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Updated guidance focuses on mental health risks, needs during pandemic

March 15, 2021

Editor’s note: The guidance has been updated since this article was published. Please see Supporting the Emotional and Behavioral Health Needs of Children, Adolescents and Families during the COVID-19 Pandemic. For the latest news on COVID-19, visit

The strain of the COVID-19 pandemic on children underscores the need for pediatricians to address emotional and behavioral health as part of standard care, according to updated AAP interim guidance.

Supporting the Emotional and Behavioral Health Needs of Children, Adolescents and Families during the COVID-19 Pandemic  outlines continued and emerging challenges children face as the pandemic continues and discusses how pediatricians can assist families. The guidance also emphasizes the importance of partnering with families, agencies and other professionals to address:

  • emotional and behavioral responses among children and adolescents;
  • the impact of the COVID-19 pandemic on emotional and behavioral health;
  • advice, education and anticipatory guidance; and
  • considerations for referral and follow-up.

Suicidal ideation and attempts have increased among youth during the pandemic. The updated guidance urges pediatricians to share resources and use telehealth tools. “These crises have strained further an already challenged behavioral health infrastructure and underscore the severity of the behavioral health crisis that is unfolding,” according to the guidance.

Pediatricians can advise caregivers to be aware of loneliness, isolation and uncertainty in children and identify emotional and behavioral responses and needs in the context of typical development.

Encouraging children and adolescents to participate in physical activities and spend time outdoors with peers, while practicing risk mitigation strategies, can help improve physical and mental health, Youth may also experience positive emotional benefits via increased socialization with friends, according to the guidance. “Socializing with peers is a mainstay of child and adolescent development,” the guidance said. “Following local, state and national guidelines for physical distancing should remain an urgent priority while families help find paths for youth to socialize safely.”

Appropriate allocation of resources is necessary to address the pandemic’s impacts, particularly for under-resourced communities, populations facing inequities, children and youths with special health care needs and children in child welfare and juvenile justice systems, according to the AAP.

The AAP noted that the pandemic has exacerbated existing disparities among children and families with emotional and health challenges. These families face additional risks such as increased morbidity and mortality and barriers to health care (e.g., COVID-19 vaccination) and education access.

The AAP continues to monitor the impact of the pandemic on communities of color, including racism and xenophobia against Chinese Americans ( “The impact of racism, including structural racism on the emotional and economic well-being of families of color cannot be overstated,” according to the guidance.

Pediatricians can help address health inequities by identifying culturally effective solutions and reaching out to community-based organizations or partners for resources and programs  with which families identify.

 “Frequent follow up and monitoring for subthreshold concerns may be accomplished through telehealth visits with the pediatrician to check in on the child and family’s status and functioning,” according to the guidance. It also urges referral to mental health providers for children with more severe emotional or behavioral manifestations.

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