As we have transitioned our medical practice at Mindful Pediatrics to Telemedicine, I find myself struggling with how different this is from the face-to-face interaction I love with my patients. Similarly, I have turned my Pilates business into a virtual teaching platform, while trying to still maintain connection with my students. These activities, and my day-to-day encounters, are simply not the same as they used to be.

This is SO HARD! 

As the weeks go on, I find myself mourning what I miss and grieving what I have lost. And as we continue to trudge our way through the “shelter at home” order, I am feeling the novelty of a “2 week long snow day” wearing off!

The 5 Stages of Grief

Elizabeth Kubler-Ross described the stages of grief we experience with any form of personal loss. These stages of denial, anger, bargaining, depression and acceptance are a part of the framework that helps us to identify what we may be feeling and learn to live with what we’ve lost.

For your teen, theses stages may look something like this:

  • Denial: This isn’t a big deal. Everyone, including my parents, is overreacting.
  • Anger: This isn’t fair! You can’t make me stay home! You can’t tell me not to see my friends!
  • Bargaining: Fine, I’ll do this for two weeks, but then I get to do whatever I want.
  • Depression: This is ruining my life and I’ll never be happy again. If I can’t leave the house, I am not leaving my bedroom.
  • Acceptance: I guess this is what I have to do, whether I like it or not.

These stages are not a linear and predictable progression—and not everyone goes through all of them. How we process grief can be as different as we are.  

The challenge of being a teen during COVID-19

This time can be especially challenging for teens. This age group already tends to reject authority and push boundaries. They take more risks and have less impulse control. Their friends and social life are their highest priority. Developmentally, they are individuating from their parents and most have never been put in a position to make a personal sacrifice for the benefit of others.

A high functioning and well-adjusted teen could be thrown into a bout of anxiety or depression from all this. For a teen who already has pre-existing anxiety or depression concerns, this time is likely even harder.

I have had the honor of working closely with teens and their parents for nearly ten years, wading through the murky waters of maintaining and attaining mental well-being throughout the adolescent years.

I’d like to share some thoughts at this time, when a teen’s mental health is being put to the test.

Acknowledge how your teen feels

An important place to start is acknowledging for your teen that you understand how hard this is for them. Seniors are most likely not going back to high school. They will miss out on spending those precious last few months with their best friends. They realize they will likely miss their prom and the opportunity to walk at their graduation ceremony. This is a lot of loss. 

For any teen, missing an entire sports season or favorite after school activity, essential to a sense of belonging, can feel extremely devastating.  If you add in relationship or self-esteem struggles, or substance abuse, this time can be even harder. 

Compliance

One of the first areas of stress for families with teens may be simply getting them to comply with the rules. We have had numerous calls from concerned parents about how to handle teens sneaking out, attending parties, or hosting get-togethers of their own. 

I am not a parent of a teen (God bless those of you that are parenting the 16 year-old while I parent the 16 month old!) and I feel that I cannot authentically write about how to go about convincing your teen to comply with a stay-at-home order!

I would, however, like to offer some ideas about how to attempt to make time under your roof more enjoyable for the teen that doesn’t want to be home, how to draw out the teen that wants to play Minecraft or scroll Instagram in their bedroom alone, and what to do if you are concerned that COVID blues or worry have become something more concerning. 

Screen time: quality vs. quantity

If you have a teen that is not trying to constantly bend the rules, you may have a teen that is happy to spend most of the day on a screen behind a closed door. Many studies show that the higher the number of hours on a screen, the greater at risk he or she is for depression or anxiety. (Sorry if I just made your anxiety or parental guilt increase, that is not my intention, please keep reading!)

If screen use increases risk for struggles with mental health, what do we do now in a time when we are asking our teens to social-distance, solely connecting with friends and family through their devices?

It may be helpful now to not focus on the number of hours your teen is on a screen (thank you iPhone, we each know exactly what that number is) but the quality of the content on that screen.

Spending 1 hour scrolling through an Instagram feed is very different from Facetiming with your best friend or taking a walk while talking to a friend on the phone.

Encouraging your teen to improve the quality of their screen time use may be a more fruitful conversation than limiting and enforcing the amount of time spent on their device.

Cultivating creative ways to connect virtually

Help your teen by brainstorming creative ways to connect with their friends virtually. Remember, this connection is so important to your teen—and they are likely feeling this loss. Here are some ideas:

  • Organize a virtual pizza or Chipotle party with soccer teammates
  • Start a movie club where everyone watches the same movie and connects virtually afterwards
  • Get band members together over video for a jam session
  • Find a friend to do a Saturday morning yoga class together online…and enjoy a cup of tea or a smoothie afterwards as you chat
  • Call a friend to help you pair together outfits and accessories from your closet!
  • Form a group for a weekly game night to play a favorite board game on an online platform

Socially distancing while still remaining social

Another option might be to allow your teen to see friends, but outside and six feet apart. Again, the more connected they can feel to their friends, the less likely they will be to sneak out or engage in other risky behaviors to fulfill their needs. 

Some parents may not be comfortable with this option—or may only agree to this if there is adult supervision.  Please trust your gut. Of course, teens must be willing to comply with social-distancing rules and should always practice good hygiene (hand washing, showering, changing clothes, etc.) even after limited contact. 

  • Organize a backyard picnic where everyone stays on their own blanket
  • Allow your teen to go on a bike ride with a friend on a wide trail where they can keep their distance
  • Set up a few chairs 6 ft apart in your yard and invite a few friends over for Starbucks

Determining if your teen needs additional support

All of these ideas above might help to draw out the reclusive teen or engage the social teen, but how do you determine if your teen needs more than just creative ideas to maintain his or her well-being?

Depression and anxiety are very real and disruptive responses that many teens are likely to struggle with, especially at this time. Below are some warning signs to look for:

Emotional Changes

  • Extreme isolation
  • Hopelessness
  • Worthlessness or guilt
  • Frustration over small things
  • Hypersensitivity
  • Difficulty concentrating or accomplishing school work
  • Frequent thoughts about death and dying
  • Talk of wanting to die or wishing life away

Behavioral Changes

  • Appetite or eating habit changes
  • Wanting more sleep or inability to sleep
  • Less attention to personal hygiene
  • Angry outbursts
  • Self-harm
  • Substance abuse
  • Risky behavior

Physical Changes

  • Stomach aches
  • Headaches or migraines
  • Unexplained pain
  • “Not feeling well”

If anxiety becomes severe, panic attacks can also accompany physical changes, including:

  • Chest pain
  • Difficulty breathing
  • Sweating
  • Feeling of “going crazy” or “dying”
  • Numbness or tingling in arms or legs
  • Heart racing


In addition, below are two screening questionnaires that parents can refer to. These will help assist you in determining if your teen needs more support than you or their peers can offer.

If you find your teen with several of the above warning signs, or a moderate to severe screening score, we are here to offer our support.

We are available to set up a Telemedicine appointment and speak with you and your teen about how he or she is struggling.

Our office can support your teen with healthy dietary and lifestyle practices and supplements that will help to improve mood. We can also offer our insight into whether or not prescription medication could be beneficial. Additionally, we have a great group of therapists we work with who are also offering Telehealth services.

Please reach out and let us know how we can best serve your family at this time.

It is my hope that we at Mindful Pediatrics can come through this pandemic better able to support, understand and empathize with the teens and their families in our practice.

About Ara Haupt, PA-C

Ara Haupt, PA-C is a pediatric Physician Assistant whose interests have always incorporated practicing Western medicine with a balanced integrated approach, looking at the entire body. Adolescent care and integrated teen mental health have been particular areas of interest. Ara enjoys learning how the body can heal itself when given the right tools and coaching. Over the past few years in practice, her passion for learning more in integrated and complementary medicine has grown tremendously, leading her to Mindful Pediatrics.

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