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Lisa Black


Pediatricians can help support children and families struggling with stress and mental health challenges amid the pandemic

The American Academy of Pediatrics, updating its guidance on the emotional impact of COVID-19 on families, recommends that all children be monitored and asked during every pediatric office visit for concerns or changes in mental and behavioral health and development. Further use of evidence based screening and assessment tools should be integrated into the visit if concerns are elicited.

In an update to interim guidance on “Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families During the COVID-19 Pandemic,” the AAP also observes that many children are coping with grief or loss. An estimated 40,000 children in the United States have lost a parent to COVID-19. The trauma and grief of losing a parent is often compounded by the loss of material stability and economic hardship and has been associated with poor educational and long-term mental health consequences.

“We were already experiencing a mental health crisis in our children and teens before the pandemic,” AAP President Lee Savio Beers, MD, FAAP, said. “Families have been under considerably more stress over the past year and a half, only making this crisis worse. The good news is, we know that many children can get through these hard times when they have a close and supportive relationship with an adult, whether it’s a parent, a teacher or coach. Children are resilient when offered appropriate support.”

The AAP notes the added vulnerability of families living in poverty and in historically underresourced communities. Also at higher risk are children who are refugees and seeking asylum, children and youth with special health care needs, and children involved with the child welfare and juvenile justice systems.

The guidance details symptoms of emotional distress, such as disruption of sleep, change in appetite, difficulty concentrating, decreased engagement with school and family, isolation, dysregulation of mood and behavior, and displays of hopelessness.

Parents, too, may be struggling with their own mental health challenges. The AAP suggests that, during every office visit, pediatricians ask parents or guardians about the impact of the pandemic on the well-being of the child, including any behavioral difficulties. Families may be reluctant to bring up such concerns or may consider them circumstantial and temporary without realizing the severity of symptoms. Integrating these questions and appropriate screenings into routine visits can help make sure all concerns are addressed.

“The emotional well-being of children is tied closely to their parents’ well-being,” Dr. Beers said. “That is why children are said to be the emotional barometers of the family. We recommend that families let their pediatrician know about anything going on in a child’s life that might be stressful. The pediatrician is a safe and supportive source for the whole family.”

Additional resources:

AAP Policy Statement: Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health | American Academy of Pediatrics ( Mental Health During COVID-19: Signs Your Child May Need More Support -


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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