The COVID-19 pandemic has taken a major toll on the mental health of children and adolescents. The number of children and adolescents with eating disorders also has increased dramatically, according to Dr. Catherine Gordon, chair of pediatrics at Baylor College of Medicine and pediatrician-in-chief at Texas Children’s Hospital. That’s why it is important for parents, family members and teachers to be aware of signs of distress and know when to take action.

Children are experiencing more stress at home, due to events such as a parent losing a job or a relative dying of COVID-19. In addition, quarantining and remote education have disrupted children’s routines, which has led to increased anxiety and depression, Gordon said.

“In-person education is important for socialization as well as academic enrichment,” Gordon said. “We know that it’s hard for students to receive consistent education at home, and it hasn’t been the same for them as being in a classroom and interacting with a teacher and peers. They have also missed out on extracurricular activities that are critical for their development.”

Gordon offers these tips to parents concerned about anxiety and depression in their children:

“I always tell parents to listen more than talk,” Gordon said. “Enable a child or teenager to share their feelings and let them know that it is okay to feel upset. Expressing feelings is a way to help them process something that may be troubling them and can ward off depression in the long-term.”

Eating disorders also are being diagnosed more frequently during the pandemic, often occurring as a manifestation of stress and anxiety.

“An eating disorder can be a sign of an adolescent trying to regain control by restricting what they will and will not eat,” Gordon said.Signs of an eating disorder may include:

“If your adolescent is not finishing his or her meals, gently ask about it,” Gordon said. “Monitor whether school lunches are being eaten from a lunch box and whether meals or snacks are being thrown away. It is important to approach the adolescent with concern rather than in a punitive way. An adolescent is more likely to open up when a parent is supportive.”

The care of eating disorders requires a multidisciplinary approach, including a physician or nurse practitioner trained in eating disorders (often adolescent medicine), a dietician and a mental health professional. According to Gordon, the treatment of an eating disorder is not a “quick fix” and typically requires months of multidisciplinary care. Eating disorders, especially anorexia nervosa, often are a disease of denial and can be difficult to diagnose in the early stages.

“If a parent begins to worry, it is a good idea to run concerns by the child’s primary care provider for guidance,” Gordon said. “A delayed diagnosis can lead to a more severe presentation once uncovered and even the need for hospitalization. An early diagnosis can lead to the adolescent being managed in the outpatient setting and more quickly getting on the road to recovery.”