Rituals and resilience

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A ritual plays out in our pediatric clinics. A happy baby lays on an office table. They receive a vaccine, an undoubtedly stressful experience. They cry, but then loving adults comfort and calm them. Baby learns that even though scary things happen, good people help us through.

While we all socially distance from a frightening foe, pediatricians are seeing fewer well-baby checkups and ear infections. In the quiet moments between patients, we now check in with families to determine what ways we can help. Some families are struggling. Some are thriving. We all are at times struggling and thriving.

In my role as a parent, I too am struggling and thriving. The pediatrics textbooks that have shaped my advice, practice, and parenting for years have given way to sheer pragmatism. My kids know that I am more likely than mom to give in on candy. Baths are optional on many days. Screen time happens. A lot. But In my conversations, I also hear moments of joy including “the kids are getting along!” and expressions of gratitude for this precious time together.

Unlike the 1918 Flu Pandemic which had a high mortality rate for children, COVID-19 has thankfully not followed suit. The effect and history of COVID-19 on the health, development, and lives of children is being written right now. No one has yet evaluated whether a pandemic, social distancing or economic shock is an adverse childhood experience, capable of causing long-term trauma or entrenching a future of poor health. There is horror in this disease. There is death and loss. For any child who bears such a loss, no doubt this would register as a traumatic experience. We know that financial struggle and familial poverty can cause greater familial stress and strife and have long-term effects on health.

Yet research also shows that children are resilient and can bounce back from challenging and traumatic experiences. Just as we support babies through discomfort, this stressful period is a perfect time for resilience to be modeled, taught, and fostered in young people. You are likely already making a big difference.

Resilience is built in good relationships. Every child needs someone who is crazy about them. Our ability to keep the house tidy (or not in my case) has no bearing on a child’s resilience. Our ability to effectively navigate (or not in my case) online learning systems has little direct bearing on resilience. Resilience is telling children that though the world is a little scary right now, you are there for them. For many, resilience is built through the daily connection online with a valued teacher, FaceTimeing with a grandparent, or conversations etched in chalk with a neighbor.

Resilience grows further by connecting children to something larger than themselves. Tradition, culture, faith, and hope. Zoom seders and online church services, small gestures to help a neighbor, online singalongs, or reliving Game 6 of the 1991 World Series all connect us to traditions beyond ourselves. Rituals such as taco Tuesday, movie night or evening walks will be remembered as the very relationship-building experience children will carry with them.

Finally, we know that resilience is built if children know that concrete help is available when needed. Times are tough. If children need help, invite them to speak with you or another comfortable adult. If you as an adult need help with resources, finances, mental health, or frankly anything, reach out. Physicians, clergy, community groups, and neighbors are eager to help during this crisis. Your courage will demonstrate to kids that helpers are out there.

“Five fruits and veggies. Fewer sugary drinks.” The advice I give is frequently not just to my patients, but to parents and myself. As the trauma of this pandemic wreaks health and economic havoc, I take small solace that each ritual; each fort we make together, each dino-mac snack we eat, and each online family reunion is not only healing our children and building their resilience for a future unknown challenge. Each ritual is also healing me.

Krishnan Subrahmanian MD, MPhil, DTM is a pediatrician and practices at our Clinic & Specialty Center and our Richfield Clinic.






  1. Vijayakumar on May 9, 2020 at 2:44 pm

    Very interesting and educating. Wonderfully presented. Congrats.

  2. Mike supple on December 7, 2020 at 11:47 pm

    Thank you, Dr. Subrahmanian!

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