“This is a national emergency, and the time for swift and deliberate action is now.” – AACAP President Gabrielle A. Carlson, M.D.
This week, the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHP) declared a state of national emergency in children’s mental health in the United States.
These three high-profile institutions together represent over 77,000 physicians, and more than 200 children’s hospitals are urging policymakers to take swift action to address this mental health crisis in children.
Before the COVID-19 pandemic, the mental health issues facing children and adolescents in America were already a growing concern. The pandemic has exacerbated this pre-existing problem while taking a particularly severe toll on young people as they face fear, anxiety, loneliness, uncertainty, and physical isolation.
Additionally, recent data shows that more than 140,000 young people have directly experienced the loss of a primary or secondary caregiver during the COVID-19 pandemic.
In a statement, AAP President Lee Savio Beers, MD, FAAP. said, “[y]oung people have endured so much throughout this pandemic, and while much of the attention is often placed on its physical health consequences, we cannot overlook the escalating mental health crisis facing our patients. Today’s declaration is an urgent call to policymakers at all levels of government — we must treat this mental health crisis like the emergency it is.”
Recent statistics from March 2020 shed light on this alarming issue. During the pandemic, there has been a:
- 31% rise in emergency department visits for children with severe mental health issues.
- 50% increase in suicide attempts among girls aged 12-17.
- 45% increase in self-injury cases among 5 to 17-year-olds.
Children’s Emotional Responses
The past eighteen months have brought great social uncertainty, which our children are not immune to. During the pandemic, they have witnessed economic decline and global loss of life and have experienced isolation from friends and family. Children have also experienced the widespread unrest we have seen with environmental catastrophes, riots, political unrest, and violence.
Children and adolescents often respond to stress differently than their adult counterparts and have unique reactions based on their personality, age, conditioning, and genetics.
Key critical universal mental health and emotional distress symptoms to look out for in children include:
- Infants and toddlers may express distress through disruptions to their usual routine and day-to-day functions such as feeding, bathroom habits, and sleep. They may display a change to their attachment styles, either becoming clingy and having separation anxiety or becoming more withdrawn and irritable.
- Preschool children can start to demonstrate emergent mental health behaviors such as perseverative behaviors, anxiety, obsessive thoughts, compulsive practices, sadness, or agoraphobia.
- Older children and adolescents can start internalizing symptoms of depression, panic, fear, and anxiety. These can emerge externally through aggression, irritability, depression, panic attacks, withdrawal, or through somatic symptoms such as chronic pain, fatigue, digestive discomfort, or headaches.
- Adolescents and young adults may be able to verbalize their issues better, but this age group may deliberately conceal their concerns in order to protect family members who are additionally experiencing stress or out of a perceived fear or stigma of speaking out. Among this age group, distress may present as irritability, hostility, lack of concentration, poor school performance, substance use, self-injurious behavior, suicidal ideation, and the emergence of mental health issues such as eating disorders.
Many young people will be able to manage their stress and continue to live healthy, fulfilling lives. This is especially the case for those who benefit from a strong family support network, financial stability, and sensitive care.
However, for many children in America this is simply not the case, and the disruption during the pandemic has taken a serious toll on their well-being. Recent data demonstrates that Black, Asian, and Minority Ethnic (BAME) children’s mental health has been disproportionately impacted.
Additionally, those children with special health care needs such as physical illness and neurodevelopmental differences such as autism are at exceptionally high risk for suffering the effects from the pandemic.
This week AAP, AACAP, and CHP have called for policymakers to take the following swift actions:
- Increase federal funding to ensure equal access to mental health services.
- Improve access and functionality of telemedicine.
- Develop and support school-based mental health care.
- Promptly integrate mental health care into primary care pediatrics.
- Reduce the risk of suicide in young people.
- Address the ongoing challenges in acute care for young people.
- Fund community-based care services with a range of treatment modalities.
- Fund trauma-informed health care services.
- Address treatment center shortfalls so that children can easily access care regardless of where they live.
These calls to action focus on the promotion, prevention, and treatment of mental health. These three core areas are equally essential to protect our younger generations as they develop in today’s uncertain world.
New challenges to children’s mental health care continually emerge with the perpetually changing times we live in. By bringing our attention to this often forgotten demographic, we can earlier identify and develop strategies to best navigate this complex realm of young people’s mental health.
Through hope, compassion, and perseverance, pediatricians, professionals, and society at large can work together to care for the emotional and behavioral health of the nation’s children and their families.
 “AAP, AACAP, CHA Declare National Emergency in Children’S Mental Health”. American Academy Of Pediatrics, 2021, https://www.aappublications.org/news/2021/10/19/children-mental-health-national-emergency-101921.
 Leeb RT, Bitsko RH, Radhakrishnan L, Martinez P, Njai R, Holland KM. Mental Health–Related Emergency Department Visits among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1675–1680. DOI: http://dx.doi.org/10.15585/mmwr.mm6945a3external icon
 Yard E, Radhakrishnan L, Ballesteros MF, et al. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep 2021;70:888–894. DOI: http://dx.doi.org/10.15585/mmwr.mm7024e
 “Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families during the COVID-19 Pandemic”. Aap.Org, 2021, https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/interim-guidance-on-supporting-the-emotional-and-behavioral-health-needs-of-children-adolescents-and-families-during-the-covid-19-pandemic/.
 Hillis, Susan D. et al. “COVID-19-Associated Orphanhood and Caregiver Death in the United States”. Pediatrics, 2021, p. e2021053760. American Academy of Pediatrics (AAP), doi:10.1542/peds.2021-053760. Accessed 20 Oct 2021.