How pediatricians can support children’s mental health mid- and post-pandemic
Mental health is a serious and growing concern among pediatric patients. In the United States, 20% of children have a diagnosable mental health disorder. In children ages 6-17, there has been an increase in anxiety and depression, from 5.4% in 2003 to 8.4% by 2012. In 2018, suicide was the second leading cause of death among ages 10-24.
Pediatricians can help parents and caregivers deal with this growing problem by encouraging them to take time to talk to children about mental health. They should also alert parents to the signs of mental health problems and advise them to contact a professional if they observe symptoms of mental health issues for more than two weeks. According to the National Association of School Psychologists, these can include:
- In preschool-age children: sleep problems, fear of the dark, bedwetting, appetite loss, withdrawal, clinginess and thumb sucking.
- In elementary school children: irritability, aggression, school avoidance, concentration problems, withdrawal, nightmares and clinginess.
- In adolescents: sleep problems, appetite problems, concentration problems, distress, aggression and delinquent behavior.
Being alert to signs of mental health issues in young patients is especially important now, as the COVID-19 pandemic exacerbated existing problems and created new challenges for receiving help.
COVID-19 mental health effects
One of the most significant effects of the ongoing pandemic is its impact on mental health, particularly among young people.
- In a 2020 survey of 1,000 US parents, 71% said their child’s mental health worsened as a result of the pandemic, and 69% said it has been the worst thing to happen to their child.
- A 2020 survey of 3,300 US high school students found almost a third felt much more unhappy and depressed than usual.
- Mental health-related emergency department visits increased 24% for children ages 5 to 11, and 31% for those ages 12 to 17, between March 2020 and October 2020, compared with 2019.
- In March 2021, young people in the US, France and Belgium were 30% to 80% more likely to report symptoms of depression or anxiety than adults, and they also reported higher levels of loneliness.
The pandemic has also reduced family stability as a result of loss, as well as increased concerns about financial, food or housing security. More than 140,000 US children experienced loss of a caregiver to COVID-19. Children have also been affected by caregiver stress, social distancing, lack of a daily routine and inability to use school support systems. Ongoing conversations about violence in schools, social justice and other topics have added to stressors across society, including among children.
Challenges accessing treatment
The closure of schools early in the pandemic meant a key source of mental health support was no longer available to children. Disadvantaged children were particularly affected, and the reduced access to care came amid ongoing shortages of psychologists, and in particular child psychologists.
Out of more than 100,000 US clinical psychologists, just 4,000 are child and adolescent clinicians. While the National Association of School Psychologists recommends a ratio of 1 school psychologist per 500 students, there are currently about 1 per every 1,211 students. Children with more challenging socioeconomic circumstances have the lowest rates of counselors and school psychologists.
These issues are compounded by a nationwide shortage of mental health care professionals of all types that has worsened throughout the pandemic. As of March 31, 2021, 37% of Americans were residing in areas with a shortage of mental health professionals, and in some states the proportion was much higher. In Wyoming, for example, 96.4% of residents lived in a mental health shortage area.
Starting the conversation
Pediatricians can help mitigate these problems by guiding parents and caregivers in discussing the pandemic with children and in helping their patients understand and adapt to ongoing effects from the pandemic. They should advise parents to keep explanations age-appropriate, be honest and accurate, stay calm, listen, and offer reassurance. Parents should monitor TV viewing and social media. Pediatricians should also encourage parents to set a daily routine, including basic hygiene, during periods of stress, and teach children the principles of self-care, such as eating well, exercising and getting enough sleep.
Pediatricians can also advise parents on discussing mental health with children, addressing it as they would any other medical issue. For example, children can understand the physical reactions provoked by an asthma attack, as well as the need to take medication and to avoid certain triggering situations. These same principles can help children understand mental health issues as physical conditions related to the brain. Pediatricians and other health care providers should check in with children as well to ask how they’re doing, and they should not hesitate to ask patients if they have had thoughts about suicide.
They can also point families to available resources like local youth centers, crisis hotlines and online consultations. There are also community- and school-based health services funded by the American Rescue Plan, as well as community-based suicide prevention efforts funded by the Substance Abuse and Mental Health Services Administration.
The National Alliance on Mental Illness has developed a coloring and activity book called “Meet Little Monster” in response to both the COVID-19 pandemic and the Black Lives Matter protests, and it can be downloaded for free in both English and Spanish. The book includes a list of mental health resources.
Advocacy priorities
In addition to working directly with children, parents and caregivers, the American Academy of Pediatrics urges pediatricians to advocate for policy changes, including:
- Improving access to new technology and telemedicine, including removing regulatory barriers
- Pushing for adoption of integrated mental health care in primary care pediatrics
- Promoting delivery of, and payment for, trauma-informed services
- Promoting strategies to address pediatric mental health workforce shortages.
Pediatricians who include mental health checks and conversations as part of standard care and who help connect children and families with appropriate resources can make a difference in addressing the ongoing COVID-19 mental health crisis and support their patients’ mental health both during the pandemic and beyond.
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April Hollis is a health care editor at SmartBrief. Connect with her on LinkedIn.