Pediatricians can play an integral role in addressing pandemic-related mental health concerns among children, which are at crisis levels, said Joshua A. Gordon, M.D., Ph.D., director of the National Institute of Mental Health (NIMH).
During a presentation at the AAP Board of Directors meeting, Dr. Gordon discussed the pandemic’s impact on children’s mental health and how some have been affected more than others.
“Mental health was already crisis proportion for children prior to the pandemic, and the pandemic exacerbated that,” Dr. Gordon said. “(But) there’s a lot that primary care pediatricians can do.”
The proportion of mental health-related emergency department visits during April to October 2020 was higher than in the same months in 2019, according to a Centers for Disease Control and Prevention report. Visits increased 24% in 5- to 11-year-olds and 31% in 12- to 17-year-olds.
Nearly 40,000 children have lost at least one parent during the pandemic. Black children make up 14% of the childhood population but 20% of the population of children who lost a parent to COVID-19.
Several studies also have shed light on negative impacts of virtual and hybrid learning on children’s physical activity, time spent outdoors, and mental and emotional health.
Research prior to the pandemic identified disparities in mental health care.
“There is not uniformity across the different aspects of the U.S. population, with youths getting different access to treatment depending on their communities and different access to quality care within those communities,” Dr. Gordon said.
Identifying risks for mental illness
The origins and onset of mental illness in childhood are complicated by many factors such as the nonlinear, nonuniform expansion of areas of the brain, Dr. Gordon said. Areas responsible for motor and sensory development expand in early childhood, while prefrontal and temporal lobes where memory and cognition are established develop later.
No single variable can determine a child’s post-pandemic outcome. However, some factors put children at risk of poor outcomes, Dr. Gordon said. Examples include:
- the nature and severity of exposure (e.g., directly exposed to death or injury, type of trauma);
- individual differences such as a history of trauma or mental illness, ongoing stressors (e.g., financial), substance use, and being female and non-White; and
- having few social supports.
A child’s environment also plays a role. One study demonstrated that routines such as regular meal times, daily schedules and consistent bedtimes during the pandemic may have protected the mental health of preschoolers, Dr. Gordon said.
Providing assistance
During health supervision visits, pediatricians can ask children how they feel about attending camp or school in person and provide time for them to talk through their pandemic-related experiences, Dr. Gordon said. This creates an opportunity for the pediatrician to normalize the child’s feelings and determine the severity of their situation.
“Explain to them that, yes, they may experience worsening (symptoms) when they actually do go back to school. They may experience stomachaches, they may experience dread or panic, and explain that that’s … par for the course. That’s also normal and have them reach out if it’s unbearable,” Dr. Gordon said.
Tools such as graded exposure therapy can help ease a child back into in-person activities. Examples of graded exposure include programs that allow incoming kindergartners or preschoolers to visit the classroom and ride the bus before the first day of school.
He also suggested pediatricians use collaborative care models with psychiatrists and support universal suicide screening and mental health delivery in schools.
“Many adolescents are dealing with or report symptoms that would result in diagnosable mental illnesses,” Dr. Gordon said. “One silver lining to this pandemic is the focus on mental health (has been) raised throughout society.”
