraid of other people. And that's not what this is. I think there's a way that we can really support each other in this, and also come back to our unique resilience, as folks that know how to live through oppression, and war, and famine. There're all the people here on this webinar. Think back to your great grandfather, great grandmother. Somebody went through a thing. So let's pay attention to that.

EmbraceRace: I love that. And it's a moment to talk to those people – those great greats and grandparents. If they can be called or reached …

Dr. Allison Briscoe-Smith: Mm-hmm.

Dr. Adiaha Spinks-Franklin: I am amen-ing Allison over here in Texas. That is exactly the message I've been giving to families. Your ancestors survived the depression. We collectively survived the Great Recession, and we can survive this too. I'm so thankful for you bringing up the concept of resilience, and really recognizing your own resilience, and the resilience of your children. There's this the ability to overcome, and to bounce back.

Address racist terminology and misconceptions.

Dr. Adiaha Spinks-Franklin: With regards to how this pandemic has affected families of color in our region.. Houston is a very diverse region. In general, it's about 25% of the four major groups: Black, White, Latinx, and Asian American, including East and South Asians. One of the first things that happened was, our impact on our Asia town, our Chinatown, and businesses being hit because of the racist misconception, that if you go to Chinatown, you can catch coronavirus, which is not true.

I'm having colleagues, being questioned about wearing a mask, because they are East Asian, or they're Chinese American, or Japanese, or Vietnamese American. Having people say that they're afraid to even sneeze in public if they are an East Asian descent, because of the negative stereotype that is out there. That it's a really big deal. And validating the feelings of people who are experiencing that form of racism.

This isn't new of course, when it comes to infectious disease. We've got centuries of experience, of attaching infections to certain ethnic groups. When those ideas come up we need to be firm in validating the fact that it's racist and it's wrong. And teaching our children appropriate terminology. That the name of the disease is called COVID-19. It is not called the "Chinese Virus." It is not called "Kung Flu." Those are different terms that patients have told me, that they've heard, and are being teased about, and joking about.

Dr. Adiaha Spinks-Franklin: This is also an important time, just like, Dr. Allison said, for if children are being teased, or being mistreated because of their East Asian ethnicity, for parents to bring out the ancestors, and talk about all of the positive experiences and the positive ways that their families have overcome adversity, and have contributed to this country. That's really important.

Another misconception I've heard early in the course of the illness was that black people are immune to COVID-19. That is wrong. No one is immune to COVID-19. The early misconceptions were due to the thought, that because they did not see black faces on television testing positive, then that must mean by some toss of logic, that black people can't get it. That isn't true. There is no population of people based on ethnicity, or race that is at higher risk for COVID-19. And there is no population, that is immune.

This is a brand new virus among the human population, so none of us have developed immunity toward it. It came from animals into the human population, so we're all susceptible. The people who are at most risk of course, are people with chronic health conditions, and those who are elderly, but they are the ones who are more likely to get these sickest, most severe forms of the disorder. But we're all at risk of it, and it's not based on race or ethnicity.

EmbraceRace: Totally. You both dropped some real pearls. Thank you so much, and not least this last point about pointing out the vulnerable populations. A lot's been said, and of course it's true, that across race, across the lines of ethnicity, immigration status, all of that, people will all be hit. All of the subpopulations will be hit, but not equally. We know that, that's true. That's always true and it's true here.

And it's so ironic Adiaha, the point about, people thinking that because they weren't seeing black people on television being tested, that black people might be immune. Ironic because I know that they're many doctors in many places, medical personnel who actually are concerned that black people and other populations, including some of the ones that you named, will not have equal access to the tests, when they're available to people. Unless you're in NBA or you happen to be one of the two black senators, maybe that sort of thing.

There's so much uncertainty here of course, and one major uncertainty, just how long this, "new normal" will last? What is the "new normal"? The new normal now, will be different than the "new normal" in a month, six months. Until we get this vaccine, at least. And even then of course by then, so many things will have happened. The repercussions will be profound.

So how do we, as parents, guardians, grandparents, caregivers, how do we support ourselves, each other, our children, in light of that uncertainty, of just, how this will unfold and what will be asked of us? Is it a year, or in three months are things somehow are different?

Dr. Adiaha Spinks-Franklin: As far as trajectory is concerned, we have no clue. All we can do is go by what has happened in other countries thus far. The peak and the trough... the peak and the valley in China, versus South Korea, versus what's happening in Italy, versus what's happening in England, and what's happening here. We don't have a centralized, coordinated, systematic public health response, in The United States. States are left to figure out their own methods of doing it, and depending on what state you're in, the individual precincts might have to figure out their own methods. So in Texas, it's really precinct by precinct, city by city, county by county without having a coordinated effort. As a result, it's going to be really hard to control and contain the spread of COVID-19.

In addition to that, we don't have enough testing kits. Therefore, I know in our region, and in other regions, they're actually criteria for being tested, which is a first. Like if you think you've got strep throat, there are no criteria for testing strep throat. You just stick a swab down the throat, bam, test for strep throat. But when it comes to COVID-19, we don't have enough testing kits, and because we don't have enough kits, that means we're going to have to be really judicious in who we test. As a result, we will not have pure data on the epidemiology of this virus in the United States. We've learned from the data coming out of China, that about 30% of adults who test positive for COVID-19 are actually asymptomatic. That means they have no symptoms.

And about 14% of children, one study says 13%, another study found 15%- So about 14% of children who tested positive for COVID-19 are also asymptomatic. That's a lot of folks. So I know in our region, if you have no symptoms, then you don't qualify to get tested. I'm worried that we're actually under-reporting the numbers. So we have not reached the peak yet. We have not yet reached the peak. We are a few months behind other countries that are to the east of us. I have a public health background. Another thing we think about is once we reach our peak, and then we began to decline in the number of new cases, we will start to get back to our regular routine.

Will there be a second peak down the road? That's a concern because as we become very comfortable, and we're not as careful around each other, we're not as hygienic around each other, this virus is now a part of our nation. It's a part of our earth, which means that we can get infected again. So we need to be really careful and judicious, in maintaining our sense of hand-washing. My grandmother, who was an incredibly wise woman, born in 1911, she used to say, "Hope for the best, but prepare for the worst."

Provide small concrete answers to children's questions.

Dr. Allison Briscoe-Smith: It's a great way of thinking about it, in terms of continuing to remain vigilant.

From the mental health standpoint, of course we all would like an answer as to when this is going to end. It'd be great. Easter, what a great, beautiful day for that to be done. And I think that's in part, because we have gotten used to, and would like to have control, and would like to be able to predict on behalf of our children.

But what we need to hold onto is, as Adiaha said, we don't know. And that's what we can tell our kids. "We don't know." And we also need to be reminded, we had been through things before, that we didn't know. How long was the war going to last? How long was, all the bad things that we can think about, going to last? I'm conceptualizing this as a natural disaster, in many different ways.

I grew up in Hawaii and in the Caribbean, so I'm used to hurricanes. So I know that when a hurricane comes, you see it, it lasts longer than you ever think it will, and then you hit the eye of the storm where you think everything's okay. And you eagerly go outside, until the other eye hits you. So we need to conceptualize this as a storm, and so that's why I'm asking very purposely, "How were we weathering the storm?" "How are we preparing?" "How are we engaging?" And also we need to be reminded, we have made it through storms before, but I cannot tell you how long the storm will last or what it's going to look like afterwards.

Dr. Allison Briscoe-Smith: We also need to be prepared to rebuild after the storm. We need to rebuild our economic structure. We need to rebuild in the context of kids. So I see a lot of the questions here. "How do we..." And, "What do we say to our kids?" I really want to encourage folks that we cannot overpromise. That's not to be like, "I don't know how long it's going to last, do you?" it's not that. Small, tangible concrete. "I'm not sure how long this is the last, but I know that right now in this moment we're okay." "I know that this week, this is our plan." "I know that our structure is this." We have to keep it small and concrete, because that's all that we can really offer. And you all also have to do a lot of thinking yourselves, how are you understanding what's going on? How do you make sense of this? I think this is a great time to offer up stories to our kids.

"I remember when mama lived through the hurricane, this is what I did." "I remember when we lived through this, this is how we managed." So we really have to bring those stories of resilience back to our kids. And that's something that can be done at any level. I see a lot of questions, young kids, older kids, their developmental ability to engage with that will shift. But here's the big thing, do not over promise. Don't tell them Easter, if we don't know that this is done at Easter. We know that this is a long time, and we know that this is hard, and we're going to have big feelings about this, but we're going to make it. All the evidence that we have, is that we're going to make it. That doesn't mean that people aren't going to be sick and impacted, and struggle, and there's not going to be lost there, but again, to cultivate that sense of what we can, and to point to those early stories that you have, some other stories. We can pull on to these stories of resilience and making it through it.

We can pull on to movies, as well to kind of help them through, like Star Wars. How long was the battle? We can kind of think about how do people make it through long type of things? I know many of you all are having kids asking, "When do I get to go back?" "When do we get to go back?" And our answer very simply has to be, "I don't know yet, but what we're going to do today? And how are we going to try to make it better today?" That's how I would think about, trying to answer that kind of question, with the medical and the public health perspective, that Dr. Adiaha just offered, helps us to contextualize. This is a marathon and not a sprint, is the other way that we have to think about this.

Community Q & A

EmbraceRace: A question from Lindsey here. "I am an interested teacher and parent. I believe kids need a sense of normalcy in schoolwork right now. My colleague disagrees. How do we strike a balance between a sense of normalcy, and simultaneously allowing kids the spaces to process this experience while being sensitive to not pathologize, or further traumatize our children and our students?"

I know you were all were talking about the importance of a schedule, and I know kids are different in terms of... and some parents are like, "Oh, they've got to be doing the school." And others are like, "Actually, no, we need to adjust."

Dr. Adiaha Spinks-Franklin: I would think of it as freedom within boundaries. When I say "have a schedule" or "have structure," I'm not talking about army boot camp. I'm just talking about, having a day that's pretty predictable for a kid. So if your child responds to picture schedules, or visual schedules, just get a piece of paper and write it out. "All right, this is our morning routine. This is what time we're having breakfast, what time we're having lunch. This is what we're doing this afternoon. We're going to go collect some rocks this evening, then we're going to have dinner, we're going to read a book, we're going to play some cards as a family." Just kind of laying out what the routine is for the day. One of the things I appreciate about teachers in this area, that I'm hearing from parents, is the teacher's flexibility. When the teachers are able to log on, for those who are doing online classes.

When the kids know what time they're going to be logging on, to have their experience with their teachers online, it also provides a nice opportunity for them to see their classmates, face-to-face again, through the video chat. That can also be a nice launch point, where parents can say, "Okay, well this is the rest of our schedule for the day. This is the time for you to do homework, but then we're going to have some free play-time and go outside, and play chase or have a bear-crawl in the backyard." Well we can do that in Texas because it's hot, but if it's snowing. I don't know if you can do this in Washington.

The other thing, I've talked about with normalcy, and to help children to take the focus off of themselves, is to think about somebody else. So I've been encouraging families to have their children call older relatives. We know that that is the high-risk population, so call the aunties, and the uncles, and the abuelas who are over 70, or over 65. And check on them and say, "I've been thinking about you, and I want to know how you're doing." And if that relative is fortunate enough to know how to FaceTime, that's even better. There's also a really nice idea, since families are home. It's a project I did with my kids many years ago, but it actually could be fun now. While you're calling and Face Timing relatives, you could actually make a notebook of your family tree

I've mentioned this as an idea where kids can call relatives, take a picture of their relative, and by the end of the week or two, they've actually built their own family tree across the multiple generations of folks that they've spoken with. And have those relatives tell them stories. And that's yet another way of building their connectedness to their community, their connectedness to their families, building their own sense of character, and self-esteem, and accomplishment.

Dr. Allison Briscoe-Smith: I think I would kind of just tap into that with the flexibility kind of idea is this notion of grace. Like this is not normal, and this is new, and there's some structures that we can put in place. So some grace for ourselves. Like I didn't want to be a seventh-grade teacher, and so I'm not great at doing that. So why would I all of a sudden overnight, become a great teacher to my kids, and be able to find curriculum... I was up all last night learn about photosynthesis again. That's not it.

That's not what I'm here to do. So some graciousness with ourselves, and some ability to do that, and also grace for our kids. So that they're learning how to make this new transition, they're watching us, and they're watching how we learn. It's flexibility and support as well. So try to think about this.

Can your children help to engage with you, and develop the schedule together? Maybe there's a way that they could actually point out: "I actually like this type of reading, I don't like this." Have their voice and choice with this, is actually key in the context of larger issues of trauma, is that we need to empower our kids to have some choices. Even littles. Get to have a little more of a choice, because what's taken out of this whole circumstance, this trauma, is choice. Think about just being graceful, not being skilled, but grace with ourselves. Be compassionate to ourselves, that we can show that, through our kids and allow them to have that too. Because we're going to toggle back and forth between "get everything done," with "not". The last thing I want to say about this, we need to understand, especially in the context of things like developmental disabilities, or challenges that our capacity to learn in this moment is changed. That our stress response is up, that we're all walking around really, really stressed out.

So our capacity to take in information, and capacity to metabolize any information, is different. Mine is, yours is, so let's have a little bit of compassion for ourselves in this. Everybody's walking around with their flight or fight system up, hypervigilant. I just got out of the store right now, and I was ready to box. So we're all showing this up in a different way. Just to think about, our bodies are responding right now, we're not walking around fully rational. So let's not have the expectation that our kids are too. Let's be flexible, and kind where we can, for this time period, because this isn't going to last forever, because nothing does.

Dr. Adiaha Spinks-Franklin: Dr. Allison, I just want to piggyback on what you just said about the fight, flight or freeze response taking over right now as our stress response. I have this conversation with families in clinic, almost every day, explaining what's happening in the brain when we are stressed. There are parts of our brain responsible for thinking, and problem solving, reasoning and learning. And then there are parts of our brain that I call the inner cave man or the inner cave woman. And when we're under stress, the inner cave man wakes up, and its whole goal is for you to survive. So it's looking for that saber tooth tiger, or that grizzly bear, so we can know to either fight the tiger, run from the tiger, or lay down and play dead with the tiger. When your stress response kicks in, the regions of the brain responsible for survival, actually shut down the regions of the brain responsible for learning, thinking, problem solving, and being rational.

So what Dr. Allison was saying is absolutely correct. It's neurological, because you're in survival mode. I like the fact that teachers are being flexible and giving children several days to doing this assignment. Having short times of video chat with teachers, so there's some structure, but it is not overwhelming. And then I ask parents to give their kids a variety of stuff to do. And then just some chill-out time too. But kids don't need to be in their room for five hours by themselves. You want to think about the flexibility of creating your day schedule. The other thing I'm going to ask parents to do, is to monitor their children for signs of depression, and monitor themselves and their older relatives. When we're under social isolation, where you're not having as much contact with other people, our risk for developing depression actually goes high.

So it's important to have some check-in time, and to see how folks are doing. Again, another nice reason to have your kids calling the older relatives, to check on them, calling friends that you haven't heard from in a while, those things are really important to try to reduce the risk of depression.

EmbraceRace: Those are excellent pieces of advice. One question we have is about young children, who are just deeply anxious. So, one, and I know we've touched on this before, but one person in particular says, "How do you deal with children's comments to the effect that they're afraid they're going to get sick and die, and they're afraid they're going to sicken someone else and cause them to die?"

But again, there's a whole bunch of questions related to that, including around children who are literally afraid of going outside. And another set of questions from grandparents. Adiaha, you mentioned a couple of times, yes, we could get the young ones to call elders. But of course in many, many families, not least, families of color, grandparents play a very, very significant role. In some cases, in many cases, being primary caregivers.

We know that, as you said, Adiaha, older folks are sometimes more vulnerable, more susceptible. And we have a couple people actually specifically said, "I don't have the energy, I used to have to engage, my 7-year-old grandchild, whom I'm primary caregiver for, and now of course I don't have the break, I'm homeschooling too." Do you have any advice on either front?

Dr. Adiaha Spinks-Franklin: When it comes to preschoolers, developmentally, it is normal for them. They engage in magical thinking. Magical thinking is where your brain blurs fantasy from reality. We begin to develop magical thinking when we were about 2 years old as our language begins to explode, and we learn a lot of words. And then around 8 to 9 years old, it tends to go away for most folks. There're some grown folks who still have magical thinking. They think a job would just come and knock on the door magically, rather than going out and seeking employment. But for the most part, we stop believing in things like the tooth fairy and so forth, around 8, 9 years old. For a 4 or 5-year-old who says, "I'm afraid of getting sick." That would be a normal response from a 4 or, 5-year-old.

But especially a four or 5-year-old who's heard the grownups around them talking about COVID-19 a lot. That's a sign that this is something that has been very commonly spoken about, in the child's earshot, and in the child's environment. It is also common for children to think that they have the power to act on someone else. Preschoolers will blame themselves for bad things that happen to someone else.

Dr. Adiaha Spinks-Franklin: What's important is to stick with very simple developmentally appropriate ways of talking to a child about how we can prevent ourselves from getting sick, by washing our hands, and using a tissue to blow our nose, and coughing in our arms. Here's a resource, and not to overwhelm you, but the American Academy of Pediatrics, which is our national organization, has a parent website called Healthychildren.org. It is a wonderful medical website for parents, and all of the articles are written by physicians. So it is up-to-date accurate scientific information, and they have a section of articles on COVID-19, dealing with the medical component, but also how do you talk to your children about it, and how do you help them?

When it comes to grand families, that is an incredibly common, phenomenon in The United States. There are millions of children being reared by grandparents, due to a variety of circumstances, part of it being the criminal justice system, incarcerating an unprecedented number of parents, and also issues with drug abuse, and mental health disorders that our parents are succumbing to. So grandparents definitely need support at this time where they are having to rear children, that they honestly physically are just exhausted, in trying to rear. Not only that, trying to manage the needs of the adult child, who may have their own financial, or mental health, or drug abuse issues, that the grandparent may still be dealing with.

So I'm encouraging grandparents to reach out to their network to try to get some support. Maybe there's someone who can, who you trust, who is safe, that can actually give you maybe an hour or two of respite, with the children, maybe another relative who's healthy that they can go and spend some time with. You can have some respite and just take a nap, or just take a walk, but recognize your own need, for some self-care. It's really important.

Dr. Allison Briscoe-Smith: I can't really say it better. Small things to remember is, when children are asking questions, it's really normal, give them small concrete bits of information. And also, help them move into action. "If you're worried about that, let's go wash your hands and then we'll be okay." Also with littles, we can distract them. With little tiny ones like, "Hey, let's go do something." "Let's go find that rock outside." "Let's go write a letter to grandma, if you're worried." So we're teaching them how to move into action, with that, and that's what we're doing all the time.

Same thing for grandparents. I think the grandparents who are parenting, is again this notion of grace, which is that, you didn't sign up necessarily to be a full-time teacher to your grandkids. You know, what an extra hour of TV isn't going to hurt nobody if you get a chance to rest. I think that's the kind of flexibility that we have to kind of think about. I can do all the caveats about what type of TV and all that, but let's just know that we have to make it through this. This is not saying that we're going to stop raising up our kids for the next five years. We're talking about, this is an incredibly stressful time period, that we need to weather, and there's got to be some things that we try to think about to help ourselves out.

EmbraceRace: We've had a number of questions among our registrants about helping older children through this. EmbraceRace typically is dealing with middle school and younger, and then most of the conversation here has been aimed at younger children, but now more than ever, there are a lot of older children, including college age children, for example, and even older, who are coming home, and have all sorts of anxieties. So for somewhat older children, older teens, and even the young 20's, what can you say?

Dr. Allison Briscoe-Smith: I think one thing that we need to think about teens is sometimes, we have more of a conversation with them, but let's not forget that they're still kids. And let's not forget that even though they may be really sophisticated, and talking to us and be able to use all the same words, developmentally, brain development, and what their life choices are, are different than what we're doing. Let's hold onto that. It's different. And also that they need some guidance and support about, "Gee, we've had to deal with other things before in our life that we thought threatened our ability to move on." Recession, Depression, war, Vietnam War. So again, go back to those kinds of stories.

And that was an unknown time. Let's not leave our kids isolated to try to figure that out. And also understand that even though they're 17, 18 and got a mustache, doesn't mean that they're fully grown. And so we still need to be present. This is a very scary time for many of our youth, in terms of high school commencement, and all of those kinds of things. Prom, not being able to see each other. There are small things that we can do, which is like, "Let's do a Zoom commencement. It's not the same, but it's something." "Let's think about postponing as opposed to canceling." Like, "It's going to be lit in October, if everything goes well." Let's think about moving some of these kinds of things and celebrations. Those are about, marking moments in time. Those don't have to go away, they just have to be changed.

I think this is a great time for us to be parents to our older kids, our teenagers, our early 20's, our millennials still need us. Maybe this is a place that we can redeem ourselves from our "okay boomer" time, and be able to talk about what we have survived, and what we're able to do. So that would be the way that I think about it.

Dr. Adiaha Spinks-Franklin: I really like Dr. Allison's suggestions. I spoke with one of my teens this morning, and she's a senior in high school, and she's just incredibly bummed about missing the prom, and, "Is graduation going to be canceled?" And, "Are we going to have our senior trips?" And it's really hard and I just had to acknowledge, and validate her feelings. She misses her friends. I said, "Well have you guys thought about doing a group FaceTime, so you can actually see each other?" Which is actually a very nice thing for kids to be able to do, in this time of technology. And I also encouraged her mother to have the teen to reach out to older relatives. Do something that's positive that can help someone else. If there's a way to contribute to others that could be helpful, and that could be safe for her. But acknowledging their concerns, not overwhelming them as little adults. They are not little adults. Like Dr. Allison said.

Their brains are going through a tremendous transformation, but they haven't developed all of the rational thinking, decision making, and futuristic planning, that a fully developed adult brain does. The female human adult brain, is not fully developed until age 25, and the adult male brain in humans is not fully developed until almost age 30. So our 20 somethings, really need us you all.

EmbraceRace: That's really great to keep in mind. We forget. Thank you so much. We're really early in this, and we're so appreciative to have expert friends like you guys to come on. We're still figuring it out all ourselves. So we're going to try to be patient with ourselves, and thank you everyone for coming. Thank you too, for answering so many great questions and sharing your wisdom.

Thank you, and apologies to folks who are not of course being able to do more than scratch the surface of your amazing questions. And good luck folks. Let's take care of each other.

Dr. Adiaha Spinks-Franklin: Thank you. Bye.

Dr. Allison Briscoe-Smith: Thank you. Bye.