Kids, Covid-19 and Nightmares

Kids, Covid-19 and Nightmares

Photo by Fusion Medical Animation on Unsplash

Kids, Covid-19 and Nightmares

Article by: Dr. Kari Moskowitz

It’s a scary time right now–as hard as it is for adults, the difficulty is magnified for kids, who don’t have the capacity to think in the same way as adults and understand why they are being restricted. When kids are scared or trying to work through something, it often comes up while they are dreaming, especially in the form of nightmares.

What are nightmares?  

Nightmares are scary dreams that generally wake your child up from sleep and seem very real to him or her.  Depending on your child’s age, it is often difficult for children to separate a nightmare from reality even after your child awakes from the nightmare.  Nightmares can often make your child upset and afraid to go back to sleep often resulting in bedtime struggles or refusal.

How is COVID-19 affecting kids?

The Center for Disease Control says risk of exposure to covid-19 is low for children, however research on natural disasters makes it clear that children are very vulnerable to the emotional impact of traumatic events that disrupt their daily lives.  For instance, children suffer when having to adjust to their routines – school closures, social distancing, home confinement – which may interfere with their sense of structure, predictability and security.  They can also be keen observers of people and the environment and react to stress with negative feelings (fears, worries, sadness, anger) in their parents and other significant others. 

Deirdre Barrett (2020), a dream researcher and assistant professor of psychology at Harvard University, reports that there is an increase of pandemic-related dreams in children.  The dreams may be about death or more metaphorical such as monsters chasing them or assaulting family members, reflecting the fact that the virus is invisible. Responses to the COVID-19 threat are unique and varied.  Some children may be irritable or clingy, some may regress, demand extra attention, and/or have difficulty with self-care.

The following are some ideas for how to deal with COVID-related nightmares in your pre-school/elementary school-aged child.

How to deal with  COVID-related nightmares

  • Help your child calm down at night, such as breathing deeply.  Stick to a relaxing bedtime routine. Keep bedtime routines light and happy and fun.
  • If they have a nightmare, coddle and reassure your child.  Stay with your child for a short period following the nightmare.  They will still be tired and may go back to sleep.  If they will not go back to sleep, give them something that reminds them of you such as a favorite tee-shirt or a special pillow.  You can leave the light on and the bedroom door open.
  • Discuss nightmares during the day.  Have your child draw pictures of the dream if they cannot articulate them.  After drawing the picture, have your child rip it up and throw it away as a symbolic gesture. 
  • Talk about the dreams and give them a positive ending.  This will give the child a sense of control about the dream.
  • Redirect your child’s attention to something good that you know you’re going to be able to do that day and will look forward to.  Do this prior to bedtime.  Take the dream and solve the problem, defeat the monster or overcome the anxiety. Rehearsing the nightmare while awake could cause a more positive outcome the next time that the child has the same dream.
  • Rather than dealing with the aftermath of a bad dream, you could try “ordering up” (as if off a menu) of some better ones prior to having your child get into bed.  For instance, have them tell themself “I want to dream about this tonight”. 

The important thing is to Increase children’s self-efficacy. Self-efficacy is the sense of having agency or control – an especially important trait during times of fear and uncertainty.  Children often feel more in control when they can play an active role in helping themselves families and communities, which in turn may decrease their nightmares about COVID-19

Resources for children about Covid-19 and staying healthy

Dr. Kari Moskowitz is a child psychologist practice at Integrative Therapy of Greater Washington who is available for consultations and treatment of children and the adults who care for them.

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I’m a Reproductive Psychologist: but I’m not on the Zulresso bandwagon

My specialty is reproductive psychology, as several clinicians that I work with also specialize in. So one would think that I should be “over-the-moon” happy about the new FDA approval of brexanolone (brand name, “Zulresso”). Two years ago, I was at a presentation that Sage (the company that tested and created brexanolone) gave, and was also skeptical. Upon the release this week, my skepticism grew.

Here is how I see it: the positives (of the medication) are: that we have something that is relatively quick for the most severe cases and that there is research looking and taking seriously maternal mental health. The limitations are: how/where it is administered, a relatively small sample size, no longitudinal research (the study mentioned that the dosage works for 30 days, but was unclear about what occurred after–was another infusion needed?), the cost (not to mention the facilities and administration costs in addition to the medication cost), and that this medication was “fast-tracked” for FDA approval, which then means people who seek out the treatment are still being “experimented” on without their consent (this goes back to the longitudinal argument).

My concern is that we continue to stratify maternal mental health–where those that have access to resources (good insurance, money, physicians) will be able to use this where as many who don’t will continue to suffer. This medication will be available to those that are in the privileged position to afford it. Yet, postpartum depression doesn’t discriminate based upon social-economic-status. 1 in 8 women suffer from it. That’s not 1 in 8 WHITE women, but in general, all women. (I should add that the statistic needs to include gender non-binary people too, so rather than just stating women, it should read “people”….but this is a post for another day).

Don’t get me wrong: acknowledging that postpartum people deserve treatment for perinatal mental health issues is a huge victory. Declassifying medications and looking at pregnancy as part of research are two overlooked and very important steps. Researching medication to treat postpartum mood issues is another huge step, and I commend Sage for looking at this group of people that truly suffer. However, keeping treatment away from all who need it sends the message that only some people are worthy of healing.

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Understanding Perinatal Mood Issues–When is it a Problem?

By Dr. Julie Bindeman

Recently I came across a blog about postpartum depression and distinguishing it from no depression post-baby and the baby blues. While well intentioned, I was dismayed to see how inaccurate the information was, as it not only combined postpartum depression with postpartum anxiety (two VERY different issues) but also over-inflated the baby blues and short-changed the variety of postpartum depression symptoms that exist. Postpartum mood disorders impact 1 in 8 new parents (for the non-pregnant parent, it tends to occur in 1 in 10 people). Perinatal mood disorder can be serious and even deadly if not treated. Fortunately, treatment is effective. A consultation with a trained mental health provider and/or psychiatrist that has specific training in reproductive health can reverse the symptoms and help you feel more like yourself.

 

To clear up any misconceptions, here is my chart:

 

Not impacted Baby Blues Postpartum Depression Postpartum Anxiety
Tears of joy or frustration on occasion Random tears (even for a toilet paper ad) that come out of nowhere Tearfulness that may or may not have a direct cause. Tears around thoughts that might be scary.
Sleep deprived, but able to take naps during the day. No issues falling or staying asleep. Learning to sleep when the baby sleeps. Getting used to sleep/wake cycle that isn’t what one is used to. Sleep is interrupted in one of two ways: difficulty rousing oneself (consistently) or not able to fall and stay asleep. Difficulties falling and staying asleep. Not able to sleep due to racing thoughts.
Your mind might feel clumsy at times and forgetful, but you are able to carry on a conversation (unless the baby interrupts) Your mind feels a little foggy and it might be hard to focus. Your mind feels full and it can be hard to express yourself. You might feel forgetful or distracted. Carrying on a conversation can be difficult, and not because of the baby. Your mind is racing and it is hard to slow it down.
You seldom worry  about things that are new for you. You worry a little, and sometimes check in with others, and sometimes keep it to yourself. You feel too sad or angry to worry. You worry constantly and some of your worries might scare you. You are afraid to tell others about ALL of your worries, though you might share some.
The changes in your life are exciting and make you look forward to the future. The changes in your life are temporarily overwhelming, but you are able to adjust with a little practice. The changes in your life are completely overwhelming and you are having difficulty adjusting to them. The changes in your life cause you perpetual worry as you struggle to make sense of them.
Bonding with your baby isn’t something that you spend time thinking about, as you do so by caring for your baby. Bonding with your baby is initially awkward, but with practice, you adjust. Bonding with your baby is hard as you feel detached from your baby and attending to its needs. Bonding with your baby is something that you are thinking a lot about: are you doing it right? Is your baby attached enough?
After a few weeks, you relish in your new routine as your “new normal.” After a few weeks, you are getting the hang of things and start to feel more like yourself. After a few weeks, you feel as bad, if not worse. After a few weeks, the worrying persists.

 

 

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Infertility Awareness

The week of April 16th is considered to be National Infertility Awareness Week…maybe you are thinking, why do we need another awareness week, after all, infertility isn’t common or it’s for “rich people” that don’t want the burden of carrying a child. The above thoughts are why we need an awareness week.

Infertility impacts 1 in 7 American couples. It doesn’t discriminate based upon race or class. While it does affect older couples more than younger ones, no one is immune. Bringing awareness about infertility can help bring about healthcare change: in fact, fifteen states mandate infertility treatment as part of health insurance packages, which means that no matter your income level, if you have insurance in these places, you are able to pursue treatment to build your family.

What is infertility? Its simplest definition is the inability to birth a living baby after a year of unprotected sex (for couples under the age of 35) and for those that are older than 35, it is the inability to attain pregnancy after sixth months of unprotected sex. For about 40% of couples, infertility is related to something with the male reproductive system not working as expected. Another 40% of couples experience infertility because of impairments with the female reproductive system. 10% of couples have no reason for their infertility (resulting in “unexplained”) and the other 10% of couples have an issue with both members of the couple.

Treatment for infertility can be as non-invasive as taking a medication that can stimulate ovulation or can be as invasive as male surgery or in-vitro fertilization (where an embryo is implanted into the woman’s uterus after an egg is extracted and fertilized with sperm).

Being able to build a family should be an option for everyone. Raising awareness about concerns that impact this goal (and possible solutions) puts us closer to family building being a universal right.

For additional information about infertility:

American Society of Reproductive Medicine (ASRM)

Resolve

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But What If It Works?

This blog is being reposted by the author, Dr. Julie Bindeman. It was originally posted to Pregnancy After Loss Support in November 2017. 

So much of a pregnancy after loss is spent with the all consuming thought: what if it doesn’t work this time too? That thought can linger in the recesses of a person’s mind and grow louder. It tends to crescendo right before a sonogram or a doctor’s appointment, and then fades dramatically once there is confirmation that things are fine. The days, weeks and months of a pregnancy after loss are spent in this pattern.

Sometimes, during a quiet moment when the thought about another bad outcome has lessened, a new thought emerges. One that can also inspire an equal amount of panic in a pregnant person: “What if this works?” Bracing yourself for a bad outcome, the idea that a good one might occur seems almost comical. Of course, it is the hope for the pregnancy that it works. Those who haven’t suffered a loss might be baffled at this kind of thinking—“You had bad luck before—of course it will work!” they might say.

Suddenly, a second cycle begins: what if this doesn’t work and what if it does begin to circle around one another as if dancing. They bring fear and hope, and certainly anxiety. It’s hard to get lost in the thought about what if it works—in the past, when that has happened, and it didn’t work, you felt crushed. You are protecting yourself with the expectation that it might not work, but with the glimmer of hope that it does. Even as the pregnancy progresses, it can take some time to wrap your mind around the idea that ‘this is working’.

Starting to slowly plan for a baby might emerge as your thought process. The cycle might continue, as if a superstitious thought about something good happening might bring on a heartbreaking outcome. Balancing this cycle, allowing yourself to be in the place of good, can be important. Finding that space and balance of each part of the cycle, and perhaps introducing a third part: silence. Now might be a useful time to start a meditation practice or a yoga practice, where silence can be cultivated. Because what if it works?

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Grieving during the “Happiest Time of the Year”

There is no good time or easier time to grieve. The first year is especially hard as new “firsts” are being lived through-such as birthdays, anniversaries, and of course holidays. There is a supposition that the first year is the most awful for grief, and to an extent, this can be true. However, no one truly “gets over” a death of a person they loved. They might incorporate that loss into their daily life and construct a new normal, but this is different from “moving on”.

 

Holidays are the time of the year that bring up the memory of the person we lost. How could they not when traditions were formed or carried out with this person in our midst.  The ways in which we celebrate inherently brings to mind remembrances, which can be both comforting and painful—sometimes simultaneously. Given that not everyone can opt out of the holidays (they seem to occur around us even if we aren’t taking party), here are some ideas to make this season just a tiny bit easier.

 

  1. Make plans. Your plans don’t have to be elaborate or follow past traditions. Being alone when everyone else is with family or friends can feel even more isolating.
  2. Share memories. Talk about who you miss and what you miss about him or her during this time of year. Share memories with others that knew this person or let someone who didn’t know what they were missing.
  3. Set time aside. There can be a give and take when it comes to occupying yourself. Total isolation is not the goal, but taking some time for yourself can be helpful.
  4. Self care. This is essential throughout the entire year. Continue practices of relaxation, meditation, exercise—even though you might not feel like it.
  5. Don’t apologize. Grief is a normal part of the human experience. Don’t feel you need to apologize for tears, should they come through.

 

What do you need to manage the holidays while grieving?

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In this moment

Being in the moment is no easy task. It almost seems that we are programmed to think ahead, formulate our plan for what is next, or automatically anticipate future actions. Our world moves so quickly and we attend to so many different stimuli (such as phones, fitness trackers, tablets, computers….) that is can feel seemingly impossible to NOT multi-task. Are we better for this?

Most of my clients would say no. Doing more with less isn’t the answer. But being in the moment is just so hard. I think back to January and the enormous Blizzard that paralyzed the Washington, DC area. Despite knowing the storm was coming, we still were unprepared. The first few days were novel–so much snow, spending family time together, and having the excuse to indulge. However, as time progressed and the plows did not come, what was once novel became a sense of being trapped. Where we might have enjoyed some of the moments we had, we now felt that we only had to escape them. Our focus was now on the future–when would we leave our houses? When would school resume? What about work demands?

Modern life makes being in the moment even more challenging. It seems that to begin with a small step (just like every journey does) and setting reasonable goals. The idea of achieving “perfect mindfulness” (if there even is such a thing) looks impossible, but the idea of having a daily MOMENT of mindfulness seems attainable.  What might mindfulness look like? Like many things, it is what it needs to be to the person experiencing it.

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Merry and Bright?

Holidays are filled with “should’s” and “supposed to’s”.  ‘We should get together with family.’ or ‘We should be happy this time of year.’  For many, the holidays are anything but a happy time and are mired in stress. There is an idea that gatherings and meals need to be “perfect”.  Holiday cards perpetuate this notion and Martha Stewert certainly hasn’t done anything to dissuade us from trying to obtain this ideal.

The change in our schedules as well as our diets can also be stressful as well as seemingly endless holiday parties that we are expected to attend. While there is certainly joy to be found in the season, it might also make sense that stress is pervasive which puts a damper on some of the positive emotions. How can you cope with holiday stress? Here are some quick ideas:

  1. 1.Prioritize–your dinner might not be Pinterest worthy, but is that what is important to you?  Complete the large tasks before settling in on the details that might be less noticeable or important.

  2. 2.Down time–make time to be by yourself. Take a bath, indulge in going out, go on a walk…no matter what you do, know it is ok to go at it alone.

  3. 3.Try to under plan-this time of year is notorious for over-extending yourself. Pick one or two things a day to commit to rather than trying to cram things in for every moment.

  4. 4.Check in–find a friend that you can check in with to keep one another less stressed. Plan a time to talk.

  5. 5.Everything comes to an end–remember, holidays are only temporary. Regardless of your experience, keep in mind that ‘This too, shall pass.’

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Back to School

For parents, this is a magical time of year. It is when the kids return to school. This means that there is a normal that can quickly be settled into once again or perhaps it might mean establishing a new normal. Not all kids will think of September (or as often is the case, the end of August) with the same feelings of relief.

Some kids worry about school as it might represent an unknown.  Maybe it is hard to navigate the social hierarchy that is established or the academic demands. Since school is a child’s “work place,” it is no surprise that they develop feelings of competence and self-worth based upon whatever feedback they are given (either by peers, teachers, administrators, or parents). Often, we see kids that are convinced that they are “bad” and start to act that way since they have internalized the expectation. As adults, we get frustrated with kids and these are moments when we tend to say things without thinking. In order to  foster an accurate sense of self for our kids, it is important to separate behaviors that we dislike from characteristics.

An example might be that you don’t like how your 7-year-old jumps up and down when he’s talking. Rather than say, “You are annoying me when you jump and talk” you might try something like, “I’m finding it hard to listen to what you are saying when you are also jumping.”  You’ve now identified the behavior that is annoying rather than labeling your child that way.

Another thing to keep in mind as the school year begins is to set your child up for success.  This might mean touring a new school, going over the schedule, talking in depth about what is coming up for them, or having them close their eyes as you both talk through what the day might look like.

What is your back to school strategy?

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Checking in on Change

Change takes time. Change is a process. Change is hard.  All three of these statements are true, and yet they don’t exactly make us want to rush out and commit to making a change. Most human beings prefer stability to change. We crave safety and security, as well as objects, people, and places that are known to us.

January is inherently a time when people try to commit to change. The New Year seems as good as a place as any to make proclamations about how things are going to be different. What resolutions might you have made this year? How are you doing at sticking with them?

Typically, by February or March, the well-intentioned resolutionaries start to fade away (this is a thankful fact to most gym-enthusiasts who can now reclaim their equipment without having to wait). Mostly, this tends to happen because people like the idea of change, but haven’t thought through their plan of action. Both of these components are central to making changes that last.

Here are six tips for making changes.

Step 1: identify what you want to change

Step 2: break it down into smaller goals

Step 3: set up supports that you can check in with and help with accountability

Step 4: incorporate the changes in your schedule (write it down!)

Step 5: begin

Step 6: if you don’t succeed, try again

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