Roughly 200,000 children in the U.S. have lost a caregiver to COVID-19. In South Dakota, mental-health experts say these cases can have added complications as kids grieve, and a range of support is needed for a strong emotional recovery.

Nikki Eining is therapist with Avera Behavioral Health and board member for the Center for the Prevention of Child Maltreatment. She said loss of a biological parent falls under the scope of Adverse Childhood Experiences.

Eining explained it can affect the child's development, because they lost a relationship that's difficult to replace.

"I might not be receiving that nurturing piece from that caregiver anymore," said Eining, "when I've developed that bond to that caregiver as an infant or a toddler, or even an early elementary-aged youth."

With social-distancing requirements, the child may have not had a chance to say goodbye, and those rules may have kept their support system at bay during the mourning phase.

Eining said that's why it's important for adults in their lives to help build new trusted relationships that offer a sense of bonding. That involvement can come from outside the home, including neighbors, teachers and coaches.

Maureen Murray, director of mental health and prevention services with Youth and Family Services in Rapid City, said her office has responded to a handful of these cases.

She said in situations where a child has to suddenly adapt to a new environment, that can extend the grieving even longer.

"A move, a different school system, loss of friends," said Murray, "even if the surviving parent is struggling with their own grief and is not there emotionally for the child."

She said it's dangerous to assume all kids are resilient, noting some will not show how much they're struggling emotionally.

Murray said providing safe spaces for them to talk when they are ready is important, while adding therapy, such as individual sessions or grief camps can help.

A bill in the Pennsylvania General Assembly would amend the state Constitution to allow more adult victims of childhood sexual abuse to sue their abusers.

Senate Bill 1 would open a two-year retroactive window for lawsuits by victims of sexual abuse who were otherwise time-barred from bringing claims.

Terry Clark president and CEO of the Pennsylvania Council of Children, Youth and Family Services, said in 2019, the state extended the civil statute of limitations for child sexual-abuse victims to file suit, from age 30 to age 55. Clark pointed out the bill would also allow legal action against organizations the Council works with to support victims.

"And this really is where our concern is, because it relates to a person being able to sue institutions," Clark explained. "Those institutions aren't just folks like the Catholic churches or Boy Scouts of America. It's also foster-care providers, adoption providers, residential treatment providers."

The bill, sponsored by Sen. Daniel Laughlin R-Erie, also includes new, stricter voter ID requirements. Clark noted the proposed amendments would have to pass in two consecutive legislative sessions, before they would be put on the ballot for voters statewide.

Clark added there are concerns opening a two-year window for sexual-abuse claims, referred to as the "look-back time," may prompt some fraudulent claims. The Council recommended legislators consider a shorter time window of one year instead of two.

"But also establishing parameters around potential defendants," Clark urged. "That would mean including some type of language that limits the scope to who the perpetrator is; the individual causing the harm being more the individual, versus being the institution itself."

Clark emphasized his group would also back requiring some level of fact-finding before a claim is filed, including evaluation by a licensed mental-health professional certifying there is a reasonable basis to believe sexual abuse occurred.

"One of the other things is really looking at creating a victim's compensation fund," Clark noted. "That's a fund that would really help victims and their families through that time. That's the emotional, physical, and traumatic time, it helps ease the financial impact of the services that they might need to heal."

Other suggestions would be mandatory, structured settlements with specific dollar amounts, and including language in the bill to cap attorney fees, to ensure most of the money in a sexual-abuse settlement goes to meeting the needs of the survivor.

Many of California's 13.5 million children and teens have not bounced back after the pandemic, especially children of color, according to the just-released 2023 California County Scorecard of Children's Well-Being. The report showcases data from all 58 counties and shows wide disparities in indicators of health, education and more.

Kelly Hardy, senior managing director of health and research at Children Now, said anti-poverty measures during COVID helped a lot, but they were just temporary.

"Thirty-eight percent are in families making less than two times the poverty level, which is around $60,000 a year for a family of four," she said, "so, that's a pretty low bar."

The data show the state has more than 170,000 homeless students, and that the shortage of state-funded child care continues. The report found that in 2017, 2019 and 2021, only one in four working families had access to a space in a licensed child-care facility.

Susannah Kniffen, Children Now's senior managing director of child welfare and government relations, said kids in foster care had alarmingly low scores for access to healthcare and academic achievement.

"These kids are facing distinct challenges that other students aren't," she said, "and they need a very targeted approach to their education if we're ever going to change the numbers, which are fairly dismal."

Vince Stewart, vice president for policy and programs at Children Now, said in terms of education, kids appear to be losing ground as they get older.

"Forty-two percent of third graders met or exceeded standards and reading, 31% of fifth graders met or exceeded standards in science, in 29% of eighth graders met or exceeded standards in math," he said. "And then 11th graders, it's only 27% who are deemed ready for college-level math."

The report does show some bright spots. California children have high rates of health insurance and a high proportion of babies are born at normal birth weight.

Dental hygienists are trying to raise awareness about the importance of oral hygiene, noting dental pain is one of the most common reasons for school absenteeism among children.

Studies show children with dental pain are three times more likely to miss school. In addition, a child or teenager with noticeable dental disorders, such as blackened teeth or tooth loss, can take a negative toll on their self-esteem.

Betty A. Kabel, director of dental outreach for North Florida Medical Centers, sees it all too often, noting for too long, people have treated oral hygiene as a secondary issue instead of a primary concern.

"If a child has a broken arm, they would not be walking around with a broken arm," Kabel pointed out. "Your tooth, if it's an infection, or it's abscess, it's broken, there is a problem, so it's not OK for a kid to be in tooth pain."

Student health is among the top causes for chronic absenteeism, which includes dental pain, vision problems or mental health, according to the Healthy Schools Campaign.

Kabel argued there needs to be more awareness and expanded access for dental care, especially in rural areas.

Kabel stated she hears first-hand from the children she treats who feel embarrassed, and find it difficult to concentrate due to severe pain. She warned there are worse outcomes for untreated dental problems.

"Children die from tooth infections," Kabel stressed. "The infection is right there next to their brain, it's in their bloodstream, so it's a matter of life and death, when you're walking around with an infection in your mouth. "

Florida is among the top states in the nation with individuals living in Dental Health Professional Shortage Areas, and Kabel noted her organization tries to fill the gaps by working with parents and caregivers to try to treat kids who end up in their school nurse's office with severe pain.

She added there are not a lot of providers who see children, so they do their best to get kids into the ones who do provide care to kids.