Pediatric Annals

Editorial Free

Children's and Families' Behavioral and Mental Health During COVID-19

Joseph R. Hageman, MD

In my first coronavirus 2019 (COVID-19) editorial,1 I mentioned an early study2 of second to sixth graders in China that examined symptoms of depression and anxiety. According to the study, of 1,784 school students, based on the Children's Depression Inventory-Short Form, 22.6% had depressive symptoms and 18.9% has anxiety symptoms.2 In another editorial,3 I discussed a survey by Patrick et al.4 that discussed worsening mental health for parents and their children during COVID-19. This issue of Pediatric Annals presents aspects of collaborative care between primary care pediatric providers and behavioral health specialists.

The pandemic has resulted in the disruption of the daily routines of everyone including children, adolescents, and young adults.1–7 Attending in-person school, physical exercise, social interactions, nutrition, screen time, family meal time, bedtime schedules, and quality of sleep are daily routines that have all been significantly disrupted. The relative impact of these disruptions and the child's response to this stress is dependent on the child's developmental stage.5 Other important factors include socioeconomic status; status of the intactness of the family; family stresses; access to technology for remote education and social interactions; nutritional status; presence of underlying chronic illness and/or mental or behavioral health problems; and access to medical, social, and psychological/psychiatric services.1–7

The mental health responses to these stressors include high rates of depression, anxiety, and posttraumatic symptoms among the children.5 Other distresses include neglect and abuse, family disruption, isolation, and loneliness.5 These are especially significant in children from underprivileged and under-resourced families, and children with chronic illness, attention-deficit/hyperactivity disorder, autism spectrum disorder, and psychological and psychiatric disorders.1–7

What can we, as pediatric clinicians, do to help? We can be available in person, safely, to provide vaccinations, well-child and sick care, as well as via telehealth to perform trauma-informed care.8 We can also counsel parents and teachers to be positive role models for children to demonstrate how to deal with the additional stressors during the pandemic.8 There is also a strategy called social prescribing in which general practitioners make referrals for patients to help improve their mental, physical, and social well-being.9 The primary care physician prescribes nonclinical community services such as fitness programs like yoga and group exercise classes.9–11 We can continue to be creative and be good listeners for our patients and their families during and after this ongoing COVID-19 pandemic.


  1. Hageman JR. The evolving COVID-19 pandemic: an update. Pediatr Ann. 2020;49(5):e201–e203. doi:10.3928/19382359-20200428-01 [CrossRef] PMID:32413145
  2. Xie X, Xue Q, Zhou Y, et al. Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China. JAMA Pediatr. 2020;174(9):898–900. doi:10.1001/jamapediatrics.2020.1619 [CrossRef] PMID:32329784
  3. Hageman JR. Can students safely return to school in the age of COVID-19?Pediatr Ann. 2020;49(9):e363–e364. doi:10.3928/19382359-20200818-01 [CrossRef] PMID:32929508
  4. Patrick SW, Henkhaus LE, Zickafoose JS, et al. Well-being of parents and children during the COVID-19 pandemic: a national survey. Pediatrics. 2020;146(4):e2020016824. doi:10.1542/peds.2020-016824 [CrossRef] PMID:32709738
  5. Marques de Miranda D, da Silva Athanasio B, Sena Oliveira AC, Simoes-E-Silva AC. How is COVID-19 pandemic impacting mental health of children and adolescents?Int J Disaster Risk Reduct. 2020;51:101845. doi:10.1016/j.ijdrr.2020.101845 [CrossRef] PMID:32929399
  6. Golberstein E, Wen H, Miller BF. Coronavirus disease 2019 (COVID-19) and mental health for children and adolescents. JAMA Pediatr. 2020;174(9):819–820. doi:10.1001/jamapediatrics.2020.1456 [CrossRef] PMID:32286618
  7. Danese A, Smith P. Debate: recognising and responding to the mental health needs of young people in the era of COVID-19. Child Adolesc Ment Health. 2020;25(3):169–170. doi:10.1111/camh.12414 [CrossRef] PMID:32812356
  8. Hageman JR. The emergence of pediatric telehealth as a result of the COVID-19 pandemic. Pediatr Ann. 2020;49(7):e283–e284. doi:10.3928/19382359-20200626-01 [CrossRef] PMID:32674163
  9. Younan HC, Junghans C, Harris M, Majeed A, Gnani S. Maximising the impact of social prescribing on population health in the era of COVID-19. J R Soc Med. 2020; doi:10.1177/0141076820947057 [CrossRef] PMID:32930056
  10. Ho FKW, Louie LHT, Wong WHS, et al. A sports-based youth development program, teen mental health, and physical fitness: an RCT. Pediatrics. 2017;140(4):e20171543. doi:10.1542/peds.2017-1543 [CrossRef] PMID:28951440
  11. Hollis JF, Polen MR, Whitlock EP, et al. Teen reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care. Pediatrics. 2005;115(4):981–989. doi:10.1542/peds.2004-0981 [CrossRef] PMID:15805374

Joseph R. Hageman, MD

Pediatric Annals Editor-in-Chief Joseph R. Hageman, MD, is the Director of Quality Improvement, Section of Neonatology, Comer Children's Hospital; a Senior Clinician Educator, The University of Chicago Pritzker School of Medicine; and an Emeritus Attending Pediatrician, NorthShore University HealthSystem.

Address correspondence to Joseph R. Hageman, MD, via email:

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