key: cord-0745687-axkv3t36
authors: Storch, Eric A.; Ding, Erica
title: Addressing the Unfolding Children’s Mental Health Crisis
date: 2022-01-16
journal: Child Psychiatry Hum Dev
DOI: 10.1007/s10578-021-01307-2
sha: 3ff5634a05b04d98a524ae500e6ab8f938ae1485
doc_id: 745687
cord_uid: axkv3t36

nan

pandemic, the U.S. national prevalence of children with at least one mental health disorder was 16.5%, which equated to about 7.7 million children, with approximately half of them untreated [7] . Once COVID-19 lockdown began, there was further decline in utilization of pediatric mental health services, likely attributable to many of these essential services being offered through schools [8] . At the same time, the proportion of mental health-related visits to emergency departments (ED) increased, despite overall decreases in total number of ED visits during the initial phase of the lockdown [9] . The same study demonstrated that while the number of more routine ED visits, such as for asthma and otitis media, decreased, ED visits for psychosocial stressors rose to comprise 69% of total visits. Stress related to the disruption of daily life and routines, illness anxiety, and social isolation were all cited as factors that triggered or exacerbated mental illness. While 12 to 17 year-olds accounted for the highest proportion of mental health-related visits, young children were in no way exempt from the effects of stress and anxiety. In fact, 3 to 5 year-olds demonstrated higher levels of social and emotional difficulties compared to previous years. In these children's formative years, their participation in preschool programs decreased by almost 25%, and many parents were simply not satisfied with the quality of remotely attending programs [10] .

These are just a small sample of the statistics that demonstrate the mental health challenges facing our children in the U.S. Globally, one in seven children have been affected by lockdowns in some fashion, and amongst adolescents and young adults aged 15 to 24 years, one in five cited feelings of depression or loss of interests [11] . Worldwide, children are suffering; not just from the virus, but the economic, social, and educational impacts from lockdown. As these measures ease, however, transitioning back to normal life poses its own unique challenges.

What normalcy means post-pandemic, and whether or not there even is such a thing as "after" the pandemic, varies. As of December 2021, almost 60% of U.S. adults are fully vaccinated, but fears of COVID-19 variants and surges continue to impact masking policies and restrictions.

Despite ongoing uncertainties, many are returning to in-person work, and importantly, children have largely returned to in-person schooling since Fall of 2021. The American Academy of Pediatrics (AAP) endorsed in-person learning for all age groups, with masking and full vaccination for groups eligible for the vaccine, most recently expanded to 5 to 11 year-olds [12] . Remote learning proved to exacerbate existing educational disparities, especially obvious amongst children with disabilities, children from families in poverty, and racial minorities. Yet, reopening and transitioning can be another source of stress for many children. According to the Center for Disease Control (CDC), for infants and young children, many were born right before or in the midst of the pandemic, and they and their caregivers might have had limited exposure to childhood socialization and early childhood programs [13] . Upon reopening, children had to adjust to new routines and meet new authority figures, not to mention learn to get along with their peers in new environments. Adolescents, too, faced similar struggles, in addition to education concerns and test anxieties. Of course, these stressors would be even more overwhelming for children with existing developmental, behavioral, and emotional issues. The need for adequate mental health resources for children cannot be overstated: from pre-pandemic to now, approaching two years into the pandemic, and looking to the future, equitable access to adequate and appropriate pediatric mental health care must be a priority for all.

Thankfully, due to the hard work of many advocates, governments and various agencies have increasingly recognized the need to address this mental health crisis affecting children. In Texas, for example, there has been unprecedented efforts within the Texas Children's Mental Health Care Consortium to expand child mental health services through various programs including telepsychiatry into schools, pediatrician consultation services, and workforce expansion. As the pandemic continues, however, mental health problems are certain to continue, requiring continued and extensive efforts to prevent another public health emergency. We hope that this editorial brings continued attention to the challenges that affect children and families as innovative efforts will be necessary to address the persisting mental health crisis.

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