Pediatric Mental Health: Issues, Treatments and Challenges

By Grizelda Anguiano, MD

Wouldn’t it be nice if patients could arrive to see their primary provider with a classic presentation of a problem, start the recommended treatment, and then have the patient return with the presenting complaint resolved two weeks later! Unfortunately, mental health does not work like this and even less when you have children involved. The presenting symptoms may be headaches, vision changes, difficulty swallowing, chest pain, shortness of breath, nausea, vomiting, abdominal pain, numbness, sleep disturbances and so many others or all of these at once. Often, the time constraints that providers have with their schedules make it nearly impossible to give patients the well-deserved time to determine the cause or put the puzzle together. With experience, it gets easier to figure out the diagnosis and appropriate treatment plans, but that is the easy part. The dilemma really comes with getting patients in for the needed treatment which, in many cases, is psychotherapy. Often physicians provide medication as a “Band-Aid” while they wait for the “real medication” of psychotherapy.

Although now it is more common for celebrities to discuss their own mental health challenges, for many, a mental health stigma prevents early presentations. The COVID pandemic forced society to isolate and ultimately contributed to the spike in mental health emergencies. The CDC noted that, in 2020, suicide was the 2nd leading cause of death for children between the ages of 10 and 14.1 The American Academy of Pediatrics (AAP) noted that 1 in 5 children in the US have a diagnosable mental health disorder and only 20% of those that seek treatment get the services needed.2

The wait time to get a patient into therapy or a prescribing mental health provider can take months which creates the unfortunate barricade to needed treatment. In October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA) collaboratively declared a National State of Emergency in Children’s Mental Health.3

So, what do we do? How can we help change the direction of these numbers? The answer: awareness and acceptance. Though not entirely sufficient, awareness of what we can do and acceptance of taking that responsibility is pivotal. We can gain the comfort in assessing, diagnosing, and prescribing medications for the most common presenting diagnosis such as anxiety and depression, while having a plan in place that includes resources for our patients to get the momentum going in the right direction as soon as possible. This will not only decompress the demands on psychiatric providers to enable availability for the more complex patients, but will empower us in the comfort in providing the care in the moment which can literally save lives.

In 2019 the AAP published an article, “Mental Health Competencies for Pediatric Practice”, which outlined steps toward achieving competencies which will broaden the ability and comfort to provide the needed services as a pediatric provider.4 There have been amazing programs such as the Patient-Centered Mental Health in Pediatric Primary Care, provided by The REACH Institute, whose mission is to provide evidence-based training that will empower primary care providers to make the needed contributions to influence the change that is possible.

Further support has been made available by federal funding through the Child Psychiatry Access Network (CPAN) program, which is free for pediatric providers to obtain on the spot consultations, training and support with care coordination. Utilizing all these resources alter the direction of care that we can provide to be participants in the improvement of mental health care and life saving encounters.

Improving the comfort in providing this care can help decrease the reservations we may have in asking about these diagnoses, promote discussions during all visits about the available support through primary providers, and provide reassurance that anxiety and depression are treatable conditions. Emphasizing that prompt discussions promote quicker recoveries, and that medication does not always have to be part of the current or lifelong treatment plan can provide the encouragement that families need to present with these concerns.

We can do this together.

Learn more about Dr. Anguiano’s Services & Programs www.anchoredtx.com

Resources

1. https://www.cdc.gov/suicide/facts/index.html

2. https://www.aap.org/en/patient-care/mental-health-initiatives/

3. https://www.aap.org/en/advocacy/child-and-adolescent-healthymental-development/aap-aacap-cha-declaration-of-a-nationalemergency-in-child-and-adolescent-mental-health/

4. https://publications.aap.org/pediatrics/article/144/5/e2019 2757/38256/Mental-Health-Competencies-for-Pediatric-Practice

Grizelda Anguiano, MD is a board-certified general pediatrician, specializing in pediatric mental health. She is the founder of Anchored, a pediatric mental health practice providing medication management, parent training and life coaching. She is also a member of the Bexar County Medical Society (BCMS).