“September of 2020 has been the highest month ever that we've seen suicidal patients admitted to our medical center,” said Kia Carter, M.D., medical director of Psychiatry at Cook Children’s. “We've seen this number rising year after year, so it's not surprising that it's this high. Suicide has become the second leading cause of death for kids and adolescents in the last year, versus two years ago when it was the third leading cause of death.”

This news comes after a near-record month in August when 29 patients were admitted for intentional suicide attempts. The patients admitted to Cook Children’s in September were between the ages of 6 and 18 years old. Dr. Carter says she feels the pandemic has played a moderate role in the increase, but that we typically see higher numbers in the fall months when kids return to school. In September of 2019, for example, Cook Children’s admitted 32 patients for suicide attempts.

“We've definitely seen this number rising in the last five years, but I do think that the amount of stress that we as a society have experienced in the last six months has caused some of our kids and adults to struggle more,” said Dr. Carter.

Virtual school may also be playing a role in mental health of kids. The Rees-Jones Behavioral Health Center at Cook Children’s has become a resource for children and teens who report feeling hopeless and not knowing how to cope with the isolation the pandemic has caused.

“I think everything in proportion is good, but when something is to this extent where some kids have had to do 100% virtual since March, it’s been very difficult,” Dr. Carter explained. “When kids have school, they have an outlet. They have other people to talk to. They have friends and social activities. Now, it’s just them, their parents and siblings.”

She says it’s important to know that some kids do very well with virtual learning, but it’s up to parents to know what works best for their child. Also, some families may have to choose virtual learning if the child or another family member falls into the high-risk category for COVID-19. In that case, parents should remember to ask for help when they need it. School counselors, nurses, teachers and their pediatrician are all great resources.

Warning Signs

Dr. Carter says the biggest thing to look for is a change in your child’s behavior, which she acknowledges can be difficult during the pandemic. She says little things like sleeping more than usual or not wanting to engage or interact in activities they used to enjoy can be signs of depression.

“Start engaging a little more and check in, like ‘Hey, are you feeling okay? I noticed you were getting a little angry at us for no reason,'” she said.

While it’s easy to write off irritation as a side effect of being a teenager, it is one of the primary symptoms of depression in children and adolescents.

Other signs to watch for include:

• Declining grades
• Lack of concern about appearance and hygiene
• Changes in eating and/or sleep
• Self-injury such as cutting
• Less motivation
• Alcohol/drug use
• Acting highly anxious or agitated
• Recklessness

Dr. Carter says girls are more likely to be hospitalized for attempting suicide, but boys tend to make more lethal attempts. As for age, Cook Children’s data shows 14 to 15 years old is the average for suicide attempt admissions, but more recently, the majority of patients have been around 12 to 13 years of age.

With many kids at home alone due to COVID-19, increased access to things like medication, firearms and the internet may also be contributing to the increase in patients. Dr. Carter says her team has also seen more patients participating in social media challenges where kids are hurting themselves.

“We have seen a rise in cutting behaviors, which are a form of self-injury. This is not always considered a suicide attempt but more of a maladaptive behavioral response to stress.”

She says these are things often picked up on social media, reinforcing the importance of knowing what your child is looking at and who they are talking to on the internet.

What Can Parents Do?

Get help.

If you’re concerned for the immediate safety of your child, take them to an emergency room. Trained professionals will evaluate your child to see what next steps need to be taken.

If you’re concerned about your child’s mental health (but not that they will harm themselves), you can contact your pediatrician, school nurse or counselor for a list of outpatient resources in your area.

If you feel your child may need a higher level of care (but it’s not an emergency), you can call Cook Children’s Behavioral Health Intake Department at 682-885-3917. Our team will help arrange referral for outpatient therapy and medication management, partial hospitalization day treatment options or inpatient treatment if needed.

Partial hospitalization allows children to receive treatment including medication management, family and group therapy at the Rees-Jones Behavioral Health Center during the day, while allowing them to go home at night. Children who are deemed an immediate danger to themselves may be admitted to the inpatient unit for 24/7 monitoring and treatment. The Rees-Jones Behavioral Health Center, is one of the few places in North Texas that offers inpatient psychiatric care for children between the ages of 2 and 12.

“Our biggest hope is that we can help families find the support and resources they need, and that we can educate our school systems about warning signs and screenings because they are hopefully going to come in contact with those kids before we do,” said Dr. Carter. “We don't want the numbers to continue to rise and we continue to lose our children. Remember that suicide is preventable.”

The Centers for Disease Control and Prevention and the American Academy of Pediatrics are recommending against spray vaccines, such as FluMist, after finding it only 3% effective in preventing the flu in children. Instead, they're urging parents and pediatricians to opt for the shot.

If your child is like most, this is bad news because needles are often enemy number one.

The good news is, there are ways to make this undesirable trip to the doctor's office a little less traumatic. At Cook Children's Medical Center, Child Life Manager Janis Smith discusses ways to help kids cope with pain and stress. When it comes to needles, she says a little distraction can go a long way.

"An iPad, a book, or even engaging conversation can often be enough to take a child's mind and eyes off of the shot," said Smith. "We also encourage deep breathing and sometimes utilize a cold spray to help numb the skin."

A newer technique taking the pain out of shots is called Buzzy. This friendly-looking device comes in the form of a bee or lady bug and can trick the body's nerves with cold and vibration.

"Buzzy's wings are made of ice packs and its body buzzes. When placed above the injection site, these sensations knock the nerves off their game and help eliminate and/or minimize the pain from the shot," said Smith.

While many pediatricians provide tools like Buzzy in their offices, parents can also buy their own in Cook Children's onsite pharmacy.

Another way to ease the sting of the flu shot is comfort positioning. This means creating a secure hold, like hugging, that offers comfort to the child while immobilizing the extremity needed for the procedure (such as the arm). This minimizes anxiety as well the need to hold a child down, which can be traumatic.

For older children, it may help to ask them to do something, such as focusing on an iPad.

"Allowing children to play an active role during the procedure process can often minimize fears and encourage positive coping,'" said Smith.

Smith also suggests offering validation to a child who is afraid of shots.

"Try saying something like, 'I know that you don't want to do this, but it's a way we can help you from getting the flu,'" said Smith. "In the end, no one likes shots. But when children do need shots, we want to provide them with opportunities to cope successfully and help make them as painless as possible."

About the Source

Janis Smith is a Child Life Manager at Cook Children's Medical Center in Fort Worth, Texas. Child Life specialists work with children and families to help them cope with the extra challenges of living with chronic illness.