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Parenting During COVID-19

Updated on Jun 30, 2022 | COVID-19, Mental Health, Your Health

Trying to be the best parent possible is a challenge even in the best of times. It is even more complex during this pandemic. Aliza Pressman, PhD, co-Founding Director and Director of Clinical Programming for the Mount Sinai Parenting Center, shares information parents and guardians can use as they care for their children during the time of COVID-19.

How can I be a good parent at this time?

If you are worried you aren’t being the best parent possible, you should know that this is not the time to focus on trying to be the perfect parent. In fact, there’s never a right time because it simply isn’t possible. Besides, it’s important for kids to see that human beings are not perfect. That gives them permission to be imperfect too.

In addition, if you’re stressed and not taking care of yourself, that’s not good for anyone. As they say, you need to put your oxygen mask on first so you can take care of your little ones. In other words, it is important to alleviate some of your anxiety so that you can take the best possible care of your kids.

The news has me feeling tremendously anxious. How can I manage this?

We are in an unprecedented time. Feeling out of control or uncertain can lead to anxiety. Everyone is feeling this way now; you are not imaging your lack of control. It is important to realize that there is no way to get this 100 percent right. No matter how much time you spend reading articles and watching the news to try to make sense of what is going on, you won’t be able to.

The best thing you can do for yourself—and for your children—is to accept this and learn to tolerate the feeling of uncertainty. Focus on the things you can control, the problems you can solve. For instance, you can control washing your hands and teaching your children to wash their hands. You can control staying inside your home and maintaining social distance when you’re outside the home.

Do you have any tips to help me stop feeling so worried?

It is perfectly normal to worry right now. This pandemic is making all of us feel threatened. But remember, worrying about things you cannot do anything about will keep you from being able to take care of your family.

Try to find ways to release the underlying emotions, through activities such as meditation or gratitude practices. These approaches will get your nervous system into a state that allows you to alleviate some anxiety and think clearly. `Additionally, it can help to make anxiety a bit of a friend. Welcome that friend, and acknowledge that this is somebody who you’re going to be hanging out with for a while and you might as well get to know each other a little bit. Sometimes you are going to want your anxiety around, and other times you’re going to say you’d like to be left alone. One way to express this anxiety is by assigning different levels of stress a particular color, or a number from one to ten. This gives you a tangible way to acknowledge your anxiety level.

My child had a tantrum and I overreacted. How can I make things right?

Show some compassion for yourself. Forgive the hard moments where you overreact with your kids, have an outburst, or breakdown. And forgive your kids if they have an outburst or a breakdown. I’m not suggesting you do away with your boundaries or expectations for yourself or your children. But labeling those emotions, showing empathy and compassion, and then moving on is going to be a lot more helpful than expecting everything to go right all the time. This is a different kind of crisis. It’s going to be a marathon not a sprint. You need to brace yourself for a long haul.

This is a challenging time for all of us and there are certainly going to be parts of it that are unimaginably difficult. But when we have moments that are painful, we grow emotionally. And we come out the other side better able to adapt to difficult situations. Think of this challenge as an opportunity for you and your family to grow and adapt. Have the compassion to remember that this may not feel like a positive challenge, but it is necessary for growth.

Dr. Pressman is the host of parenting podcast Raising Good Humans. Recently, she and Mariel Benjamin, LCSW, from The Mount Sinai Parenting Center, answered questions from health care providers and staff on the front lines to help support their parenting curing COVID-19. Additionally, The Mount Sinai Parenting Center maintains a COVID-19 resources page for parents, caregivers, and health care workers.

How to Stock Up and Eat Well While Social Distancing

Updated on Jun 30, 2022 | COVID-19, Diet and Nutrition, Your Health

As multiple states issue shelter in place and stay at home orders to combat COVID-19, people across America are required to stock up on food for extended periods of time. Families want to remain food secure while making sure their kids eat nutritious meals.

Clinical Nutrition and Wellness Manager Kelly Hogan, MS, RD, CDN, and Clinical Nutrition Coordinator Rebecca Fernandez, MA, RD, LD, CDN, CDE, provide advice on stocking up and eating well as we do our best to stay home to ‘flatten the curve.’

What should people focus on when food shopping?

Rebecca Fernandez: Try to get things you can use long term like staples for the pantry. These are items that will not be expiring quickly like grains and oats which you can buy in large amounts. Also, consider getting shelf stable milk—which does not require refrigeration—and, unopened, is good for up to six months. Take advantage of the frozen goods like frozen vegetables and fruits that you can stick in the freezer.

Kelly Hogan: Going in the store with a list is important. You don’t want to forget anything and have to make extra trips. Having some go-to recipes that you can batch cook to have leftovers is helpful.

What should people avoid when shopping?

Ms. Hogan: Try not to feel like you have to buy a crazy amount of things at once. The grocery stores are not closing. They’re well stocked and will continue to receive shipments of food. Do try to limit your exposure to health advice online or through social media, as it often comes from those who are not health or medical professionals. For example, advice telling you to avoid or eat certain foods because they may impact immunity has been largely inaccurate and misleading. Focus on shopping for a variety of foods you know you enjoy and will use, including fruits, vegetables, whole grains, legumes, lean proteins and a few of your favorite treats.

What are some healthy snacks for kids?

Ms. Fernandez: There are gummy fruit snacks that are made with less sugar, less preservatives, and are flavored with real fruit juice. I encourage getting kids involved in making snacks whether it’s popping popcorn and adding toppings, such as a dash of maple syrup or Parmesan cheese, or making trail mix using nuts, pretzels, mini M&Ms, and chocolate chips.With these snacks, they’re getting the flavors they love (sweet and/or salty) but in a healthier more nutritious way.

Should we add any new vitamins to our diets during this time?

Ms. Hogan: Most healthy people do not need to take extra vitamin supplements, but this should always be discussed with their dietitian or doctor. I am always wary of herbal supplements, however, especially ones that claim to benefit immune health. These are not regulated by the U.S. Food and Drug Administration and may have adverse effects and/or interact with medications. Instead, focus on other things that can help with immunity such as eating healthy food, getting adequate sleep, and managing stress.

Sample Shopping List

Pantry foods

Pastas
Rice
Oats
Dry cereals (low sugar)
Unsalted/low salt crackers
Unsalted nuts
Beans/lentils
Tomato sauce
Granola bars
Dried fruits (apples, raisins, cranberries, mango, apricots)
Cooking oils

Foods that can be frozen

Meats (chicken, turkey, fish)
Vegetables (broccoli, green beans, peppers)
Fruits

How the Loss of Smell and Taste Relates to COVID-19

Updated on Jun 30, 2022 | COVID-19, Ear Nose Throat, Your Health

Cough and fever—followed by potentially life threatening pneumonia—have been the most talked about symptoms of COVID-19. However, as we learn more about the illness, it appears that the initial symptoms can often be associated with the upper respiratory tract or the nose, mouth, throat. In particular, otolaryngologists in South Korea, China, and Italy have noted that a decrease in the sense of smell and taste—medically known as anosmia and dysgeusia respectively—often precedes the other symptoms of COVID-19. Patrick Colley, MD, rhinologist and skull base surgeon within the Division of Rhinology and Skull Base Surgery at New York Eye and Ear Infirmary of Mount Sinai, answers frequently asked questions about this discovery.

Are these symptoms common among COVID-19 patients?

Observations from physicians in Germany noted that two out of three patients in that country who were COVID-19 positive experienced a loss of smell and taste. In other countries where a larger number of patients were tested for COVID-19, they noted that 30 percent of patients that tested positive for the virus had loss of smell and taste as the major presenting symptom. This means that somewhere between 30 to 60 percent of patients infected with the illness will experience these symptoms. For this reason, The American Academy of Otolaryngology has recommended—in the absence of other respiratory diseases such as allergic rhinitis, acute sinusitis or chronic rhinosinusitis—that a loss of smell and taste should alert physicians to the possibility of COVID-19 infection and warrant serious consideration for self-isolation and testing.

Is this an early or late symptom of COVID-19 infection?

Based on the data that is currently available from other countries with COVID-19 outbreaks, it appears that the loss of smell and taste associated with this virus is an early sign of infection. This means that many individuals will experience these symptoms prior to showing the signs of fever, cough, or shortness of breath more commonly associated with COVID-19.

How can I tell the difference between a loss of smell due to seasonal allergies and a loss of smell due to COVID-19? What should I do if I have these symptoms?

Patients suffering from allergies can experience decreased senses of smell and taste, but will usually have nasal congestion, a runny nose with predominantly clear liquid, and sneezing. They also frequently note itchy eyes, nose or throat. This is very different from the cough, fever, and shortness of breath that is typically seen in COVID-19 patients.

If you experience sudden loss of smell and taste in the absence of recent head trauma, allergic rhinitis, or sinusitis; observe strict self-isolation protocols and contact your primary care doctor, otolaryngologist, or a COVID-19 hotline to discuss the appropriate next steps of care.

How long will the loss of smell and taste last? Will patients fully regain their senses after recovering from COVID-19?

When associated with a viral upper respiratory tract infection, the senses of smell and taste can be expected to return to normal in three weeks to three months. The time course is dependent on whether the virus damaged any nerves in the nasal cavity.

It is unknown at this time how many patients will recover their sense of smell and taste completely after COVID-19. In other upper respiratory tract infections, the recovery rate is 90 to 95 percent by three months after the infection has resolved. Older patients and patients with underlying medical problems tend to have a lower recovery rate. We are assuming a similar recovery rate for COVID-19, but it is too early to provide any accurate data at this time.

How is the loss of smell and taste associated with COVID-19 treated? How can I be evaluated for a decreased sense of smell or taste?

The primary treatment of loss of smell and taste associated with COVID-19 is to treat the viral infection itself. Proper rest, self-care, and monitoring of symptoms are important for ensuring the best outcomes in patients infected with this virus. The loss of senses is only a symptom of this infection and will often resolve after the infection has resolved.

Individuals experiencing a decreased sense of smell or taste in addition to a cough, fever, or shortness of breath should contact their primary care doctor or a COVID-19 hotline (NY/NJ/CT). If this is the only symptom you are experiencing, schedule an appointment with an ear, nose, and throat specialist. Physicians at Mount Sinai’s Department of Otolaryngology are available for telemedicine consults.

Patrick M. Colley, MD

Assistant Professor, Department of Otolaryngology and Division of Rhinology and Skull Base Surgery, New York Eye and Infirmary of Mount Sinai

Call 212-979-4200 to make an appointment with Dr. Colley

What Causes the Loss of Smell and Taste?

The sense of smell stems from small olfactory nerve fibers that are found in the superior portion of the nose. These nerve fibers connect through small holes in the skull directly to the first cranial nerve inside the brain. Air that flows through the nose deposits smell particles in the superior portion of the nose where these nerves can detect smell.

This is the same mechanism that is used to taste the majority of the foods that you eat. The taste receptors, or taste buds, that are found in the mouth only detect salty, sweet, bitter, sour, and umami flavors. The remaining flavors are detected by air flow from your mouth back into your nose where they come in contact with the same olfactory nerve fibers. These nerve fibers in the nose are actually where you taste garlic, onions, herbs, and many other flavors commonly used while cooking.

The decreased sense of smell and taste that is often seen in upper respiratory tract infections such as COVID-19 can either be due to nasal congestion causing decreased air flow through the nose and obstruction of the nerve fibers. It may also be caused by a viral infection of the nerve fibers themselves, causing them to stop functioning or die.

COVID-19: Coping and Resiliency Skills

Mar 31, 2020 | COVID-19, Mental Health, Psychiatry, Your Health

As the outbreak of COVID-19 spreads throughout the greater New York area, people are adjusting to radical changes in their daily life. Businesses are closed, people are working from home—if they are able to work at all—and kids are trying to learn at home. It’s a stressful time for everybody. Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai, offers this advice about resiliency skills and coping with the COVID-19 crisis.

It’s hard not to get overwhelmed by the news. Should you limit the amount of news you watch?

There’s a part of me that wants to keep up with every update. I try to limit my exposure because much of the news is repetitive and some of it is sensationalized. I was out west in mid-March for a brief trip, and saw pictures on the news of empty shopping shelves here in New York. I was pretty worried until I got home that there might be shortages. Of course when I did return, I realized that the situation wasn’t quite as bad as portrayed. People did panic-shop, but the shelves were also getting restocked. So my worry in that case was exaggerated.

On the other hand, it is a good idea to check in a couple times a day to get the latest reports. Let’s face it, a pandemic is a scary thing to be a part of, and there are important updates that we need in real time. The important news is information about what we can do or should be doing. We need to make sure we get our news from reputable sources, like the World Health Organization. Some news outlets have an agenda that they are trying to promote, and I don’t think that’s helpful or healthy to engage in because it may increase distress. But, even if you’re getting news from reputable sources, you don’t need it 24/7.

It’s hard to avoid if you’re home.

True, but it’s also a time when you can do other things at home other than having the TV on. It’s a time that you can read, write, do something creative, meditate, or try a recipe you’ve wanted to try. You can spend time playing with your children, writing letters, or get organized, even clean out your closet.

Think of something you can do at home that will make you feel productive, and that you’ve accomplished something at the end of the day. Put the focus on enhancing your home experience as opposed to what you can’t do in the outside world.

It’s also a really good time to check in on friends, neighbors and particularly, older folks. Now is the time to catch up with other people, perhaps there’s someone you haven’t had a chance to talk to. Or maybe there’s an older person who’s shut in and isolated and needs help. It’s a healthy and healing thing to think about other people, rather than focus exclusively on yourself.

Some people are reporting that they are learning a new “coronavirus skill or art.” Think about the things you have always wanted to do, but never had the time. Arts and crafts. Watercolors. Play a musical instrument.

Does sticking to a daily routine help keep you on track?

For some people it’s very good. For children, in particular, the structure of a routine is very grounding. But there is also something liberating about a guilty pleasure of going off routine. If you always wake up really early to commute to work, there is nothing wrong with giving yourself a treat of an extra hour of sleep to make up for some of the negative aspects of not being able to go out and do whatever you want. So I wouldn’t rigidly advocate it for everyone. If you feel lost without a structure, like you are wasting the day or failing to be industrious or productive, a schedule can be important. But for people who find themselves over-scheduled, there is something about putting the world on mute and listening to one’s needs that can promote a sense of well-being.

The key is to be mindful about it. We are being given an opportunity to connect with something inside of ourselves that hasn’t been nurtured. We have been given more time. Sleep an extra hour, or skip a meal if you want. Do something you don’t ordinarily get to do. It’s a chance to embrace possibilities outside the box. We’re in a serious situation, but we can try to make the most of it and squeeze something positive out of it.

The people who are going to do the best are those who find special moments, special meaning, and special opportunities during this time. During the past couple days, I’ve gotten texts from people just asking “How are you doing? I’ve been thinking about you.” It’s wonderful to get those messages and connect when, otherwise, we might not have had time. And we’ll come out the other end of this changed in some way—maybe for the better.

Can you talk a bit about resiliency skills?

Optimism is certainly a big resiliency skill. Being able to look at the positive side of things is very important. I believe spiritual mindfulness is key; understanding what is in your control and what is not. And taking whatever control you can take, acting on it, and not feeling victimized. And knowing that this will all pass, and maybe good things will come from it in the future. This is hard to do while people are getting sick and dying, and when people are losing their jobs and faced with economic hardship. Grieving losses in real time is an important key to resilience in the future. Realistically assessing and starting to think about what will need to happen in the weeks to come if one has lost one’s job is also important.

Not feeling helpless, but trying to act is also an important way to build resilience. I am reminded of 9/11. At this time we want to behave in a way that when we look back, we will be proud of what we did during this pandemic—individually and as a society. If you bear that in mind, you won’t have disappointed yourself, and that is an important key to resilience.

Doing things for others—altruism—is also key. If you help others, even if there’s a certain amount of risk to yourself, you’ll feel good about yourself when all is said and done. Certainly health care workers on the front lines are expressing altruism each day. People are scared right now. Even people I know who are always positive are worried about getting sick, or even worse, being a carrier and getting someone even more vulnerable at risk. You should be careful if being helpful means posing a risk to yourself or to others. Yet there are many ways to contribute without leaving the house. We can show up each day in our lives—for ourselves and other people—and ask what can we do today to help. That’s resilience.

Is There a Connection Between COVID-19 and IBD?

Mar 27, 2020 | COVID-19, Digestive Diseases, Your Health

COVID-19 is a concern for everyone. But people with inflammatory bowel disease (IBD) may be at increased risk of contracting this virus–or developing a bad case of it. This mostly has to do with medications they may be taking. Ryan Ungaro, MD, Assistant Professor of Gastroenterology at the Susan and Leonard Feinstein Inflammatory Bowel Disease Center, shares information IBD patients need to know about COVID-19.

Is there a connection between COVID-19 and gastrointestinal conditions?

More and more information suggests that the gastrointestinal (GI) system is involved with COVID-19. We are seeing more reports of GI symptoms among COVID-19 patients. For instance, the very first case in the United States noted nausea, vomiting, and diarrhea. In addition, some reports out of China indicate that there are a significant number of COVID-19 patients experiencing GI symptoms. The virus has several ways to get into the human body. This includes the nasal passages, the airway into the lungs, and through the intestines. It may be that contact surfaces in the bathroom could cause transmission. Scientists have found the virus in the stool of some patients.

Are there any special precautious that IBD patients should take?

Any IBD patients who are taking immunosuppressants–drugs that reduce the body’s immune system–should follow the at-risk population guidelines issued by the Centers for Disease Control and Prevention. Take these standard precautions very seriously. Be vigilant with social distancing and limit the number of people you’re in contact with. Be particularly diligent about hand washing and trying not touch your face. Treat yourself as if you’re part of the high-risk population, like the elderly or people with lung disease.

If you are unsure if the medication you take qualifies as an immunosuppressant, check the Crohn’s and Colitis Foundation’s IBD Medication Guide.

If I’m taking any of these medications, should I stop?

In general, you should stay on your medications now. That includes biologic drugs and immunosuppressants. The one exception I would say is steroids. If you are on oral steroids, you should talk to your doctor to see if it’s possible to taper down to a minimum dose or get off them completely. Everyone’s case is individual and if you have any questions, you should raise them with your physician. You want to stay on your medications because the health system is overburdened or is potentially going to become overburdened. You do not want to have a flare-up that requires a trip to the hospital, where there will be increased risk of exposure. If you do need care, we’re trying to do this by telemedicine visits at the IBD Center, except for the most urgent cases.

Is there any research going on about COVID-19 and IBD?

There are several initiatives taking place. The International Organization for Inflammatory Bowel Disease is developing more nuanced guidance for patients and physicians. That should be out shortly. In addition, we, with collaborators at the University of North Carolina, have launched a registry for cases of COVID-19 in IBD patients called SECURE-IBD. The registry will gather information on confirmed cases; medications the patient was receiving; the activity of the disease; and the outcomes, in terms of hospitalizations and disease severity. The goal is to determine which medications may contribute to the risk of developing COVID-19 or having a more severe response to the virus. Gastroenterologists who have patients with COVID-19 are encouraged to report cases directly on the SECURE-IBD website.

What Older Adults and Their Families Need to Know About COVID-19

Mar 26, 2020 | COVID-19, Geriatrics, Your Health

A leader in geriatric medicine, R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, shares information that older people and their loved ones need to know about physical distancing in the time of COVID-19.

Are there any special steps that older people should take?

Because COVID-19 is so contagious–carried in droplets in the air and lingering on surfaces–we should all practice physical distancing. This is the term the World Health Organization (WHO) now wants us to use instead of “social distancing.” The idea is that we want to maintain a physical distance of at least six from the nearest person, to avoid infection. But we also want to maintain social and emotional closeness with friends and family, because that is also crucial to our well-being.

Distancing means that older adults should limit the number of visitors who come into their home or apartment, and this can be particularly hard. It means that children, grandchildren, even young adults, should not be visiting.

And it means that older adults should go out only when they can be assured that they can practice physical distancing and, if at all possible, should avoid going to grocery stores, riding public transportation, or going out for meals or religious services.

What about the emotional toll of this kind of self-isolation?

One of the things that many people worry about, including me, is the risk of depression. What can we do to prevent that from happening? First of all, if an older friend or relative is self-isolating in their home, call them frequently, and don’t just talk about COVID-19, talk about normal things.

Have different people call, so it’s not always the same person. Use video calls whenever possible, so grandparents can see their grandchildren and talk to their grandchildren–hear what’s going on in their lives.

What can older adults do to protect their mental well-being?

Stream movies, and watch TV, but try not to focus on the news. When we are exposed to minute-by-minute coverage of COVID-19, it can really increase our anxiety. Check in a couple times a day as to what’s happening in the United States, your community, and the world, but then turn to something else. Nothing is going to happen that you’re going to need to respond to immediately and that won’t still be there when you turn the television on again in say six or eight hours.

Are there any signs of depression to watch out for?

It’s important to realize that depression presents differently in older adults. Older adults may not experience it as sadness. What they may experience is loss of appetite, weight loss, difficulty sleeping, tiredness and fatigue, and sometimes memory problems. These are the things that both adult children and their parents should be watching for and self-monitoring, and if any of these develop, that’s the time to call your doctor right away so an intervention can be made, and treatment can be started before things progress.

What can I do to boost my immunity to COVID-19?

Unfortunately there is no magic pill that can rapidly boost your immune system. However there are things that you can do: Make sure you’re getting enough rest and sleep. Eat well. Stay well-hydrated. Exercise. This becomes hard in a setting of physical distancing, but there are things you can do. Use a stationary bike or a treadmill if you have them in your home or apartment. Go out for long walks in the community, or out in the park, at a time when few people are around, and make sure you stay six feet away from the nearest person.

Finally do everything you can to minimize your stress and anxiety in this very worrisome time. Steps you can take are limiting your time on social media, particularly the time you’re focusing on COVID-19 on social media. There is a lot of misinformation out there, and there are a lot of very, very scary posts. Instead, keep up-to-date by looking at the data. Look at the websites of the Centers for Disease Control and Prevention, WHO, your state and local health departments, and Mount Sinai, and also your local newspaper and one of the reputable national newspapers or news television shows.

What kind of supplies should I have on hand?

I would recommend that older adults have a 30-day supply of food, medicine, and other essential items. That’s a 30-day supply, not a six-month supply, of toilet paper.

Any more thoughts on the COVID-19 crisis?

We as a community, we as a country, and we as the world have not gone through a global humanitarian crisis like this in our lifetime. But we will get through this. We know what to do to control COVID-19. If we wash our hands thoroughly and often, disinfect high-contact surfaces, and rigorously practice physical distancing, we will get through this, and we will get through this well.

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