Editor's Note: (Dr. Edith Bracho-Sanchez is a primary care pediatrician, director of pediatric telemedicine and assistant professor of pediatrics at Columbia University Irving Medical Center. )
(CNN) Teachers and parents who are currently weighing their options when it comes to school reopenings in the middle of a deadly pandemic may have one additional challenge ahead: children who are fearful of returning to school.
Like the rest of us, children in this country have been told to stay inside, to wash their hands and to wear a mask for months now. For some kids, the restrictions, what they've heard on the news and their own personal experience with Covid-19 have made the outside world feel like a dangerous place.
"He is different now, I can see that," said Rose Israel, whose 6-year-old son Jeremiah Israel-James has refused to go outside in recent weeks. On the rare occasion Jeremiah agrees to leave their East Harlem home, he must first peep through the window, declaring it safe when "there's not that many people outside."
Once out, Jeremiah wants to get back inside as quickly as possible. "Before when he was outside he wanted to explore, he wanted to see, now it's all, 'Let's go and come back, Mama,'" added Israel.
"There's no question that this has been an overall extremely stressful and in some ways a traumatizing experience for a lot of us," said Dr. Barbara Robles-Ramamurthy, a child and adolescent psychiatrist at The University of Texas Health Science Center at San Antonio, UT Health San Antonio.
"I think lack of information, misinformation, the uncertainty of what things will look like in the next few months in the school year is extremely stressful and difficult for families to deal with," she added.
Throughout these months of isolation, Robles-Ramamurthy has been encouraging parents to take their kids outside while socially distancing and wearing masks. "[Children] need to see the blue skies and white clouds and the green trees and other kids laughing and playing. We need those everyday experiences."
But fear of contracting Covid-19 and the inability to properly distance once outside has kept many families inside for prolonged periods of time, with some kids growing more and more fearful of the outside world.
"What about school? You have to go to school." Israel asked her son. "No Mama, I don't wanna go to school, I'm not going to school, they will kill me. I don't want to die," Jeremiah replied.
Jeremiah, like many children, is struggling with anxiety around the upcoming school year, explained Robles-Ramamurthy. "I have been hearing kids saying things like 'I don't wanna go to school and get coronavirus,'" she said.
It doesn't help that decisions on school openings vary by state and even by school district, with some going fully online this fall, some proposing a hybrid model of in-person and virtual education, and some trying to start with all in-person schooling. And of course, that could change if infection rates rise.
Some kids may have an easier time than others making the transition to in-person schooling, said Dr. Neha Chaudhary, child and adolescent psychiatrist at Massachusetts General Hospital and Harvard Medical School and co-founder of Stanford Brainstorm.
"They might even be excited to go back to school and see their friends and be back in that environment," she said.
But for others, especially those who already struggled with anxiety, the transition back will be a difficult one, she added.
Children like Jeremiah will also bring to school an added layer of personal experience with Covid-19. In his case, both his grandmother and his aunt, who live in the same New York City household, contracted severe cases of Covid-19.
"Every time my mom would feel like she couldn't breathe, Jeremiah was always there," Israel said. "He said 'I want to see, I want to see what's going on, Mama.' You know, he loves them, and that's when he started to understand more about Covid," she added.
Children's varying levels of fear, anxiety and personal experiences with Covid-19 may ultimately make it more difficult to learn this fall.
"When a child is anxious or fearful, the parts of their brains responsible for attention, thinking, and learning just aren't able to function as well," Chaudhary said.
"Teachers might find that some kids are more distractible, seemingly disengaged, not understanding the material as easily, or even easily annoyed or more emotionally reactive," she added.
Both Chaudhary and Robles-Ramamurthy acknowledged the enormous task ahead for both teachers and parents, and yet remain hopeful for this fall, stressing children's resilience and ability to adapt to changing circumstances.
"(Kids) are usually more likely to settle into new norms with grace than adults as long as we help them navigate the bumps in the road along the way," Chaudhary said. "And that means supporting teachers so that they can support our kids," she said.