The start of an academic year can bring fear and uncertainty for many, this year concerns may be compounded by the ongoing COVID-19 pandemic and recent gun violence-linked mass casualties. Incidents of school shootings and gun violence have a devastating impact far beyond those directly affected. We are left with several unanswered questions and the lingering fear of future events. As schools reopen, the questions many families now face are: Is my child safe at school? How can I protect my child from the COVID-19 surge AND school shootings? Fortunately, reliable information and useful resources can help address these concerns.

The American Psychiatric Association (APA), American Academy of Pediatrics (AAP) and American Academy of Child and Adolescent Psychiatry (AACAP) encourage families to reach out to schools and inquire about their active shooter safety protocols and COVID-19 precautions. All three support policies that will reduce the possibility of future gun violence in schools and provide resources to cope in the aftermath of these kinds of events.

More than 311,000 children have experienced gun violence at school since the Columbine mass shooting in 1999, according to the Washington Post. Given the extensive media coverage of gun violence and COVID-19 and a changing educational environment, many children and families will be anxious about returning to school. Parents and schools should acknowledge the fear and apprehension surrounding these topics. These are some proactive tips to mitigate anxiety:

• Explicitly reference safety protocols for active shooters and COVID-19 precautions during the transition back to in-person classes: Clear communication allows families to plan for and anticipate challenges. Active shooter drill themselves can cause stress and anxiety for some children, see some tips on talking to children about the drills.
• Have a transition schedule prior to starting, two weeks prior if possible: Parents may consider gradually establishing routines such as around sleep habits, physical activity and study times, to transition children from summer to the academic year. Creating a routine also helps anchor the child’s activities and reduce feelings of anxiety.
• Buddy up with a similarly aged peer: Families and schools may consider creating a buddy system with a peer to help their children build more social connections.
• Validate the child’s emotions and offer contingency rewards. Young children may show their anxiety and emotional distress non-verbally. While they may not be able to say, “I feel anxious” or “I feel scared,” they may appear irritable or avoid certain activities. Furthermore, for children who have histories of school anxiety, parents can reward their children after a successful reentry, such as with a toy or quality time with a parent.

In addition, parents should look out for anxiety “red flags” in their children. For “red flag” situations, parents and schools should reach out to a child and adolescent specialist for further assessment and help, as these warning signs may suggest an undiagnosed or untreated psychiatric illness:

• Excessively searching or asking for news relating to gun violence or COVID-19.
• Frequent nightmares or sudden recurrence of bed-wetting.
• Significant distress during, or in anticipation of, school that greatly disrupts a child’s daily activities (such as severe tantrums, non-stop crying, loss of appetite).
• Severe physical symptoms (such as repeated vomiting, severe stomach aches).
• Worsening mood symptoms (such as feeling more depressed, disinterest in their hobbies).
• Safety concerns (such as thoughts of hurting or killing themselves, threats of harming others).

In addition to being aware of these “red flags,” it is also important to maintain open communication with children about their emotions, fears, and appropriate ways to cope with distress. Children should know you are available to talk to them at home and who they can talk to at school if they are feeling distressed. Encourage children to reach out to teachers and school counselors in these situations.

While many children may know to call 911 in the event of a medical emergency or active shooting, they should also be taught (as age-appropriate) to call the 988 hotline, which is a new national resource for mental health crises. (See an FAQ on the 988 crisis line.)

In conclusion, a safe return to school is invaluable for students of all ages. Children need to feel validated and to have their concerns and the concerns of their parents acknowledged, in order to assure a smooth transition back to school.

Authors

• Adrian Jacques Ambrose, M.D., M.P.H.
• Anish R. Dube, M.D., M.P.H.
• Rana Elmaghraby, M.D.
• Stephanie Garayalde, M.D.
• Gabrielle Shapiro, M.D.