Six-year-old Elijah Wastell started feeling anxious last fall.

It came hard for the Omaha kindergartener at bedtime. His parents tried breathing exercises. They attempted to build his confidence.

The anxiety got worse.

It got to the point where "he wanted to be in bed with a blanket over his head before the sun went down, which can be tricky in September," said mother Anna Wastell.

Elijah himself didn't tie his newfound anxiety to the pandemic that has altered the lives of everyone – including children – over the past two years.

But experts say cases like Elijah's have become increasingly common as COVID-19 stole normal school years and upended children's social and emotional development.

"For kids, routines and structure are so important to their mental health and their well-being, and the pandemic just turned it upside down," said Kristine Bosiljvec, Boys Town National Hotline manager.

Nebraska providers report seeing a spike in all mental health issues, including:

Screenings that detect depression have hit a new high at Omaha's Children's Hospital and Medical Center. Normally 15% of kids age 11 and up receive a positive depression screen at pediatrician appointments, hospital officials say. During the pandemic, that's risen to more than 20% – some months nearing 30%.

Between February 2020 and 2022, the Boys Town National Hotline received more than 50% more calls from Nebraska children reporting anxiety than they did the two years prior.

The Children's intensive eating disorder program, with a capacity of eight, saw its waiting list grow to 25 children during COVID-19.

These mental health struggles don't stop at the state borders. Nationally, reports of suicidal ideation and thoughts of self harm have skyrocketed, up 45% in early 2021 when compared to 2019.

"Our entire family systems were stressed, and we were all being asked to deal with issues that we'd never developed coping strategies for," said Michael Vance, director of behavioral health at Children's. "While we were trying to deal with this ourselves, we were at the same time trying to figure it out for our kids."

The Wastells continue to try to figure it out. They took Elijah to Play Therapy Omaha. After his first few sessions, his anxiety lessened. He continues to attend therapy, though less frequently now. Elijah agreed to share his story with the Flatwater free press, as did his parents.

"We work hard to normalize mental health care and mental health treatment," Anna Wastell said. "I don't ever want my children to find any shame or any guilt in mental health care."

The Wastells are far from the only Nebraskans trying to guide their kids through new mental health needs.

Early in the pandemic, the Boys Town National Hotline saw a jump in calls from both youth and adults, Bosiljvec said. Call volume remains high, but Boys Town is now starting to see a dip in more serious calls, like suicidal thoughts.

"But there's still stress and anxiety," she said. "I think there's enough going on in our country that people are still feeling a little bit anxious about what's going on."

The pandemic brought unpredictability to kids' lives. Current second graders have never had a "normal" school year. Others wondered: Was the track meet going to happen? Was school going to be on tomorrow?

"Human beings in general, and kids in particular, really benefit from structure and routine and predictability," Vance said. "And the pandemic threw a wrench in all that."

Things like school cancellations had the added problem of removing unofficial support networks, like coaches and teachers, that some kids rely on for mental well-being.

This was coupled with family stress as many parents lost jobs and grandparents got sick. Kids also missed out on peer interaction, often key for social development.

"We were dealing with something that none of our generations had dealt with that had such a collective impact on our lives, and it was not something that was under any of our control," Vance said.

One factor that no experts identified as a problem: Mask mandates.

"Not at all," said Tom Reimers, Boys Town behavioral health director. "Nobody likes to wear a mask, but the kids have adapted much better than the parents."

Tim Royers, president of the Millard Education Association, said teachers are seeing the biggest struggles from students who were kindergarteners, sixth graders and high school freshmen during the 2020-2021 school year – kids who entered a new school at the pandemic's height. While Millard resumed in-person school in fall 2020, many school social events remained canceled until summer 2021.

"I don't regret the decisions that we made," Royers said. "It's just that there are always consequences."

Now, teachers and others are trying to reach struggling kids. But teachers themselves feel overwhelmed.

"...that's one of the worst feelings in the world, when you know there's kids that need more, and you can't get to them, and you've given them everything you can," he said.

Another challenge: Children, particularly young ones, aren't always able to articulate their feelings. Some kids act badly instead. Others internalize.

"They communicate through behavior," said Stephanie Hoesing, Omaha Public Schools' social work supervisor. "They don't even necessarily understand what they're experiencing physically or emotionally to be able to name it."

Jennifer McWilliams, a doctor and psychiatrist at Children's, has two pieces of advice for worried parents. One, look for changes suggesting your child is struggling more than normal. Two, listen to your kids without trying to share your experiences.

The key is "listening to what your kids say and not minimizing it," she said. "It's easy to say 'Well, we didn't have anybody that we knew died.' Sometimes a lost softball season is pretty darn traumatic to that particular kid."

There is some good news: After two years of coping with COVID, pediatric health experts, school districts and others are identifying solutions.

Some Nebraska school districts have implemented partnerships with mental health providers, lowering the barrier for kids to get care.

OPS has long-time partnerships with the Methodist Community Health Program and Project Harmony that strengthen students' access to services, Hoesing said. Millard has a new initiative to hire staff who support kids' emotional well-being.

"One of the unintended consequences is more recognition around mental health," Hoesing said.

Even as adults work to help Nebraska children recover, it will take time for kids to rebound from the mental health effects of COVID-19.

"There are going to be some days where we measure progress in inches not miles," Royers said. "There's no way to force a kid to move out of trauma at a certain speed. You have to meet them where they are and support them where they are."

The Flatwater free press is Nebraska's first independent, nonprofit newsroom focused on investigations and feature stories that matter.