Research Commentary: COVID-19 Worsened the Mental Health Crisis for Young Children, Too.

Research Commentary: COVID-19 Worsened the Mental Health Crisis for Young Children, Too.

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This article was written by Emily Aron, MD. Our research commentary recommends ways to increase physician capacity, access to telehealth, resources for underserved communities, and more to help support early interventions.

While COVID-19 alone didn’t cause a crisis in children’s mental health, it exposed and worsened already disturbing trends that require our immediate attention. The developing brains of children younger than 5 were especially vulnerable to the pandemic’s stressful and sometimes traumatic conditions. 

In October 2021, The American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children’s Hospital Association declared a national emergency in children’s mental health. 

The declaration notes that from March to October 2020, emergency department visits for mental health reasons rose 24% among kids aged 5-11, and 31% for teens aged 12-17. Startlingly, suspected suicide attempts increased by nearly 51% among teen girls in early 2021 compared to two years before. More than 140,000 children experienced the death of a caregiver during the pandemic. Children from historically minoritized groups have been born with a disproportionate share of this burden.

To address the crisis, the organizations recommend urgent action to increase funding, integrate mental health care into primary care, and more. Much of the focus has been on older children and teens, but the youngest children face mental health challenges, too.

Our research commentary, published in the Journal of the American Academy of Child and Adolescent Psychiatry, discusses the impact of the pandemic on young children and responds to some of their recommendations to help.


The impact of COVID-19 on young child mental health.

While limited data on young children is available, the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey shows that young people in the U.S. face a mental health crisis. 

Kids younger than age 5 are disproportionately affected by mistreatment and traumatic experiences, which influence the development of their brains. With parents and caregivers experiencing “unsurmountable stress” due to COVID, rates of verbal aggression, physical punishment, and neglect rose, increasing risks to children

Additionally, when preschools and daycares shut down, access to meaningful education and social experiences was limited, further impacting brain development in young children and worsening achievement gaps between low-income children and their peers.

Recommendations to address the mental health crisis in young children.

MedStar Health Research Institute and similar organizations can help pediatricians understand and identify mental health concerns early in the very young. Our published commentary includes the recommendations below, which build on action items proposed by the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and the Children’s Hospital Association: 

Increase pediatrician capacity.

Pediatricians are often the first responders for children’s mental health. They have a unique opportunity to identify, manage, and refer young children for early mental health interventions and diagnose neurodevelopmental delays. 

Tactics like virtual clinics and lectures on topics such as “How to Talk with Young Children About COVID-19,” and “Supporting Parents During COVID-19” can help pediatricians build capacity to support families and the youngest children in challenging times. 

Improve access to care through telehealth.

While in-person treatment is sometimes best, videoconferencing software and telehealth can help more people get care. Evidence-based treatments, such as Parent-Child Interaction Therapy, are well-suited for telehealth. 

A hybrid model of in-person and remote therapy can help meet the mental health needs of more patients, and many clinics can continue pandemic-era policies that help increase access.

Increase capacity of mental health professionals.

Clinicians treating young children need foundational knowledge in early childhood mental health. Georgetown University has developed professional certificate programs for clinicians, consultants, and paraprofessionals to increase and diversify the workforce. Work is ongoing to train clinicians and provide opportunities to benefit the communities they serve. 

Reach medically underserved communities.

Well-known disparities make it difficult for some people to access healthcare. To address this problem, Children’s National Medical Center, MedStar Georgetown University Hospital Department of Psychiatry, and local agencies serving young children came together to form The Early Childhood Innovation Network (ECIN). 

This collaborative provided services and culturally appropriate care to help families with early childhood mental health concerns. Clinicians worked with mental health consultants in early learning centers to get to know families needing support and to work with other community agencies to help provide resources and services such as food, housing assistance, employment assistance, and mental health care.

The role of a child psychiatrist.

Child psychiatrists help recognize and address needs by incorporating questions about adverse experiences. They can tailor treatments and ensure trauma-informed care. Child psychiatrists can also provide primary care providers with consultation, training, and advocacy support. Further, they can advocate for policies that support equitable care for young children and families, such as paid sick leave and affordable housing.

Helping families help children.

Community service providers and school-based health centers should consider mental health care an imperative, and staff should be trained to help reduce the burden on clinicians. 

Early childhood mental health is about prevention and early intervention. Investing in young children and their families can pay dividends as they age and grow. If we don’t put needed services in place now, this crisis will worsen in a few years.

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