AAP: Children should be monitored for mental health concerns at every visit

The AAP updated guidance on mental health screenings in the wake of the COVID-19 pandemic to recommend that all children be monitored and asked about concerns or changes in mental and behavioral health at every pediatric office visit.

According to the AAP, more than 40,000 children in the United States have lost a parent to COVID-19, the trauma of which is often compounded by the loss of material stability and economic hardship and has been associated with poor educational and mental health.

“We were already experiencing a mental health crisis in our children and teens before the pandemic,” AAP President Lee Savio Beers, MD, FAAP, said in a statement. “Families have been under considerably more stress over the past year and a half, only making this crisis worse. The good news is, we know that many children can get through these hard times when they have a close and supportive relationship with an adult, whether it’s a parent, a teacher or coach. Children are resilient when offered appropriate support.”

Families living in poverty and in under-resourced communities may be at an additional risk, the AAP noted. Children who are refugees and seeking asylum, children with special health care needs and children on welfare and in the juvenile justice system are also at a higher risk.

According to a news release, the guidance details symptoms of emotional distress, such as disruption of sleep, change in appetite, difficulty concentrating, decreased engagement, isolation, dysregulation of mood and behavior and displays of hopelessness.

“Surveillance can take the form of incorporating questions about the impact of the pandemic on the well-being of the child, including any behavioral difficulties,” the guidance says. “Screening utilizes evidence-based social, emotional, and behavioral screening tools. Families may be reluctant to bring up behavioral concerns in their children and may consider them circumstantial and temporary without realizing the severity of symptoms. Implementing a universal surveillance and screening strategy helps to overcome these barriers.”

The AAP said parents may also be suffering from mental health challenges. It recommended that during every office visit, clinicians ask parents and guardians about the impact of the pandemic on the well-being of the child. Integrating these questions into routine visits can help make sure all concerns are addressed, the AAP said.

“The emotional well-being of children is tied closely to their parents’ well-being,” Beers said. “That is why children are said to be the emotional barometers of the family. We recommend that families let their pediatrician know about anything going on in a child’s life that might be stressful. The pediatrician is a safe and supportive source for the whole family.”

References:

AAP. Interim guidance on supporting the emotional and behavioral health needs of children, adolescents, and families during the COVID-19 pandemic. Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families During the COVID-19 Pandemic (aap.org). Accessed Aug. 3, 2021.