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Preschoolers not immune to mental health challenges: What pediatricians can do

September 13, 2022

Editor's note: For more coverage of the 2022 AAP National Conference & Exhibition, visit

While awareness of mental health problems among youths has been increasing, younger children often are left out of the conversation.

But that doesn’t mean they have been unscathed by the events of the past two-and-a-half years, said Mary Margaret Gleason, M.D., FAAP, vice chair of pediatrics at Eastern Virginia Medical School and vice chief of mental health at Children’s Hospital of The King’s Daughters.

“We know rates of emotional and behavioral concerns in young children are similar to rates in older children,” Dr. Gleason said, “and unfortunately, too many are not identified or addressed.”

Dr. Gleason will describe approaches that can be used in the pediatric primary care setting to address these concerns during the session “National Emergency in Children’s Mental Health: What About the Baby?” (S3017) from 7:30-8:30 a.m. PDT Sunday, Oct. 9 in rooms 256-258A of the convention center. She will be joined by Joyce Harrison, M.D., FAAP, associate professor of psychiatry and behavioral sciences, Kennedy Krieger Institute/Johns Hopkins School of Medicine in Maryland, and a member of the AAP Section on Developmental and Behavioral Pediatrics.

The AAP, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association declared a national emergency in children’s mental health, citing the toll of the COVID-19 pandemic on top of existing challenges.

In her work in a pediatric primary care consultation program, Dr. Gleason has seen disparities in how the pandemic, racial reckoning and violence have affected preschoolers.

“In the children I see, the impact of the last few years is buffered or exacerbated by how the family has been affected,” she said. “Families whose income, housing, food access, caregiver mental health, child care access and family overall health and survival weren’t affected by the events of the last two years don’t seem to have pandemic-specific symptoms or challenges. When those have been affected, we’re seeing more emotional and behavioral symptoms.”

Due to the lack of mental health services, pediatricians are called on to fill the void. Yet, many pediatricians don’t feel confident that they have effective approaches to address these concerns, Dr. Gleason said.

“What’s most important about these emotional and behavioral — or mental health —concerns is that we know a lot about how to treat them,” she said. “We don’t have nearly enough access to specialty early childhood mental health professionals, but many of the principles of intervention can be introduced and reinforced in the pediatric primary care setting.”

During the session, she and Dr. Harrison will use case vignettes to highlight first-line approaches pediatricians can use to address common challenges such as disruptive behavior patterns, anxiety and trauma reactions. They also will discuss how to support the strengths in families and connect them to community resources to address risks and symptoms.

“I’m hoping the talk will be useful in sharing some practical tools that can support young children and their families and that the attendees will feel confident using these tools in practice,” Dr. Gleason said.

She also offered some words of encouragement to pediatricians.

“You can do it!” she said. “Using tools from the AAP, pediatricians are perfectly poised to start the first steps to supporting young children’s mental health.”

For more information on the National Conference, visit View the conference schedule at

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