How to Support Your Teen During the Pandemic with Dr. Ellen Rome

Podcast Transcript

Nada Youssef:  Welcome to the health essentials podcast brought to you by Cleveland clinic. I'm your host, Nada Youssef. Just when teenagers were looking forward to spring and summer, the COVID-19 pandemic has delayed and canceled events that have a lot to do with a teenager's normal life. That includes many activities like parties, dances, sports, or just hanging out with friends. Many teenagers are feeling depressed, angry, and bored. While younger children may be okay with having their parents' attention 24/7 adolescents are likely to feel a little bit different. So here to help us navigate this moment of stress and confusion, here with us today is Dr. Ellen Rome. Thank you so much for being here today.

Dr. Ellen Rome:  Thank you for having me.

Nada Youssef:  Dr. Rome currently serves as head of the Center for Adolescent Medicine at Cleveland Clinic Children's. She's a board certified pediatrician, who is among the first in the United States to be board certified in adolescent medicine. And to our listeners, please remember this is for informational purposes only, and it's not intended to replace your own physician's advice.

So, Dr. Rome, teenagers tend to feel invincible and maybe under the impression that this virus is only problematic for the older population, what do you say to them?

Dr. Ellen Rome:  The messages may vary from a younger teen to an older teen. Younger teens may not yet have developed the ability to have abstract thought or the ability to foresee consequences. That's a developmental process that happens in late adolescence as the frontal cortex develops. With a younger teen or a high school student, you can problem solve with them. Who do they know who might be impacted by a disease that can severely compromise breathing? Do they have any family members with severe asthma or other lung disease? What about friends who vape a lot? How might this affect them? Thinking through the impact on teachers can work well if you have a kid who loves school, but not so often kid who's disconnected at school. And that may be less of a motivator for that kind of a kid.

Nada Youssef:  Many young people think that COVID-19 is like having the flu. How is it different and what long-term effects or conditions are possible?

Dr. Ellen Rome:  Influenza, or the flu, is caused by a different virus than COVID-19. COVID-19 impacts lungs in a different way than flu causing inflammation in the lungs that can block oxygen delivery, almost like putting a thick layer in the very small airways of the lungs. The challenge is that influenza rarely kills otherwise healthy children, and we know how to treat it. And we also have a vaccine to prevent it. COVID-19 can cause serious illness with weeks to months of health compromise. It can cause death even in young people and it can come and go with no discernible symptoms.

Kids rarely get influenza without symptoms. When they get the flu, they've got the high fever, they feel lousy. Kids with COVID-19 may not realize they have it, but pass it on to somebody who's vulnerable. This stealth contagion of COVID-19 without clear evidence for best treatment and in the absence of a vaccine mixed COVID-19 riskier for the entire community.

Nada Youssef:  Thank you. That's very helpful. Now I'd like to talk about the spread of COVID-19 in teenagers. While some children have been sick with COVID-19, adults seem to make up most of the known cases today. Teenagers may hear about this on the news and maybe not take proper measures to stay safe, like wearing a mask or maybe properly social distancing. What steps can we take to protect our teens?

Dr. Ellen Rome:  Partner with teens to be part of the solution, help them lead the campaign to stay safe, and we say that's six feet away from everyone. To wear masks and to be great hand washers. There's a great cartoon that has a circle of things that matter, another overlapping circle of things you can control, and the overlap of the two, that little part in the middle is labeled what you should focus on. We want kids to be part of the solution to help focus on these things that they can control and do effectively that really diminish spread of disease. So, that's where we want to help our kids focus their energies.

Nada Youssef:  Excellent. Now for teenagers and young adults, friends are very important. So bonding with peers at this time is usually very essential, especially for development for adolescents. So when we see our kids frustrated, upset, or confused, what is the best thing for us to do as parents?

Dr. Ellen Rome:  So in Clinic Children's, we encourage parents, kids, and peers to lead with the heart, and that means responding with empathy. It's fair game to acknowledge the suck, that this really isn't fun and ask the young person to share more of their thoughts and feelings, things that they're sad that they're missing.

And then also just be able to emote about it and have the adult or caring person in their lives. Be an active listener, not necessarily jumping in with a solution. Role model great hand washing, mask wearing, and social distancing, because do, as I say, not as I do, doesn't tend to work well with kids in general. And you can help them channel their inner Mr. Rogers. One of my favorite Mr. Rogers quotes is when he says, "When I was a boy and I would see scary things in the news, my mother would say to me, look for the helpers. You will always find people who are helping." Help the teens empower themselves to be the helpers.

Nada Youssef:  That's excellent. Thank you so much. And I do remember that. Now with so much downtime, what should we be doing with our teenagers to get their mind off of these stressors and to keep them developing?

Dr. Ellen Rome:  Besides channeling their inner Mr. Rogers, you can encourage them to perform random acts of kindness and role model that yourself. So a phone call or a Zoom call to a grandparent or a loved one, a written note, a great old school thing to do, to a distant relative or a teacher or another favorite adult can be a great gift of kindness. Planting flowers outside a window. For those who are handy, sewing masks or other things that are actively being part of the solution, all can help. Laughter also can be the best medicine. So find opportunities to laugh with, but never at, your teen and family and find moments to be grateful and encourage your kids to do the same as part of family dinner or other times.

Together, you can find other ways to get into nature, explore the parks, do a virtual tour of the Grand Canyon or of a museum, or learn a new hobby. And if all else fails, borrow a toddler. The kid's mother, assuming that you're a safe house for them to go in, will be very appreciative for an hour or two of a distraction for that kid. And with that toddler, pretend to be one yourself and find the joy and the wonder in all of the daily little bits of life. So wander the house and see how amazing it is from a toddler's lens. And all of these things can be useful distractions and productive use of time as we go through this pandemic.

Nada Youssef:  I love it. It sounds like a silver lining to this quarantine. And my kids are younger than teenagers, but hiking and board games and even chess was all brand new things that we did this year that was very helpful and very fun for us.

Dr. Ellen Rome:  And you could have family game nights, family charades, are all a part of part and parcel of that silver lining process.

Nada Youssef:  Yes. Agreed. Very good. Now let's talk about schools, because the school's opening back up very soon, should we, as parents be worried about our children getting infected or bringing it home?

Dr. Ellen Rome:  There's the million dollar question. We all need to be concerned about that. We do know that transmission in hospitals and metals medical settings can be quite low. For instance, at Cleveland clinic, our caregivers are remarkably low and our view is that odds are, if any of us get it, we're getting it at the grocery store or in a community event as opposed to from work because we're so vigilant on hand-washing and masks and six feet away from everyone. So encouraging social distancing and great hand washing and mask wearing really does make a difference. If a family member is elderly or immunocompromised, that prevents presents a significant risk and that child or that family may be encouraged to do online learning if at all possible. If their level of concern is such that the risk of transmission isn't worth the risk of being in the classroom.

But the risks of kids being at home may outweigh the risks of school. If a home is a site of domestic violence or other tragedy or disfunction, school may be the safer place for a child. If there is no usable technology and/or the internet connection, isn't usable at home, learning may cease or lag far behind, and that's not great for a kid, either. That kid would do better in school also.

Nada Youssef:  Excellent, so we have to make sure that the resources that they need should be home if they are staying home, otherwise we can send them if we're feeling safe.

And I want to get to the mental health part real fast, but first I want to talk about masks. If you could talk to a teenager right now about how to wear mask properly, what would you say to them?

Dr. Ellen Rome:  I tend to use an ask, tell, ask approach with teens and ask for their ideas first, then suggest if they cannot come up with anything useful or build on what they've shared and then ask if it's something they feel they could be a leader on or an instrument of change to get more people in there and more of their peers better at mask wearing. And masks right now save lives. I'd love all teams to own it, wear it, be a leader in making it trendy and a thing to be a healthcare hero.

Nada Youssef:  Great. Okay. So let's talk about encouraging some healthy habits, because during this stressful time, we always think of what habits our teenagers can adopt to help them stay healthy, both physically and mine.

Dr. Ellen Rome:  In times of stress, we don't want anyone to forget to attend to the basics: good sleep, good food, a dose of nature as often as you can, and reasonable exercise health permitting. Many teens in the summer get off sync in sleep and eating habits and that was amplified as social isolation began at the start of captivity for us here last March.

And if you have kids who are sleep deprived, feel lousy, angry, or grumpy or otherwise not at their best, they're not going to learn well, they're not going to do well, and that's going to be hard on them and the family. Especially before school starts in a bedtime and wake up routine that works to ensure around nine, nine and a half hours of sleep for the average teen. And that's the amount that the average kid needs. If the kid is awake till 2:00 AM and up at the crack of noon, then they may be getting enough sleep on the vacation, but not functioning well when classes begin at 8:00 AM. So that can also wreak havoc on mealtimes and steady food schedules. So you might have that kid cheat the bedtime up from 2:00 AM to 12 and then 12 to 11 to whatever time really works well in the school year to get that maximum number of sleep.

Nada Youssef:  So, just like you mentioned, a lot of kids right now are sleeping in and sleeping late when they go to bed. And you mentioned nine, nine and a half hours of sleep is what they need. So is keeping a consistent sleep schedule vital for their health?

Dr. Ellen Rome:  Absolutely. And there's no time like now to start getting in a better pattern. So for instance, for most kids, school starts in a couple of weeks to a month. So again, if they're going to bed at two, get them to start at midnight this week, and then maybe 11 next week, then move to whatever time is going to be the optimal time.

Set, some media limits as needed. So for instance, you'd want them to unplug from screens an hour before bedtime so that their brain can unwind and be ready to actually have useful sleep, to get to sleep, to stay asleep. Have their cell phone face down and on silent, not vibrate if they're going to have their phone in the room and even better charge it in the kitchen or some other place. And enforcing limits on time spent using technology, may be more challenging now than parents are used to, since the same devices are getting used for reading the news, for doing homework, for doing everything and let alone staying connected with peers and extended family. So parents may choose to discuss with their kids about modifying previous limits on technology use when you have a kid who's trapped at home and figure out how to make that so it's productive time and not time that's enhancing or exacerbating depression or anxiety.

Nada Youssef:  Okay, so two very important things you said, limit electronics when they're way, they should be completely away and gradually put your kids to bed every day at a certain time, not just like one time at like eight o'clock is still never sleep that way.

Dr. Ellen Rome:  Right.

Nada Youssef:  That's really good. Okay, excellent. So let's talk about boosting our immune system and keeping us healthy during this pandemic. Let's talk about first of all, how do our teens stay safe while exercising? Because many people are worried about that.

Dr. Ellen Rome:  Masking and staying six feet away from everyone is optimal. If they're doing team sports, see if the coach is supporting social distancing and masking. And with more isolated sports, a mask can be let down when they're away from everyone, and great hand washing and showers at the end of the school day and/or practice is definitely a key feature.

Nada Youssef:  Would you say that putting on a mask while exercising is safe?

Dr. Ellen Rome:  It's ideal. It gets really hot, so if the sport is running like cross country or track and they're outside and away from people, then that mask can be taken down. If it's basketball and everybody's in each other's face, then it's a better idea to have it on.

Nada Youssef:  Excellent. All right, let's talk about diet and food. What essential foods should our kids be adding to their diets right now to keep our immune system tip top shape?

Dr. Ellen Rome:  So again, attend to the basics. Three meals with three food groups, that means protein, fat and carbs each day, at least six cups of fluids, and you basically are trying to get enough fluids in so that your urine is running fairly clear and not bright yellow, meaning you're dehydrated. Everyone knows five a day, fruits and veggies. You'll also want to get four things with calcium and vitamin D in them in a day for strong bones. And that can mean anything dairy, soy, tofu, kale, other things that have high calcium. And so three meals with three food groups, at least two snacks with two food groups. So that can mean like a banana and peanut butter, cheese and crackers, pita and hummus, things like that.

And then unplug from the phone or screen an hour before bedtime so you can unplug your brain and then zero missed meals. So we've got our six fluids, five a day fruits and veggies, four a day calcium, three meals with three food groups, two snacks with two food groups, an hour before bed unplug and zero missed meals. That's your six, five, four, three, two, one, oh, go.

Nada Youssef:  All right. I have to write this down real fast. Now many teenagers are turning to vaping and it's stressful times people are going to smoking. And so is that putting them at a high risk for COVID-19? And how can parents help their children to stop smoking even though they think it's safer than cigarettes?

Dr. Ellen Rome:  Yes. Yes. And yes. So it's absolutely a higher risk for COVID-19 because vaping in general, which is far more prevalent in teens then is cigarette smoking, so vaping, the process of the heating element, which is even more amplified with dabs, when you're heating it even higher, you're getting heavy metals and ions and stuff in the lower lung airways exactly where COVID-19 hits. So it's kind of a double whammy if you get infection. And we know that kids who vape do get serious lung disease called EVALI that's been showing up in the literature in the last year, especially that can kill and compromise their health. So add COVID-19 to that, and that can make for a serious life threatening illness.

To help kids quit smoking, one, if you're a parent work on your own smoking cessation yourself. So, do as I say, not as I do, doesn't work well, and Cleveland Clinic and Cleveland Clinic Children's have lots of resources as do many places that you can find online to help with nicotine, if they're nicotine addicted. So that can mean the patch, that can mean the gum. There's other medicines that can help with the addiction piece of it. There's also ways to partner with kids in particular, who usually have less of a nicotine history than a parent with a smoking year history of 20 years to help with the kids. So you can get them to figure out a reward system and then to check in with them pretty regularly. So for instance, if you set a quit date for the next holiday coming up, Labor Day or Halloween, or Thanksgiving, if you make it to one week with no vape, or no whatever, what reward do you want to earn for yourself?

If you make it to the next holiday, what's that reward going to look like? If you make it to the holiday after? And if the kid falls off the wagon, then figuring out a way to move that back on. I had a parent whose second grader was very upset with dad's cigar smoking. So she said, "Dad, if you promise to never smoke a cigar again, I promise I'm never going to smoke a cigarette in my life or anything. No pot, no cigarette, no nothing." Or she used second grade language for that. The parents says, "Great, done. I'm out." When the kid was in 10th grade, she came to dad and said, "Dad, you can have a cigar." He said, "Okay. Can I have one cigar or should I have a whole bunch of cigars?"

She goes, "Just one. And then you have to quit again." "Okay." And that was a way that she used some family lore and family humor to educate her father and share that she'd tried and she'd said no. So help families to one, find their language and humor and two, enhance rewards that are personal, that can help a kid get on a path of success.

Nada Youssef:  I love that. It's positive reinforcement, it works really well. Well, let's talk about mindfulness techniques that could probably be very helpful for any age group, especially in the stressful and overwhelming situations. How can we get our teenagers to start practicing mindfulness? If they're not already doing it?

Dr. Ellen Rome:  Role modeling is good. Talking about it as useful. For those who are technology natives, I'm a digital tourist, my kids are digital natives. The Headspace app is very, very good, which is an app that they can do on their phone or on their device, and can get them some easy, usable, accessible strategies, immediately. Learning yoga or walking in nature or pausing and being grateful or thoughtfully performing a random act of kindness are all mindfulness techniques that can get you back centered and feeling good.

Nada Youssef:  And I love that you said we have to be kind of the example of that. So my children seeing me meditate, they start learning how I'm breathing and seeing it, or even just going hiking and being in the moment is teaching a lot. That's great. Thank you for that.

Now, if a parent's noticing his teenager is lashing out, it can be easily blamed on their teenage lives, hormone changes and things like that, but how do you know if it's normal during this time and went it could be problem?

Dr. Ellen Rome:  Excessive sleep, excessive eating, or insufficient sleep and insufficient eating can be red flags, and you want to have a high vigilance for those red flags. Other ones can be a super short fuse, a teen that is getting angry or irritable all the time, sudden changes in behavior, appetite changes, mood swings. Suddenly the kid's a vampire, meaning up all night and asleep all day. Anything that doesn't seem right, might be a response to this stress. And so you want to give the kid outlets to manage that stress and rewards and practice for the resiliency that they're able to show.

Nada Youssef:  Excellent. And with this pandemic, it has robbed a lot of everything from school events to summer events, graduation, prom, senior year, a lot of things for teenagers. How do we know if our kids are grieving? What should we do if they are grieving and to make them feel like basically that there's an end in sight?

Dr. Ellen Rome:  Yes. It's permission to be sad, angry, or have any other emotion expressed with boundaries for ethical standards and safety, can keep the young person able to experience that emotion without being overwhelmed. Anxiety can be normalized and explained. It's the way the body alerts itself to danger and it's an appropriate initial response to COVID-19. We want to acknowledge the uncertainty and disappointment that the team may feel given the rapidly changing guidelines, cancellation of big events in their lives, graduations, other celebrations, birthdays, whatever it is. And the ability or inability to participate in their team or in their bar mitzvah or bat mitzvah or their sweet 16 party that they'd planned with their friends for ages, or whatever it is may leave the teenager feeling sad, lonely, bored, or other negative emotion. And these loss of milestones can really take a toll on kids and families.

And while some of the events can get postponed or rescheduled, that grief or loss is real and parents can anticipate and validate those feelings. And also acknowledge that the kid can have very opposite feelings in the same brain at the same minute, at the same time, they can feel, wow, this is, this is really awful that I don't get to do this and this and this. But on the other hand, I get that I don't want my Grandpa Joe to, to die of COVID because I brought it into the household. So they can also be altruistic about the whole community, and yet also grieve or mourn the loss of something big that they were excited about before.

So holding those opposite thoughts is fair game. And it's fair game to talk about both and to acknowledge that no, it's not selfish or negative to grieve the loss of these things that you were excited about or that you were looking forward to. And we feel with you the pain of the loss of those things. We also get that you're being the bigger person and you're helping keep our family and our community safe, and we love you for that.

Nada Youssef:  And that brings me to the next question, because these are risky times for some risky behavior. We're talking about vaping, smoking, maybe drinking, but if our teenagers are acting off, especially if that kid had a history of anxiety and depression, what signs should parents be able to look out for that could be very serious signs or hidden anxieties that we're not paying attention to?

Dr. Ellen Rome:  So look for an increase in somatic complaints, if your teen suddenly has a headache, belly pain, or anything else achy. With the kid and the parent potentially unaware of the role of stress in amplifying their personal pain response. So you can also look for maladaptive coping strategies. That may mean looking for love in all the wrong places. And we really do kids still getting pregnant or STIs during COVID-19. Or else vaping or jeweling, as we just talked about, or other forms of self harm or disordered eating or any other not very useful coping strategy.

The teen's lack of abstract thought, that ability to see consequences, may impede their ability to see the downstream effects of their actions in the moment.

Nada Youssef:  That is a very good information. And with all these things that are happening and us as adults, as parents, it's already giving us a lot of stress. And sometimes with our children, we may think it's normal. They're just bored, but that's why it's very important as parents to read on what to do with their children, if they're acting different. So thank you so much for this interview. It's very, very helpful for everyone. Thank you.

Dr. Ellen Rome:  Thank you so much for having me here.

Nada Youssef:  Now, is there anything else you would like our viewers to know?

Dr. Ellen Rome:  Young people thrive with clear caring, open and honest communication. School aged kids and kids may take their cues from parent's anxiety levels and reactions to COVID-19.

If you're seeing a kid with undue stress dial down or turn off the constant barrage of news media and be conscious of the effects on your kid's anxiety and emotional wellbeing. When you get the opportunity, ask about kids' fears and concerns and respond with openness and empathy and heart, so that the kid can problem solve with you. And kids are digital natives born and raised in this time of technology, so help them figure out some of their solutions for resourcing, how to do school, how to do your work, how to collaborate in the home for innovative solutions in this new reality. Kids are an asset in the household, treat them as such and enjoy the time that we get with them.

Nada Youssef:  Excellent. Thank you. And if you'd like to schedule an appointment with Cleveland Clinic Children's, you can call (216)444-KIDS. And for more podcasts with our Cleveland Clinic Experts, visit ClevelandClinic.org/he podcast. And for more health tips, news and information from Cleveland Clinic, make sure to follow us on Facebook, Twitter, and Instagram @ClevelandClinic. Just one word. Thank you so much for joining us.