Pandemic-related stressors pose physical and mental health challenges for pediatric rheumatology patients

Pediatric rheumatology patients have faced unique physical and mental health challenges during the COVID-19 pandemic, according to clinical social worker Liz Morasso, LCSW, MSW, from the Department of Radiation Oncology at the University of California, Los Angeles.

Morasso discussed the effects of virtual schooling, social isolation, and concerns about immunosuppression in the pediatric population on Tuesday, Nov. 9, during the session, Kids Coping in the COVID-19 Era. The session can be viewed by registered meeting participants through March 11, 2022.

Morasso cited a narrative review that found children without rheumatic diseases are coping with the stressors of the pandemic in ways that mirror how children respond to other distressing events in their environment based on age. Parents report clinginess and fear of infection in family members among children 3 to 6 years old, and inattentiveness and persistent information-seeking among children older than 6 years. Adolescents and young adults report anxiety about the cancellation of milestone events such as college entrance exams, graduation, and school dances, and depression related to isolation.

“Generally, what we saw was uncertainty, fear, and isolation,” Morasso said. “And what that specifically looked like was reports of disturbed sleep, nightmares, poor appetite, agitation, inattention, and separation-related anxiety.”

Among pediatric rheumatology patients included in the narrative review, only those older than 13 reported higher anxiety related to COVID-19 than children of the same age in the general population, with slightly more concern among males, she noted.

Virtual schooling is one of the stressors that families of children with rheumatic diseases have had to contend with during the pandemic. Some of the challenges include decreased physical activity compared to in-person school attendance, weight gain, irregular sleep patterns, disruption of services, and demands on teachers and parents.

“All of those things might have an effect on our patients’ overall health and well-being, and potentially an effect on their rheumatic disease,” Morasso said.

There are also benefits to virtual education, including preventing and limiting the spread of SARS-CoV-2 infection, flexibility around rest and breaks, increased comfort at home, fewer distractions, increased autonomy for the student, and the ability to attend to health needs.

As parents consider whether they should send students who have been learning virtually back to in-person classes, Morasso recommends they reflect on their values as a family and educate themselves about the building’s physical environment, including ventilation, as well as the school’s masking and infection-screening practices, and vaccination requirements.

“It’s OK to be scared. None of us were prepared for this,” Morasso said.

For patients with rheumatic diseases, in general, there is higher rate of complications from any type of infection. And for patients taking disease-modifying antirheumatic drugs (DMARDs) or immunosuppressive medications, there’s a higher rate of bacterial infection, Morasso noted. DMARDs do not lead to increased risk, incidence, or complications from COVID-19, but a patient’s fragility — their general health status — and the complexity of their disease state are contributing factors, she said.

“Therefore, during the pandemic, it’s extremely important to keep the underlying disease under control by continuing their treatment because it’s well known that disease flares can be a risk factor for overlapping infection,” Morasso said. “So, we want to prioritize our patients’ disease control instead of potentially what might happen related to their immunosuppressive treatment.”

The ACR offers information for providers to help pediatric patients and their families navigate the pandemic. These resources include COVID-19 Clinical Guidance for Pediatric Patients with Rheumatic Disease and Clinical Guidance for Pediatric Patients with MIS-C Associated with SARS-CoV-2 and Hyperinflammation in COVID-19.