Doing Better Therapy

A Blog For Mental Health Professional's

Returning To School: 
Advice from a Child Psychiatrist 
Sarah Klagsbrun, MD, DFAPA, DFAACAP, Medical Director, Four Winds Hospital


In response to schools re-opening, parents will likely be reaching out to their pediatric providers with both health and psychological concerns.  As school re-opening decisions vary among school districts, there will likely be a combination of virtual and in-person learning.  How do you know if a child is having an expected negative response to the COVID pandemic or there is an underlying psychiatric illness brewing? COVID has led to isolation, cancelled trips, cancelled playdates, which has led to justifiable feelings of upset. A 13 year old told me through tears “I am supposed to be at camp playing with my friends.” A 19 year old told me “my college years are ruined. I finally made it onto the football team and now I lost that opportunity for at least half my time in college.”  Sometimes upset, despair, tears are to be expected and not clinical signs of depression and an expected response to what has been taken away and is being mourned the same way any loss needs to be mourned. The longer the losses go on, the more the despair can increase.

Pay Attention To Kids’ Behaviors
A change in a child’s behavior is often the key that something is wrong. Children express their thoughts and feelings through their behaviors. If a child is extra moody with increased irritability, mood fluctuations, temper tantrums, changes in appetite or sleep habits a pediatrician and parent should take those behaviors seriously. Another child may be more withdrawn, quiet, removed from family and friends in order to try to avoid their worries. 
The solution may be as simple as a child needing more sleep or these behaviors may signal underlying anxieties or psychiatric issues. Do not be surprised if things get worse before they get better when a child returns to school with a new routine. That is why it is extra useful to pay attention to behaviors prior to the start of school in order to notice any changes which may signal a problem upon the return to school.

Questions To Ask Parents 
Has the child’s behavior changed? Is the child more isolative than usual? Any changes in appetite or sleep? Is the child using substances like smoking weed or vaping? Teens usually text and communicate with each other remotely via Instagram and Snapchat - is the child still connecting to peers or completely 
isolating from peers? 

Questions To Ask Teens
Teenagers prefer that adults be direct with them. When parents or pediatricians are concerned they should ask children/adolescents directly: How is your mood? Any trouble eating or sleeping? Do you feel depressed? Anxious? Are you feeling so upset that you would rather be dead? Have you ever actually thought about a way you might kill yourself - even if you do not plan to act on it? (Kids may say I would never act on my suicidal feelings - but you need to know have they actually thought about ways to suicide.) When you get upset, has your mind ever played tricks on you? Hear/see things not there? Tell me about your thoughts? Are they racing? What is the most upsetting thing going on? Any way I can help? 

Use Psychiatric Questionnaires
I recommend pediatric practitioners use the Project TEACH Website and use the psychiatric questionnaires available. Parents or children can go to the website themselves to print them out. Ask the child to fill out the Scales to help evaluate their level of anxiety and depression especially if you are evaluating them virtually. Once you have the responses, you can dig deeper.

Always Remember Project Teach Child Psychiatrists Are Here To Help! 
Project TEACH Child and Adolescent Psychiatrists are available through the Project TEACH warm lines to provide guidance on assessment of children’s and adolescents’ mental health symptoms and evidence-based treatment during the COVID-19 pandemic. You can find additional resources on COVID-19 and its impact on children and families across NYS here:



Four Winds Hospital is committed to serving our patients. Please know that, as always, the health and safety of our patients and staff is our highest priority as we continue to provide treatment during this time of crisis. We are continuing to accept inpatient referrals for children, adolescents and adults and invite you to call our Admissions Office directly at 1-800-528-6624 or 1-914-763-8151, select prompt "1" to be connected.

We have implemented measures for the protection of those on our campus in response to the COVID-19 crisis, following the directions of both the CDC and DOH, and our own protocols. As we remain committed to providing the very best in mental health care, please let us know if we can help.
To Make A Referral, call: 1-914-763-8151 or 1-800-528-6624. 24 Hours A Day, 7 Days A Week.