Use of Pharmacological Restraints in Pediatric Mental Health Hospitalizations Up 141%

Pediatric mental health disorders have increased significantly over the past 20 years, and this trend intensified during the COVID-19 pandemic. According to a new study, “Pharmacologic Restraint Use During Mental Health Admissions to Children’s Hospitals,” in the January 2024 Pediatrics (available online Dec. 11, 2023) the number of days children were restrained using drugs while in in-patient care is also increasing. Researchers studied data on 91,898 pediatric mental health hospitalizations of children, ages 5-17, between 2016 and 2021 and found a 141% increase in the incidence of pharmacologic restraint use during the study period and a 138% increase in the number of patient days these children and teenagers spend in the hospital. These drugs were used in 3% of admissions and 1.3% of patient days in the hospital. Most patients admitted for a primary mental health diagnosis were white (57.9%), female (69.7%), and ages 9-12 (44.4%) or 13-17 (49.4%). However, the patients disproportionally more likely to be restrained were younger (ages 5-8), male, Black, poor (household income under $25,000) and publicly insured. Certain diagnoses had higher rates of pharmacologic restraint usage. This includes autism (7.9% of patient days), despite a significant decrease in the use of these medications in patients with autism, and also substance-related disorders (4.5%) and disruptive disorders (4.5%). Additionally, longer hospital stays (a week or longer) were also associated with pharmacologic restraint use, which is noteworthy during an era of psychiatric bed shortages and rising boarding durations. Researchers concluded that these findings should assist doctors and psychiatrists and help reduce avoidable pharmacologic restraint use in pediatric patients but that more research is needed.

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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.