On Monday, April 5, many Massachusetts elementary students will return to school in-person, full-time, joining many other kids across the nation. For some, it will be the first time in over a year that they're stepping foot inside a classroom. There will be new teachers, new classmates, new classrooms, new protocols for them to follow and new routines to adjust to.

For some students, the return to in-person learning will be a welcome relief. For others, it could be a time of rising anxieties.

"I've seen, sort of, a split," said Dr. Fatima Watt, director of Behavorial Services at Franciscan Hospital for Children. "I've seen kids that are so excited and just looking forward to those social interactions and having their friends again. And then there are certainly the kids that are more reluctant. They haven't had as much practice over the last year interacting with friends."

In addition to Watt, GBH News spoke with clinical child psychologist Dr. Julia Martin Burch about some of the challenges facing children as they head back to in-person learning, as well as what parents can do to recognize rising anxiety in their kids and help them successfully navigate this major transition.

Their responses have been lightly edited for length and clarity.

What are some signs your child is anxious?

Watt: Changes in behaviors that seem unusual for your child. I think as parents, we know our children very well. And so if something's not sitting right, if something seems different — they're sleeping too much or sleeping too little, eating too much or eating too little, withdrawing, not engaging for younger kids if they're regressing in their skills, or not meeting expected developmental milestones — those are all signs that the child might be experiencing some stress.

Burch: When we think of signs of anxiety, we usually think about "flight, fight or freeze." The flight is kind of the classic presentation where anxiety looks like avoidance of situations, people, the things that make you feel anxious. And then some kids present more fighters when they're anxious. So this can look like getting kind of irritable, having outbursts, sometimes even getting aggressive. And then finally, some kids fall into this category where they just get stuck and almost immobilized when they're anxious. And it often looks like getting really rigid in their thinking and kind of stuck on a particular idea, a way to do things.

What can you do if they’re resistant to going back to school?

Watt: Whether it's going back to school for the first time, whether it's increasing the amount of days that they're there, when there's major changes to routine and structure, that can certainly increase a lot of anxiety. And when we feel stress and anxiety, we might refuse to do things. We've seen a lot of children in clinic that are having a lot of issues with school refusal because it's a big change, and kids who are already prone to anxiety are going to feel that when it's time. And so I think parents can work to help their child acknowledge and label what they're feeling and then come up with solutions for how they're going to manage it. The more tools our kids have in our in their toolbox, the more comfortable they're going to be able to be in, the more successful they'll be in the classroom.

Burch: When a kid is resistant to going back, you want to try to get a sense of why and what is the hesitation. Are they anxious about something in particular? Is it being away from you? Is it being around a lot of other kids? Is it uncertainty about just the protocols and how different it's going to feel? We never want to make assumptions about what kids are actually afraid of. I think as a parents and as a clinician, I'm always consistently surprised to learn that what I suspected they were anxious about might not be the case. Once you know, parents can sit down with their kids and talk about how this is something that's feeling really scary and hard, and I know you can do it. And so let's make a road map together of how you're going to slowly and gradually work your way towards the thing that you're feeling afraid of.

How important is routine during the transition back to in person learning?

Watt: Parents and children, they've sort of gotten used to where they've been, and now having another shift is certainly creating a lot of stress. And so I think talking about the change in routine as much as possible is good. And if you can come up with a visual, especially for younger children or for kids with developmental disabilities, where they can see what's going to happen. We're going to wake up at this time and have breakfast, then you're going to get on the school bus or Mommy's going to drop you off, then you'll be in class from this time to this time. So the more that we can help them predict what's what's coming, I think the better off we're all going to be.

Burch: I think oftentimes, just as adults, when things feel uncertain, we tend to cling to really rigid routines because it makes us feel more comfortable. But I'd say flexible routines are the way to go. You want your kid's life to feel predictable. You want them to have familiar routines that are comfortable. That's really empowering to kids to actually to know, 'OK, I know what's coming next. I know what to do now.' And so, it's finding that balance between keeping your building blocks of the family schedule — so you eat meals at roughly these times and your kid knows the routine to transition to school. It doesn't mean that, you know, if you're out the door at 7:16 instead of 7:15, your child's mental health is going to suffer, but roughly trying to have the same rhythm to each day.

Are there things parents can do to prepare their kids in advance?

Watt: Definitely, share any information that you know about what the day is going to look like or about what they should expect. And so if desks are going to be farther apart than they last remembered when they were in school, if masks are going to be worn, anything that's going to be different — really preparing them for those changes and then offering them ways to be able to express themselves and to express their concerns to the other adults that are around them.

Burch: Talk with your kids about the return to school in advance. I think often times well-intentioned adults will avoid bringing up potentially stressful situations because we don't want our kids to become more anxious or more overwhelmed. But kids actually do best when we demystify things and have information and predictability. Ask your kids how they're feeling about it and what are they excited for, what questions do they have? It's just starting that conversation to get a sense of how your child is doing, so that you can give kids information and correct any misinformation that they might have.

How about the first few weeks? Is there something you can or should be doing to ease the transition?

Watt: You can discuss ways that your child can problem solve to help them navigate and manage difficult situations — if another child is getting too close to them and they feel uncomfortable, or if someone doesn't have a mask on and they're feeling uncomfortable.

For younger kids, role playing can be really helpful. Practicing basic social skills and learning how to warm up can be helpful. So, practicing conversation skills with them, sharing what they've been up to for the last year, anything that can give the child or teen more control, I think, is going to be a useful tool for them.

Burch: The first thing that parents can do is just take a breath and remind themselves that transitions are really, really hard and that parents and kids are going to get through this. Kids pick up on their grown ups' mood so parents can do a lot by just doing their best to project calm, no matter what's going on for them internally. This is a really nice time to start folding in some family rituals if people aren't doing them already. So, things like talking about your rose, your thorn and your bud at dinner — which is a highlight from the day, a lowlight, and then something you're looking forward to tomorrow — or just having little pockets of special time, little moments to be spending a little bit more time with your kid as they make this transition.

What are some signs your child might need professional help?

Burch: I think it can be helpful for parents and kids to just know there are going to be easier days and tougher days. Expect ups and downs. That's a very normal part of a really big transition and so know that that's coming.

As a clinician, I think about a couple of things. One is, how is your kid functioning? So is their level of anxiety consistently making it hard for them to do their job as a kid? So your job as a kid is to be a student, to be a friend, to be a soccer player, a violin enthusiast, whatever it might be. Is anxiety starting to keep a kid from doing what they need to do, not just once or twice, but pretty consistently? That could be a sign to seek support.

Another thing that we often think about in the clinical world is the size of your kid's distress. Is it really, really big? Are they having headaches and stomach aches every single morning? Is it just more stress than you're used to seeing in your child? Because that can absolutely warrant some support.

And then finally, we think about the size of their reaction. Is it disproportionate to the stresses that they're facing? So, you know, it can be stressful to return to soccer practice when you haven't been around a lot of kids in a while. But if your child is having a huge emotional reaction and thinking about it for two or three nights beforehand and crying, we'd consider that pretty disproportionate to the actual stresser of going to soccer practice. Those are the things that we would look for.

You can hear a more in-depth conversation with Dr. Fatima Watt on GBH's In It Together.