January 29, 2025 • 13 mins
The devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. In March of 2020, we recorded episodes exploring the impact the coronavirus pandemic could have on child development. Now, a year later, we wanted to continue these conversations and discuss what we’ve learned, what needs to change, and where we go from here.
In the second episode in this 4-part special series, host Sally Pfitzer speaks with Dr. Rahil Briggs, National Director of ZERO TO THREE’s HealthySteps program. They discuss the potential impact of the pandemic on infant and toddler development, how an overstressed pediatric health care system responded, and the importance of overcoming equity challenges and public fears to resume well-child visits.
Upcoming episodes of this series will feature expert speakers reflecting on the longstanding social policies and systemic racism that resulted in the pandemic disparately impacting communities of color, and the pandemic’s impact on the mental health system. The experts will discuss how we can take what we learned over the past year and make meaningful changes that will improve outcomes for children and families. Listen to the first episode of this series, where Center Director, Jack P. Shonkoff, M.D. discusses what COVID-19 revealed about the needs of caregivers with young children or during pregnancy.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to The Brain Architects, a podcast from the Center on the Developing Child at
(00:04):
Harvard University. I'm your host, Sally Phitzer. In March of 2020, we recorded episodes exploring
the impact the coronavirus pandemic could have on child development. You may remember
we discussed the importance of self-care for caregivers and the importance of physical
distancing, not social distancing. And now a year later, we wanted to continue those
conversations and discuss what we've learned, what needs to change, and where we go from
(00:26):
that. Joining us on today's podcast is Dr. Rahil Briggs, National Director of Zero to
Three's Healthy Steps program. Rahil, thanks so much for being here with us today. And
just for timing, I'm going to jump right into our first question. What can we tell parents
and caregivers about the potential effects the pandemic lifestyle changes could have
on development, particularly on infants and toddlers?
(00:47):
Thank you, Sally, and thanks for having me. I know this question is on a lot of people's
minds. We're a year into this, and what's been the effect for some of these kids? It's
half of their life that they've lived within the COVID pandemic. But for parents of babies
and toddlers, I think we mostly have really good news. Because they are learning through
serve and return interactions, it doesn't need to occur in one particular kind of learning
(01:13):
environment or even a specific variety of environments for them to continuously be learning.
So parents can rest assured that babies and toddlers who are having that regular interaction
with their primary caregivers in loving, supportive, nurturing ways, with all sorts of serve and
(01:33):
return moments all day long are still learning a lot. Reading books, singing, playing music,
just observing what's going on around them. We often talk about it, you know, nobody expects
that you're going to put your life on hold and read 20 books to your kids every hour.
But can you just comment on what you're doing as you're cooking dinner? Now I'm putting
(01:55):
the water in the pot and now I'm putting the rice in and let's watch it boil and just really
narrating our sportscasting that day. I'll say it again and again and again, you know,
it's about really taking care of oneself, avoiding toxic stress, bringing in mindfulness
if you can. And I don't mean that we all become yogis and meditate every day. That is not
(02:19):
realistic right now. We're trying to juggle 12 different things every minute. It's about
self-care of adults. Self-care is not selfish, as we've discussed before. Reducing that caregiver
stress will reduce baby and toddler stress. And when babies and toddlers are less stressed,
do they learn better? Just like us, right? We learn better when we're less stressed and
(02:41):
it's exactly the same for them. And of course, there's one thing we've all learned in this
last year. It's that stress can't be avoided per se, but it's about regulating. And so
for parents and caregivers, it's about self-regulating or asking for help. And when you do those
things, either self-regulate or ask for help, you model a really important social emotional
(03:04):
skill that babies will eventually learn through that example.
Rahil, I really appreciate that connection you just made between the health of caregivers
and the health of children. I think it's something that can easily be overlooked, especially
with everything going on. And I'm wondering, are there concrete examples of things that
caregivers should look out for? Something that might indicate that their child has been
(03:24):
negatively impacted by the uncertainty and chaos surrounding the pandemic?
Sure. So we know that the difference between a one-year-old and a two-year-old, say, in
developmental terms is pretty remarkable. It's quite different than the difference between
a 33-year-old and a 34-year-old, for example. And so developmental regression is something
(03:48):
that you might look at and you might look for. So as a child who used to be toilet trained
now going back to having accidents or asking for diapers, or a child who used to be fully
weaned from a bottle or breastfeeding or a pacifier suddenly going back in that direction,
(04:08):
those can be signs of them just saying, like, hey, this is all a bit overwhelming for me
right now. And I want to go back to a place where things are a little bit easier and I
get a lot more soothing and a lot more care. From some of the wonderful work of people
like Joan Luby and others, we know that preschool age children can be unfortunately depressed.
(04:29):
They can be reliably diagnosed with depression, meaning that a number of different professionals
would agree, yes, this looks like depression. And not too unlike ourselves in the adult
phase of life. You know, it could be impacting sleep, diet, interest in everyday things.
So I would say that's a great time to really reach out to your pediatrician and say, this
(04:52):
is what I'm seeing. Does this feel like the new normal and just what I should expect because
of how we've all been? Or does this feel like something that needs a little bit more attention?
And so any prolonged or substantial changes might be something to bring to a pediatrician.
We know that lots of families have been worried about going to the pediatrician. I saw just
(05:12):
this week, the American Academy of Pediatrics has put out a new call that parents are superheroes
when they bring their children to the pediatrician to get them up to date on vaccinations. But
it's also those times to ask those questions and really double check, like, is this okay?
Is this something to be expected or is this something to be worried about?
(05:34):
So the pediatric system, like many had to adapt rapidly to the pandemic. What do you
think has worked well and what has not worked well?
So talk about superheroes. Um, when I think about my colleagues in pediatric care at Montefiore
and around the country, um, and all through healthcare, the lengths to which people have
(05:55):
gone to support families is remarkable. Um, we've heard about just pediatric practices,
sort of turning themselves inside out and becoming one-stop shops for families, diapers,
formula, and the like. So just gratitude to everyone in pediatric healthcare. Um, they've
been stressed to say the least. And so that pediatric system, um, has had to get retooled
(06:21):
to serve adult patients. There have been some children's hospitals where full floors have
become adult focused, uh, out of need. And of course, as people have gotten sick or been
less available, we've seen that as well. So the pediatric system was stressed to say the
least. We saw, and we continue to see dips in well child visits. We see dips in vaccinations,
(06:45):
not COVID, but all those other diseases that we have these wonderfully evidence-based vaccinations
for, and it's around the country. Um, we've also heard about pediatric practices closing,
just not being able to stay open for business because the volume was down or because the
workforce issues. There's been a slow rebound on all of these points, but I'd say we're
(07:06):
not yet back to pre-pandemic levels. And so that means the families are missing out. They're
missing out on that really important care that happens at the pediatric office. If we
don't reverse this and quickly, that will be concerning. Um, I think about it, especially
from an equity lens, when all babies and toddlers have a strong start and when they can get
(07:30):
that start through a partnership, through a high performing pediatric practice, the
entire country is better, right? Pediatric primary care is like the only setting we have
in this country that almost universally reaches all babies, all toddlers and their families,
no matter what your income is, no matter where you're living. So I'd say some of the transitions
(07:52):
we saw, you know, as folks got to recognize that this new normal was going to be around
for a lot longer than they had anticipated. Um, we saw our healthy steps practices really
adhere to the guidance that was put out by the American Academy of Pediatrics and by
the CDC. And so for many practices that meant postponing visits for older kids and only
(08:15):
seeing kids birth to age two in person. That was some early American Academy of Pediatrics
guidance. Um, some practices experimented with drive through vaccinations. Um, others
went fully remote and started seeing families virtually. Um, telehealth in pediatrics is
not quite as seamless as it may be for us in the adult world, right? Um, that was a
(08:39):
really big adjustment for people. I think it'll be here to stay in some form, but lest
you think it's easy, try to imagine a baby or a toddler on the other side of that telehealth
visit and telling them, please sit there for the next three minutes and don't move and
show me the inside of your wrist. Right. It's like, uh, no, so not always the most compliant.
(09:08):
Um, you know, but for a lot of folks, for families and providers, seeing, seeing their
patients virtually was better than not seeing them at all. Again, though, I think about
equity here. And so many of those inequities that we saw pre COVID are still relevant,
perhaps more relevant than ever. And they really come to light when we think about telehealth
(09:30):
and folks who don't have multiple computers in the home. And the one that they do have
is needed for the school age child to do online schooling. They don't have unlimited internet
access or cell phone data. And then when we close the public spaces, previous options
like using a computer at the library or the like aren't, aren't really feasible. We've
(09:52):
heard from our practices in rural areas that broadband access is a huge issue. This was
again pre COVID and that affects telehealth and of course, remote learning for older children
and work. Um, as we become vaccinated, many of us, you know, practices are mostly back
to in person with the safety precautions that they need, which is really promising. And
(10:18):
I'd say, um, we've all learned a lot. We've learned where you are more flexible than we
knew we could be. And we have been reminded about the inequities that existed pre COVID
because they have been magnified. My real hope is that we renew a focus, um, on changes
that really last for families committed to health, wellbeing, school readiness of all
(10:43):
babies and toddlers. Um, our work at healthy steps continues with, I'd say even more urgency
than we had earlier. And hopefully the world and the community at large can join us with
really that mission to give all babies and all toddlers that critically strong start.
Yeah. You started talking about this a little bit, but I'm curious when families are really
(11:06):
stressed and they're starting to say like, well, a well child visit might be something
that I can skip because there's so much going on and I'm worried about exposure. Um, what
would you say to those families and how would you kind of help them think through what that
might mean?
It's a great question in terms of skipping well child visits. We have, um, data that
suggests that there are negative outcomes when you skip well child visits. So what are
(11:30):
some things that can happen? Well, developmental delays can go undiagnosed. And we all know
that the earlier we catch those developmental delays and the earlier that we provide evidence
based treatment, the better the outcome for children. Sometimes erasing what was a delay
in only just a year. We also know about the incredibly life-saving importance of vaccinations.
(11:52):
We all are pretty well, you know, the number of people who can talk about what an MRNA
vaccination does these days is remarkable. And hopefully they remember that we've got
vaccinations for lots of other really life-threatening diseases. And it's critical. Early childhood
is the moment when you're getting vaccinated, right? Every, almost every visit, there's
some combination of vaccinations. They're just so important. Um, growth is an obvious
(12:18):
one. Not everybody has a perfect infant scale at home. And so being able to make sure that
babies are gaining back that early birth weight and then gaining weight at the rate we would
expect really has significant implications for development and wellbeing overall. Um,
so it's really one of those visits that feels pretty darn worth it to, to mask up, to call
(12:43):
ahead about safety protocols and to know that each and every one of those healthcare providers
is going in there every day, just as worried about their own health and wellbeing and that
of their families and wouldn't do anything to put their patients in danger.
You always make me feel better when I talk to you, Rahil. I love those concrete examples
too. I think that'll be really helpful. I'm your host, Sally Fitzgerald. The Brain Architects
(13:05):
is a product of the Center on the Developing Child at Harvard University. You can find
us at developingchild.harvard.edu. We're also on Twitter at Harvard Center, Facebook at
Center Developing Child, Instagram at Developing Child Harvard, and LinkedIn Center on the
Developing Child at Harvard University. Brandy Thomas is our producer. Dominic Mathurin is
our audio editor. Our music is Brain Power by Mila from freemusicarchive.org. This podcast
(13:31):
was recorded at my dining room table.
Welcome to The Brain Architects, a podcast from the Center on the Developing Child at
(00:04):
Harvard University. I'm your host, Sally Phitzer. In March of 2020, we recorded episodes exploring
the impact the coronavirus pandemic could have on child development. You may remember
we discussed the importance of self-care for caregivers and the importance of physical
distancing, not social distancing. And now a year later, we wanted to continue those
conversations and discuss what we've learned, what needs to change, and where we go from
(00:26):
that. Joining us on today's podcast is Dr. Rahil Briggs, National Director of Zero to
Three's Healthy Steps program. Rahil, thanks so much for being here with us today. And
just for timing, I'm going to jump right into our first question. What can we tell parents
and caregivers about the potential effects the pandemic lifestyle changes could have
on development, particularly on infants and toddlers?
(00:47):
Thank you, Sally, and thanks for having me. I know this question is on a lot of people's
minds. We're a year into this, and what's been the effect for some of these kids? It's
half of their life that they've lived within the COVID pandemic. But for parents of babies
and toddlers, I think we mostly have really good news. Because they are learning through
serve and return interactions, it doesn't need to occur in one particular kind of learning
(01:13):
environment or even a specific variety of environments for them to continuously be learning.
So parents can rest assured that babies and toddlers who are having that regular interaction
with their primary caregivers in loving, supportive, nurturing ways, with all sorts of serve and
(01:33):
return moments all day long are still learning a lot. Reading books, singing, playing music,
just observing what's going on around them. We often talk about it, you know, nobody expects
that you're going to put your life on hold and read 20 books to your kids every hour.
But can you just comment on what you're doing as you're cooking dinner? Now I'm putting
(01:55):
the water in the pot and now I'm putting the rice in and let's watch it boil and just really
narrating our sportscasting that day. I'll say it again and again and again, you know,
it's about really taking care of oneself, avoiding toxic stress, bringing in mindfulness
if you can. And I don't mean that we all become yogis and meditate every day. That is not
(02:19):
realistic right now. We're trying to juggle 12 different things every minute. It's about
self-care of adults. Self-care is not selfish, as we've discussed before. Reducing that caregiver
stress will reduce baby and toddler stress. And when babies and toddlers are less stressed,
do they learn better? Just like us, right? We learn better when we're less stressed and
(02:41):
it's exactly the same for them. And of course, there's one thing we've all learned in this
last year. It's that stress can't be avoided per se, but it's about regulating. And so
for parents and caregivers, it's about self-regulating or asking for help. And when you do those
things, either self-regulate or ask for help, you model a really important social emotional
(03:04):
skill that babies will eventually learn through that example.
Rahil, I really appreciate that connection you just made between the health of caregivers
and the health of children. I think it's something that can easily be overlooked, especially
with everything going on. And I'm wondering, are there concrete examples of things that
caregivers should look out for? Something that might indicate that their child has been
(03:24):
negatively impacted by the uncertainty and chaos surrounding the pandemic?
Sure. So we know that the difference between a one-year-old and a two-year-old, say, in
developmental terms is pretty remarkable. It's quite different than the difference between
a 33-year-old and a 34-year-old, for example. And so developmental regression is something
(03:48):
that you might look at and you might look for. So as a child who used to be toilet trained
now going back to having accidents or asking for diapers, or a child who used to be fully
weaned from a bottle or breastfeeding or a pacifier suddenly going back in that direction,
(04:08):
those can be signs of them just saying, like, hey, this is all a bit overwhelming for me
right now. And I want to go back to a place where things are a little bit easier and I
get a lot more soothing and a lot more care. From some of the wonderful work of people
like Joan Luby and others, we know that preschool age children can be unfortunately depressed.
(04:29):
They can be reliably diagnosed with depression, meaning that a number of different professionals
would agree, yes, this looks like depression. And not too unlike ourselves in the adult
phase of life. You know, it could be impacting sleep, diet, interest in everyday things.
So I would say that's a great time to really reach out to your pediatrician and say, this
(04:52):
is what I'm seeing. Does this feel like the new normal and just what I should expect because
of how we've all been? Or does this feel like something that needs a little bit more attention?
And so any prolonged or substantial changes might be something to bring to a pediatrician.
We know that lots of families have been worried about going to the pediatrician. I saw just
(05:12):
this week, the American Academy of Pediatrics has put out a new call that parents are superheroes
when they bring their children to the pediatrician to get them up to date on vaccinations. But
it's also those times to ask those questions and really double check, like, is this okay?
Is this something to be expected or is this something to be worried about?
(05:34):
So the pediatric system, like many had to adapt rapidly to the pandemic. What do you
think has worked well and what has not worked well?
So talk about superheroes. Um, when I think about my colleagues in pediatric care at Montefiore
and around the country, um, and all through healthcare, the lengths to which people have
(05:55):
gone to support families is remarkable. Um, we've heard about just pediatric practices,
sort of turning themselves inside out and becoming one-stop shops for families, diapers,
formula, and the like. So just gratitude to everyone in pediatric healthcare. Um, they've
been stressed to say the least. And so that pediatric system, um, has had to get retooled
(06:21):
to serve adult patients. There have been some children's hospitals where full floors have
become adult focused, uh, out of need. And of course, as people have gotten sick or been
less available, we've seen that as well. So the pediatric system was stressed to say the
least. We saw, and we continue to see dips in well child visits. We see dips in vaccinations,
(06:45):
not COVID, but all those other diseases that we have these wonderfully evidence-based vaccinations
for, and it's around the country. Um, we've also heard about pediatric practices closing,
just not being able to stay open for business because the volume was down or because the
workforce issues. There's been a slow rebound on all of these points, but I'd say we're
(07:06):
not yet back to pre-pandemic levels. And so that means the families are missing out. They're
missing out on that really important care that happens at the pediatric office. If we
don't reverse this and quickly, that will be concerning. Um, I think about it, especially
from an equity lens, when all babies and toddlers have a strong start and when they can get
(07:30):
that start through a partnership, through a high performing pediatric practice, the
entire country is better, right? Pediatric primary care is like the only setting we have
in this country that almost universally reaches all babies, all toddlers and their families,
no matter what your income is, no matter where you're living. So I'd say some of the transitions
(07:52):
we saw, you know, as folks got to recognize that this new normal was going to be around
for a lot longer than they had anticipated. Um, we saw our healthy steps practices really
adhere to the guidance that was put out by the American Academy of Pediatrics and by
the CDC. And so for many practices that meant postponing visits for older kids and only
(08:15):
seeing kids birth to age two in person. That was some early American Academy of Pediatrics
guidance. Um, some practices experimented with drive through vaccinations. Um, others
went fully remote and started seeing families virtually. Um, telehealth in pediatrics is
not quite as seamless as it may be for us in the adult world, right? Um, that was a
(08:39):
really big adjustment for people. I think it'll be here to stay in some form, but lest
you think it's easy, try to imagine a baby or a toddler on the other side of that telehealth
visit and telling them, please sit there for the next three minutes and don't move and
show me the inside of your wrist. Right. It's like, uh, no, so not always the most compliant.
(09:08):
Um, you know, but for a lot of folks, for families and providers, seeing, seeing their
patients virtually was better than not seeing them at all. Again, though, I think about
equity here. And so many of those inequities that we saw pre COVID are still relevant,
perhaps more relevant than ever. And they really come to light when we think about telehealth
(09:30):
and folks who don't have multiple computers in the home. And the one that they do have
is needed for the school age child to do online schooling. They don't have unlimited internet
access or cell phone data. And then when we close the public spaces, previous options
like using a computer at the library or the like aren't, aren't really feasible. We've
(09:52):
heard from our practices in rural areas that broadband access is a huge issue. This was
again pre COVID and that affects telehealth and of course, remote learning for older children
and work. Um, as we become vaccinated, many of us, you know, practices are mostly back
to in person with the safety precautions that they need, which is really promising. And
(10:18):
I'd say, um, we've all learned a lot. We've learned where you are more flexible than we
knew we could be. And we have been reminded about the inequities that existed pre COVID
because they have been magnified. My real hope is that we renew a focus, um, on changes
that really last for families committed to health, wellbeing, school readiness of all
(10:43):
babies and toddlers. Um, our work at healthy steps continues with, I'd say even more urgency
than we had earlier. And hopefully the world and the community at large can join us with
really that mission to give all babies and all toddlers that critically strong start.
Yeah. You started talking about this a little bit, but I'm curious when families are really
(11:06):
stressed and they're starting to say like, well, a well child visit might be something
that I can skip because there's so much going on and I'm worried about exposure. Um, what
would you say to those families and how would you kind of help them think through what that
might mean?
It's a great question in terms of skipping well child visits. We have, um, data that
suggests that there are negative outcomes when you skip well child visits. So what are
(11:30):
some things that can happen? Well, developmental delays can go undiagnosed. And we all know
that the earlier we catch those developmental delays and the earlier that we provide evidence
based treatment, the better the outcome for children. Sometimes erasing what was a delay
in only just a year. We also know about the incredibly life-saving importance of vaccinations.
(11:52):
We all are pretty well, you know, the number of people who can talk about what an MRNA
vaccination does these days is remarkable. And hopefully they remember that we've got
vaccinations for lots of other really life-threatening diseases. And it's critical. Early childhood
is the moment when you're getting vaccinated, right? Every, almost every visit, there's
some combination of vaccinations. They're just so important. Um, growth is an obvious
(12:18):
one. Not everybody has a perfect infant scale at home. And so being able to make sure that
babies are gaining back that early birth weight and then gaining weight at the rate we would
expect really has significant implications for development and wellbeing overall. Um,
so it's really one of those visits that feels pretty darn worth it to, to mask up, to call
(12:43):
ahead about safety protocols and to know that each and every one of those healthcare providers
is going in there every day, just as worried about their own health and wellbeing and that
of their families and wouldn't do anything to put their patients in danger.
You always make me feel better when I talk to you, Rahil. I love those concrete examples
too. I think that'll be really helpful. I'm your host, Sally Fitzgerald. The Brain Architects
(13:05):
is a product of the Center on the Developing Child at Harvard University. You can find
us at developingchild.harvard.edu. We're also on Twitter at Harvard Center, Facebook at
Center Developing Child, Instagram at Developing Child Harvard, and LinkedIn Center on the
Developing Child at Harvard University. Brandy Thomas is our producer. Dominic Mathurin is
our audio editor. Our music is Brain Power by Mila from freemusicarchive.org. This podcast
(13:31):
was recorded at my dining room table.
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