Don’t underestimate the effect of the coronavirus crisis on children’s mental health.

Children do not fall under the high-risk population for COVID-19, yet they may be the largest demographic to suffer in this pandemic.

According to a recent UN report, even though the number of affected children is relatively low, the indirect impact of the pandemic could be catastrophic for them. Thousands of children may suffer or even die as a result of the virus infecting every dimension of their life, including their physical and mental health, as well as their developmental, educational and socioeconomic standing.

The impact of the pandemic could be particularly dire for children’s mental health. According to a survey conducted by the Kaiser Family Foundation, “45 percent of adults say the pandemic has affected their mental health, and 19 percent say it has had a major impact.” If the effects of these strategies on the adult population are so devastating, we must wonder about our children.

Kelly, my 13-year-old patient, fears the virus and feels uncertain about her future. Her eyes looked tired, and her face was exhausted. She was worried about her grandmother who had been hospitalized with COVID-19. “I wanted to visit her, but they wouldn’t let me,” she said. “I keep thinking — what if she does not get better? What if I don’t get to say goodbye?”

Kelly’s anxiety and sleep problems escalated to the point that she was not able to function properly. During this unprecedented time, many more teens like Kelly are having similar difficulties.

I am concerned that the emotional ramifications of this pandemic will be immense for kids. It might cause long-term psychological morbidity among children, especially those with preexisting mental conditions who are already at increased risk. The post-pandemic effect will have profound effects on children with challenges such as autism spectrum disorder, intellectual disabilities and cerebral palsy, who are the most vulnerable as the pandemic crushes whatever delicate balance they have established.

Empirical evidence has shown that the incidence of post-traumatic stress disorder after health-related outbreaks is similar to after natural disasters and terrorism. I worry that the impact on children’s mental health will be overlooked. According to a study published in The British Journal of Psychiatry, “The mental health of children and young people can be disproportionately affected and easily overlooked in the context of emergencies and disasters. Child and adolescent mental health services can contribute greatly to emergency preparedness, resilience and response and, ultimately, mitigate harmful effects on the most vulnerable members of society.”

Three main trends present the most pressing dangers to children’s mental health amid the pandemic.

First, children need structure, and school is an essential component of their regular structure. For many children, school is an escape from a dysfunctional family environment. When schools close, children lose that pivotal coping mechanism for distress. For children with mental health needs, such closures also mean lack of access to school-based resources. This may create stress among family members, which can exacerbate children’s mental illness.

Second, during the pandemic, a spike in domestic violence has been observed worldwide. In France, domestic violence has increased by 30 percent since the lockdown. The overlap between domestic violence and child abuse is well-documented. As a child psychiatrist, I worry about children’s safety with this recent increase of domestic violence or strained relationships between parents. The pandemic traps thousands of children in homes with their abuser without any means to access help.

Finally, America already struggles to provide access to mental health services to children, and the need for those services will greatly increase during the post-pandemic period. We are not prepared to support our children’s mental health needs in a context of large-scale disaster such as COVID-19. I urge Congress to establish emergency grant funding to ensure adequate mental health services that can begin to address both the current and post-pandemic mental health needs of children and families.

Our children are at risk, and we cannot let them become the hidden victims of this pandemic. To ensure their well-being, we first must acknowledge that the pandemic might cause psychological trauma among many children. Then, we must act.

Afifa Adiba, M.D., is child and adolescent psychiatry fellow at Yale Child Study Center and the vice president of Connecticut State Medical Society-Resident Fellow Section.