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AAP provides guidance on treating acute pediatric mental health, behavioral problems

The American Academy of Pediatrics’ Committee on Pediatric Emergency Medicine and the American College of Emergency Physicians’ Pediatric Emergency Medicine Committee recently released a two-part clinical report to address knowledge gaps regarding pediatric mental health emergencies.

“In the United States, 21% to 23% of children and adolescents have a diagnosable mental health or substance use disorder. Among patients of EDs, 70% screen positive for at least one mental health disorder, 23% meet criteria for two or more mental health concerns, 45% have a mental health problem resulting in impaired psychosocial functioning, and 10% of adolescents endorse significant levels of psychiatric distress at the time of their ED visit,” Thomas H. Chun, MD, MPH, FAAP, of Alpert Medical School, Brown University, and colleagues wrote. “Despite studies demonstrating moderate agreement between emergency physicians and psychiatrists in the assessment and management of patients with mental health problems, ED clinicians frequently cite lack of training and confidence in their abilities as barriers to caring for patients with mental health emergencies.”

The report is written from the perspective of ED clinicians but is intended for all clinicians caring for children and adolescents with acute mental health and behavioral problems.

Part I of the report addresses issues that may occur among children presenting to the ED with a mental health primary complaint, including:

• Medical clearance of pediatric psychiatric patients;
• Suicidal ideation and suicide attempts;
• Involuntary hospitalization;
• Restraint of an agitated patient, including verbal, chemical and physical restraint; and
• Coordination with the medical home.

Part II of the report focuses on patients with primary medical or indeterminate presentations where an underlying mental health condition may be unclear or a complicating factor. These include:

• Somatic symptom and related disorders;
• Adverse effects to psychiatric medications, including antipsychotic adverse effects, neuroleptic malignant syndrome and serotonin syndrome;
• Children with special needs in the ED, such as autism spectrum disorder and developmental disorders; and
• Mental health screening in the ED.

The clinical report supports the 2006 joint policy statement from the American Academy of Pediatrics and the American College of Emergency Physicians on pediatric mental health emergencies. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.