Using peers to help teens with mental health

A poll of parents examines whether utilizing peer support could be an effective way to help teenagers discuss mental health issues.

Impact of cannabis use disorder on teens and young adults with mood disorders

An investigation examines how cannabis use disorder affects teenagers and young adults with mood disorders.

Are people with autism more at risk of suicidality?

A recent investigation examines if people with autism spectrum disorder may be at greater risk of both death by suicide and suicide attempts.

Dr. Tina Q. Tan wonders how the event of 2020 will affect 2021.

Articles

It was a very busy week for the Contemporary Pediatrics team.

In case you missed it: January 18 to January 22

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

The COVID-19 pandemic has led to many alterations in behavior, such as maintaining distance from others and always reaching for a mask before walking outside. Another change is the proliferation of hand sanitizers being used much more frequently. A 

 examines whether the increased use was linked to an increase in severe ocular lesions.

The researchers ran a retrospective case series from April 2020 to August 2020. The cases came from either the national database of the French Poison Control Centers as well as a pediatric ophthalmology referral hospital in Paris. Any case of ocular exposure to a chemical exposure in a child aged younger than 18 years was examined. Data on sex, age, circumstances of exposure, symptoms, size of the epithelial defect at first examination, time between the incident and re-epithelialization, and medical and/or surgical management were collected. The researchers compared the number of eye exposures to alcohol-based hand sanitizer in children between April to August 2020 and April to August 2019.

The researchers found in the poison control database that there were 7 times more pediatric cases of exposure to alcohol-based hand sanitizers between April and August 2020 than in the same period of time in 2019 (9.9% of pediatric eye exposures in 2020 vs 1.3% in 2019; difference, 8.6%; 95% CI, 7.4-9.9; 

 < .001). Within the period in 2020, there was also a marked increase in the cases that occurred in a public space from 16.4% in May to 52.4% in August. In the hospital setting, the admissions for exposure to alcohol-based hand sanitizer also increased in the same time period (16 children in 2020 including 10 boys; average age, 3.5 years vs 1 boy aged 16 months in 2019). Eight of the children had a corneal and/or conjunctival ulcer and 6 of the cases involved more than 50% of the corneal surface. An amniotic membrane transplant was necessary for 2 cases.

The reviewers said that the data supports the likelihood of unintentional exposure to alcohol-based hand sanitizer. To ensure that children are safe and to support continued use of hand sanitizer use, the researchers urge clinicians to warn parents and caregivers about the potential danger that alcohol-based hand sanitizer can pose to children’s eyes.

1. Martin G, Le Roux G, Guindolet D, et al. Pediatric eye injuries by hydroalcoholic gel in the context of the coronavirus disease 2019 pandemic. 

. January 21, 2021. Epub ahead of print. doi:10.1001/jamaophthalmol.2020.634

Hand sanitizer has become much more common because of COVID-19. Has this ubiquity increased eye injuries in children?

Hand sanitizer ubiquity increases eye injury in kids

The role of a mother’s health beyond pregnancy has increasingly become identified as an influence on her offspring’s well-being. A 

 looks at whether a mother’s autoimmune disease is connected to attention-deficit/hyperactivity disorder in her offspring.

Investigators conducted a cohort study of all singleton children who were born at term gestation, 37 to 41 weeks, in New South Wales, Australia, from July 2000, to December 2010. Each child was followed-up until the end of 2014. The children who were exposed to maternal autoimmune disease were propensity score matched (1:4) to unexposed children. For the purpose of the study, a child was considered to have attention-deficit/hyperactivity disorder if they had an authorization or filled prescription for stimulant treatment of the disorder or a hospital diagnosis. Children who were linked to a first attention-deficit/hyperactivity disorder event before 3 years of age were not included in the study.

The study had a cohort of 63,050 infants: 12,610 infants exposed to maternal autoimmune disease and 50,440 control infants. In the cohort, attention-deficit/hyperactivity disorder was linked to type 1 diabetes (hazard ratio [HR], 2.23; 95% CI, 1.66-3.00), rheumatic fever or rheumatic carditis (HR, 1.75; 95% CI, 1.06-2.89), psoriasis (HR, 1.66; 95% CI, 1.02-2.70), as well as any autoimmune disease (HR, 1.30; 95% CI 1.15-1.46). The researchers also ran a meta-analysis of 5 studies, which included their study. In this meta-analysis, they also found that attention-deficit/hyperactivity disorder was linked to type 1 diabetes (4 studies: HR, 1.53; 95% CI, 1.27-1.85), hyperthyroidism (3 studies: HR, 1.15; 95% CI, 1.06-1.26), psoriasis (2 studies: HR, 1.31; 95% CI, 1.10-1.56), and any autoimmune disease (2 studies: HR, 1.20; 95% CI, 1.03-1.38).

The investigators concluded that maternal autoimmune disease was linked to increased attention-deficit/hyperactivity disorder, which they believe could indicated a shared genetic vulnerability between both. They said that future research into this should further the understanding of the underlying mechanisms.

1. Nielsen T, Nassar N, Shand A, et al. Association of maternal autoimmune disease with attention-deficit/hyperactivity disorder in children. 

. January 19, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.5487

A new study examines whether maternal autoimmune diseases are linked to attention-deficit/hyperactivity disorder (ADHD).

 Is there a link between ADHD and maternal autoimmune disease?

Just as in the general adolescent and young adult population, cannabis use as well as cannabis use disorder can be common in those who have mood disorders. Cannabis use disorder has been linked to suicide, self-harm, and overall mortality risk in previous research, but it has not been extensively reviewed in teenagers with mood disorders. An 

The researchers ran a population-base retrospective cohort study that used Ohio Medicaid claims data that was linked to death certificate data. The review included people aged 10 to 24 years who had a diagnosis of mood disorders between July 2020 and December 2017. Each participant was followed up to 365 days from the index diagnostic claim until either the end of enrollment, a self-harm event, or death.

A total of 204,780 people with an average age of 17.2 years were included in the research. The investigators found that cannabis use disorder occurred in 10.3% of the participants and was significantly linked to a number of characteristics including:

Older age: (14-18 years vs 10-13 years: adjusted risk ratio [ARR], 9.35; 95% CI, 8.57-10.19; and 19-24 years vs 10-13 years: ARR, 11.22; 95% CI, 10.27-12.26)

Black race: (ARR, 1.39; 95% CI, 1.35-1.44)

Prior history of self-harm: (ARR, 1.66; 95% CI, 1.52-1.82)

Psychiatric hospitalizations: (ARR, 1.66; 95% CI, 1.57-1.76)

Mental health emergency department visits: (ARR, 1.54; 95% CI, 1.47-1.61)

Bipolar or other mood disorders: (bipolar disorders: ARR, 1.24; 95% CI, 1.21-1.29; other mood disorders: ARR, 1.20; 95% CI, 1.15-1.25)

Additionally, cannabis use disorder had significant links to both nonfatal self-harm (adjusted hazard ratio [AHR], 3.28; 95% CI, 2.55-4.22) as well as an all-cause mortality (AHR, 1.59; 95% CI, 1.13-2.24), which includes homicide (AHR, 3.23; 95% CI, 1.22-8.59) and death by unintentional overdose (AHR, 2.40; 95% CI, 1.39-4.16).

The researchers concluded that in adolescents and young adults with mood disorders, cannabis use disorder was a risk marker for self-harm, all-cause mortality, and death. They also believe that their research should be considered by any state considering the legalization of either medical or recreational marijuana.

1. Fontanella C, Steelesmith D, Brock G, Bridge J, Campo J, Fristad M. Association of cannabis use with self-harm and mortality risk among youths with mood disorders. 

. January 19, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.5494

The impact of cardiometabolic levels on a person’s mental health has become more elucidated in recent years. A new 

 examines the role that insulin levels as well as body mass index have on depression and psychosis later in in life.

The researchers did a cohort study from the Avon Longitudinal Study of Parents and Children, using data from participants aged 1 to 24 years. Fasting insulin was measured at 9, 15, 18, and 24 years and body mass index measurements were performed at 1, 2, 3, 4, 7, 9, 10, 11, 12, 15, 18, and 24 years. The researchers also looked at data for a number of potential confounders including emotional and behavioral problems from childhood, smoking, physical activity, the father’s social class, and average caloric intake.

Fasting insulin level data were available for 5790 participants and body mass index data were available for 10,463 people, with a slight female majority in both categories. The researchers found that there were 5 distinct trajectories for body mass index and 3 distinct trajectories for fasting insulin. Every distinct trajectory was differentiated by mid-childhood. A persistently high fasting insulin level was linked to both a psychosis a psychosis at-risk mental state (adjusted odds ratio [aOR], 5.01; 95% CI, 1.76-13.19) and psychotic disorder (aOR, 3.22; 95% CI, 1.11-9.90). However, it was not liked to depression (aOR, 1.38; 95% CI, 0.75-2.54). Additionally, a major increase in body mass index at the onset of puberty was not tied to psychosis (aOR, 1.98; 95% CI, 0.56-7.79), but was linked to depression (aOR, 4.46; 95% CI, 2.38-9.87).

The investigators concluded that some of body mass index and fasting insulin levels at certain times in childhood have links to both psychosis and depression later on in life. Preventing and treating these early on could help alleviate future comorbidities of psychosis and depression.

1. Perry B, Stochl J, Upthegrove R. Longitudinal Trends in Childhood Insulin Levels and Body Mass Index and Associations With Risks of Psychosis and Depression in Young Adults. 

. 2021. doi:10.1001/jamapsychiatry.2020.4180

A report looks into how insulin levels and body mass index may have ties to mental health concerns.

Are cardiometabolic issues linked to later mental health concerns?

The pandemic has led to a number of changes in children’s lives, including going to school at home, socializing less with their peers, and spending more time indoors. A 

 examined whether the period of home confinement caused by the pandemic led to an increased burden of myopia.

The researchers ran a prospective cross-sectional study that used the school-based photoscreening results from children aged 6 to 13 years in elementary schools in Feicheng, China. The results from the period spent in home confinement were compared with data from previous years. During the testing the spherical equivalent refraction was noted for each child.

A total of 123,535 children were included in the analysis, with 64,335 being boys. Test results from 194,904 photoscreener examinations were included in the study. The researchers found that there had been a significant myopic shift (approximately −0.3 diopters [D]) in the 2020 photoscreenings among the younger children aged 6 (−0.32 D), 7 (−0.28 D), and 8 (−0.29 D) years, when compared to the previous years of 2015-2019. Additionally, the prevalence of myopia found in 2020 through photoscreen exams was higher than the previous highest prevalence of myopia in 2015-2019 for children aged 6 (21.5% vs 5.7%), 7 (26.2% vs 16.2%), and 8 (37.2% vs 27.7%) years. For children aged 9 to 13 years, the differences in both spherical equivalent refraction and the prevalence of myopia in 2020 when compared to previous years was minimal.

The investigators concluded that being confined to home due to the pandemic seemed to be linked to a high level of myopic shift in children aged 6 to 8 years. They speculated that younger children may be more sensitive to any change in the environment than older children because the younger children are at a critical point in the potential development of myopia. However, they did note that some caution should be used when considering these links because of the lack of orthokeratology history or ocular biometry data for the participants. Further research could help provide further proof and eliminate these cautions.

1. Wang J, Li Y, Musch D, et al. Progression of myopia in school-aged children after COVID-19 home confinement. 

. January 14, 2021. Epub ahead of print. doi:10.1001/jamaophthalmol.2020.6239

An investigation examines whether the large amount of time at home is increasing the risk of myopia for young children.

Is staying at home increasing the risk of myopia?

Much of the discussion on helping teenagers with mental health issues has previously focused on how parents and care providers can help. The 

 from the C.S. Mott Children’s Hospital National Poll on Children’s Health may indicate that turning to peers could also be a way to help teenagers navigate anxiety, depression, and other mental health issues.

The researchers asked 1000 parents who had at least one teenager aged 13 to 18 years about how they felt about peer support leaders. Peer support leaders are a group of teenagers that have been selected by a school’s administration to receive training on being a good listener. These leaders are also trained to encourage their peers to seek help and also tell adults if a peer exhibits signs of suicidality or other serious mental health health issues.

When asked about such programs in general, 72% of the parents said that they thought peer support leaders would encourage adolescents to discuss any mental health issues. Additionally, most of the parents also believed that a peer support leader would be more likely to understand what challenges a teenager was facing than adults in the school, such as teachers and counselors.

When asked about how they felt about their own teenager using such a program, 38% of the parents believed that their child would reach out to a peer support leader, if the school offered the option, and 41% of parents said that their child might use the resource. However, 62% of the parents wondered if the peer leader would maintain their teenager’s confidentiality. Other concerns included whether teenagers could actually be trained to provide such support, if a peer would be able to identify a crisis that required immediate help, or if the support leader would be able to know both when and how to tell adults about a problem.

When asked about whether they want to have such a program in their school, 33% of the parents said that they would definitely favor having one and 46% said that they would likely support having one in their school. Just 7% said that would not favor having such a program available to their child. Over a quarter of the parents said that a program existed in their school system and these parents were twice as likely to favor having one available to their child.

Many of the parents also said that they would allow their child to be trained as a peer support leader, saying that it would help their child develop leadership skills, become more understanding of the challenges and feelings of others, and also foster community in the school. When asked about their concerns, the biggest concern was their child feeling responsible if a bad outcome occurred.

1. C.S. Mott Children’s Hospital. National Poll on Children's Health: Teens talking with teens about mental health. 2021;37(5). Published January 18, 2021. Accessed January 18, 2020. 

https://mottpoll.org/reports/teens-talking-teens-about-mental-health

With the rise of suicide among children and adolescents, there’s been a push to understand who might be at increased risk of suicide. A recent 

 examined whether people who have autism spectrum disorder are at increased risk of both suicide attempts and suicide when compared to those without autism spectrum disorders.

The researchers used nationwide register data from January 1995 to December 2016 to find information on Danish citizens aged 10 years and older. The inclusion age of 10 or older was selected because both suicide attempts and death by suicide are relatively rare for children who are younger. Suicide attempts were identified when a person went to an emergency department or psychiatric hospital and were given the following codes from the 

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10)

 codes: X60 to X84 or Y87.0 or a care provider noted the reason for the visit was self-harm. Death by suicide was noted when there was a record of the same 

 codes or manner of death was noted as suicide.

From a population of 6,559,266 people, 35,020 were given a diagnosis of autism spectrum disorder, a majority of which were male. Within the whole population, 64,109 suicide attempt incidents and 14,197 death by suicides were found, with 587 attempts and 53 deaths occurring in people with autism spectrum disorder. Overall there was a 3-fold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI, 2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) in people who had autism spectrum disorder than those who didn’t have the disorder. When compared to male individuals with autism spectrum disorder, the aIRR for a suicide attempt was 4.41-fold (95% CI, 3.74-5.19) higher in females and even among those without autism spectrum disorder, females had a 1.41-fold (95% CI, 1.39-1.43) higher aIRR than their male counterparts. All age groups of people with autism spectrum disorder had increased rates of suicide attempts. Additionally, the researchers that noted an increase in attempts and death by suicide in participants with autism spectrum disorder who had at least 1 other comorbid disorders, with 542 of the individuals with autism spectrum disorder who attempted suicide having at least 1 and 48 of the individuals with autism spectrum disorder who died by suicide also having at least 1 comorbid diagnosis.

The researchers concluded that people with autism spectrum had a higher rate of death by suicide and suicide attempt and that psychiatric comorbidity was a major risk factor. Because the risk factors for this population are different from those in the general population, a tailored suicide prevention program should be used.

1. Kõlves K, Fitzgerald C, Nordentoft M, Wood S, Erlangsen A. Assessment of suicidal behaviors among individuals with autism spectrum disorder in Denmark. 

. 2021;4(1):e2033565. doi:10.1001/jamanetworkopen.2020.33565

After years of tentative moves toward utilizing telemedicine, the pandemic threw many clinicians into providing most or all care without being in the same room as the patient. Although some care can be difficult to provide this way, some providers found that contraceptive counseling was possible and that it should even be expanded with time.

 provided a survey to providers to ask about their experiences. Many indicated that they felt telemedicine were an effective way to provide needed contraceptive counseling. Most of the respondents said that they had to refer less than a quarter of their patients to in-person visits, with the majority of in-person visits being for the insertion of long-acting reversible contraceptives.

Telemedicine has become one of the main avenues for practicing medicine in the era of COVID-19. Here’s a look at contraceptive counseling when using such services.

Using telemedicine for contraceptive counseling

Lucia had begun to take school seriously in 8th grade but now, in 9th grade, she has become disheartened and says the teachers do not explain things well virtually. She does not like to show her face on camera and has begun to stay in her room, refusing to even eat dinner with the family. She keeps asking them to leave her alone. Her parents are worried. She just wants to play video games and play music in her room, and she has stopped seeing her best friend. The freshman guidance counselor called the parents to say she has missed more than half of the school days in the last week. The parents had no idea because they both work through the day online and assumed Lucia was participating in school virtually. They don’t know what to do.

The impact of the COVID-19 pandemic has hit home, school, work, and social life unlike any other acute change in our lifetime. Resulting isolation, loss of routine, limited social contact, grief, hardship, and stress have increased difficulties and further challenged youth. The deficiencies in our health care provision of mental health care for children have been further highlighted in the press and academic journals. What can those of us on the front lines caring for children do?

Devising an approach for health care workers to address mental health concerns in brief office visits may feel overwhelming. The sections below offer practical pandemic relief to help manage mental health concerns brought by families. During office visits, you can discuss the pillars of well-being by including these 10 priorities.

 Since the pandemic hit, there have been a range of reasons for misery for everyone. Remind families that it is understandable that stress levels are high, and worrying is rampant. Parents and children face new stressors to navigate. Acknowledging this reality has potential benefit. Family environment, parenting practices, coping, and support influence psychological consequences on children.

Parental mental health significantly impacts children, so remind parents that their own self care is important for their own and their children’s well-being. Help parents acknowledge how much their children are missing from their usual lives. School no longer includes the favorites of lunchtime chatting and playful recess interaction. Children are not likely having much opportunity online to solidify new friendships or flirt with a new crush. Their favorite activities are likely limited or on pause. Encourage parents to set aside time to devote their full focus on their children. Emotional support from parents can be protective.

Speak privately to your patients themselves to hear concerns, validate their struggles, and share guidance for those whose home life is affected by substance use or other dysfunction. For the teenagers, their peers become top priority, yet their current environment is blanketed by a large dose of family. Family members that do not support a patient’s LGBTQIA identity, or hold opposing cultural beliefs or sociopolitical values may create tension in the home. Find out if your patients are facing rejection at home and ensure they are coping with that difficulty. Consequential stress from these conflicts and/or the presence of domestic physical, verbal, and/or emotional abuse may have a lasting impact that could be mitigated if identified.

Teach families the myriad ways the pandemic is increasing stress for many by reviewing how stress occurs in the following conditions:

When an event is UNPREDICTABLE as to when or how it may occur.

When competence is being THREATENED (challenged/threatened).

When lack of control forces SURRENDER of your autonomy.

Despite current times meeting all of the above criteria, there is reason for optimism. A study among 381 undergraduate students (age range: 17–24, mean: 20.16, SD = 1.46 years) suggested that active coping strategies predicted life satisfaction during the 2003 Beijing SARS epidemic, whereas the number of stressors and use of avoidant coping strategies predicted psychological symptoms.

Present this pandemic crisis as an opportunity to learn and support well-being.

 Because unpredictability contributes to stress, a schedule does much to regulate our daily lives and contribute to a sense of stability.

Recommend families maintain consistent routines for wake up, bathing, meals, exercise, designated screen time, unwind time, and sleep. Suggest schedules be discussed collaboratively with children emphasizing what is healthy and within reason. Instead of hours, speak in minutes

 about their available time after school of 180-360 minutes depending on grade and homework prior to bedtime. The reason? To children, 120 minutes of screen time sounds like a lot compared to 20 minutes for sitting with family for meals.

 Emphasize what you already know about the importance of sleep’s effect on physical health, appetite, mood, and coping ability. This may be the simplest but most powerful intervention you can suggest, as so many parents do not realize how significantly inadequate sleep affects a child’s functioning. Advise families on good sleep hygiene.

 Watching or scrolling through the media makes us even more anxious. An excess of news and visual images about a traumatic event can create symptoms of posttraumatic stress disorder and negative health effects that remain years later, according to research by University of California at Irvine’s Roxy Silver, PhD, and others.

 Turn off the background news. Monitor Internet safety. Encourage families to view the Netflix documentary, “The Social Dilemma,” because it provides a convincing argument to limit internet use.

 Sedentary scores have shot up during the pandemic. Our brains are programmed to move and when we don’t it’s not good for our mind or body. Children in school are recommended to get 60 minutes of exercise daily. Encourage parents to keep their children active. Websites online offer creative indoor options such as “indoor and at home exercises for kids” at 

 Suggest families identify a new skill/hobby/or activity to learn or do together. Learn sign language, paint a room, create questions to share with family at meals, create homemade gift surprises, play board games, learn to cook, teach the pets new tricks, make posters of passionate beliefs for windows, listen to audiobooks together, or start sharing a daily high and low.

 Research supports the link between altruistic behavior and increased health and well-being.

 Do something that makes someone’s day better. A surprise sticky note, help with cleaning up dinner, call a relative who is alone during the pandemic, bake cookies for neighbors, write a letter to a favorite teacher, volunteer online.

 Anyone interested can learn this skill with simple, brief, regular practice. Help your patients understand that their goal is not to empty their minds of thought but to become aware of their sensations, emotions, and thoughts so they can use that self-awareness for their own benefit. There is evidence supporting benefits on mood, cognition, and symptoms including pain and associated with depression and anxiety.

 There are many options for learning, and countless easy and practical ways to incorporate mindfulness into a daily routine.

 Social isolation and loneliness can contribute to worsening of mental health.

 It’s a human need. Urge families to prioritize social meet ups while keeping safety in mind. Meeting outdoors wearing masks and socially distancing can still allow kids to see each other at a park, for a walk, in the yard, on a deck or porch. Even a prearranged consistent Zoom connection for your child and a friend has value. A limited group of contacts by designating a pod within which to socialize could be considered. Reiterate Centers for Disease Control and Prevention guidelines, handwashing, and testing options to maintain safe activities.

 Encourage parents to initiate the daily practice of noticing 3 positive moments of the day and share them with family. Create opportunities to enjoy time together. Noticing and appreciating daily pleasures can help improve mood.

In every mental health diagnosis that by definition is causing impairment and/or significant suffering, whether mild, moderate, or severe, evidence supports inclusion of psychotherapy in the treatment plan. Especially in pediatrics, this may include parental guidance and intervention. When conditions are severe, a combination of psychotherapy and medications provides the best outcome across conditions. For anxiety and depression-related conditions that cause moderate impairment, consider adding Selective Serotonin Reuptake Inhibitors medication if needed to help them engage in therapy, if they have persistent issues despite evidence-based therapy, or they are unable or refuse currently to access therapy.

Finally: As caregivers, our role is to both support well-being and address common reactions during these historic threats. Additionally, we must remain vigilant and prepared to initiate treatment when challenges have progressed into significant impairment and suffering.

Coping advice and helpful links for range of potential challenges: 

https://psychiatry.ucsf.edu/copingresources/covid19

American Academy of Child and Adolescent Psychiatry Link

Broad list and links of resources for both Families and Clinicians

Clinician resources for mental health management in primary care

 (courses on caring for the mental health needs of youth for Pediatricians, PAs, NPs, Therapists, & Schools) 

Guidelines for Adolescent Depression in Primary Care (GLAD-PC).

This comprehensive and practical resource includes practice guidance for administrative steps and billing as well as clinician tools such as diagnostic guidelines, rating scales, and pt/family handouts.

https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Pages/Primary-Care-Tools.aspx

A Guide to Psychopharmacology for Pediatricians

http://web.jhu.edu/pedmentalhealth/Psychopharmacolog%20use.html#Other_issue

Text crisis line: 741741 (only 6 digits); text STEVE for POC counselor

Trans Lifeline Peer Support US:1-877-565-8860

TrevorLifeline(LGBTQIA support) 1-866-488-7386

RAINN Sexual Assault Hotline: 1-800-656-4673

National Helpline for Substance Use 1-844-289-0879

Substance Abuse and Mental Health Services Administration National Helpline 1-800-662-HELP, or TTY 1-800-487-4889

American Academy of Child and Adolescent Psychiatry: 

1. Cobham V.E., McDermott B., Haslam D., Sanders M.R. The Role of Parents, Parenting and the Family Environment in Children's Post-Disaster Mental Health. In 

. 2016;18(6) doi: 10.1007/s11920-016-0691-4

2. Gudmundsdóttir D.G., Ásgeirsdóttir B.B., Huppert F.A., Sigfúsdóttir I.D., Valdimarsdóttir U.A., Hauksdóttir A. How Does the Economic Crisis Influence Adolescents’ Happiness? Population-Based Surveys in Iceland in 2000–2010. 

. 2016;17(3):1219–1234. doi: 10.1007/s10902-015-9639-3

https://www.mentalhealth.org.uk/a-to-z/s/stress

. Published February 20, 2020. Accessed October 1, 2020. 

https://humanstress.ca/stress/understand-your-stress/sources-of-stress

. Published August 22, 2017. Accessed October 1, 2020.

5. Guessoum SB, Lachal J, Radjack R, et al. Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323662/

. Published September 2020. Accessed October 1, 2020.

6. As suggested by Grizelda Anguiano, MD, FAAP on REACh PPP call. 

https://mindworkstx.com/staff/grizelda-anguiano-md-faap/

7. Healthy Sleep Habits: How Many Hours Does Your Child Need? HealthyChildren.org. 

https://www.healthychildren.org/English/healthy-living/sleep/Pages/Healthy-Sleep-Habits-How-Many-Hours-Does-Your-Child-Need.aspx

8. Roxane Cohen Silver EAH. Mental- and Physical-Health Effects of Acute Exposure to Media Images of the September 11, 2001, Attacks and the Iraq War - Roxane Cohen Silver, E. Alison Holman, Judith Pizarro Andersen, Michael Poulin, Daniel N. McIntosh, Virginia Gil-Rivas, 2013. 

https://journals.sagepub.com/doi/10.1177/0956797612460406

9. Irani A. Positive Altruism: Helping that Benefits Both the Recipient and Giver. ScholarlyCommons. 

https://repository.upenn.edu/mapp_capstone/152

. Published 2020. Accessed October 1, 2020. 

10. Simkin DR, Black NB. Meditation and mindfulness in clinical practice. 

. 2014;23(3):487-534. doi:10.1016/j.chc.2014.03.002 

https://www.sciencedirect.com/science/article/pii/S0022347616315487

11. N. Leigh-Hunt, D. Bagguley, K. Bash, V. Turner, S. Turnbull, N. Valtorta, W. Caan. An overview of systematic reviews on the public health consequences of social isolation and loneliness, 

12. The Neuroscience of Gratitude and How It Affects Anxiety & Grief. PositivePsychology.com. 

https://positivepsychology.com/neuroscience-of-gratitude/

. Published 2020. Accessed October 1, 2020.

The COVID-19 pandemic has had a severe negative toll on the mental health of many children. Here are some tips to help children achieve better psychological well-being.

Pandemic pediatric tips for mental health

The understanding of concussion and what is needed to effectively treat it without the risk of long-term effects has changed in recent years. A 

 looks at how children are doing a year following an acute concussion as well as those who had subsequent repeat concussions.

The investigators ran a secondary analysis of the Predicting Persistent Postconcussive Problems in Pediatrics study, which was run in 9 emergency departments in Canada. The participants in the study were children aged 5 to 18 years who presented ≤48 consecutive hours of concussion and also agreed to complete a post hoc survey a year after the injury. A standardized 25-question symptom scale was used to assess outcomes.

A total of 432 children from the study completed the 1-year survey and 34 of them indicated a repeat concussion. After an acute concussion, children or adolescents were more likely to be symptom free than after a repeat concussion (75% vs 50%; difference = 25% [95% CI 8-41]; P = .002) as well as to have a full recovery (90% vs 74%; difference = 17% [95% CI 5-34]; 

 = .002) after 1 year. Physical symptoms had lessened in the year following the concussion for both groups, but those with a repeat concussion indicated greater persistence of headaches (26% vs 13%; difference = 13% [95% CI 1,31]; 

 = .024). Both groups were also able to return to a normal school routine (100% vs 95%; difference = 5% [95% CI −5 to 8; 

 = .618]), but those who did not have a repeat concussion were found to more frequently return to sports (95% vs 82%; difference = 13% [95% CI 3-29]; 

 = .009) and normal physical activity (98% vs 85%; difference = 13% [95% CI 4-28]; 

The researchers concluded that most children and adolescents who have a concussion are fully recovered as well as symptom-free after 1 year. However, a repeat concussion could lead to delays in returning to normal routines and could lead to non-optimal outcomes.

1. van Ierssel J, Ledoux A, Tang K, et al. Symptom burden, school function, and physical activity one year following pediatric concussion. 

. 2021;228:190-198.e3. doi:10.1016/j.jpeds.2020.08.061

How well do children recover from a concussion? A report offers some answers.

Looking at outcomes a year after concussion

The understanding of concussions has changed over the past several years. A new investigation offers some insight into how children are doing a year after a concussion.

A look at how the long periods of time spent in the home may alter the prevalence of myopia in young children.

Plus, the COVID-19 pandemic has put enormous stress on children’s mental health. We offer 10 tips to help provide mental health support to stressed children.

A look at what to expect from Contemporary Pediatrics this week

What's new on Contemporary Pediatrics: January 18 to January 22

It is hard to believe that 2021 has arrived. I am sure we all are happy to bid 2020 farewell and are looking forward to a much more “normal” year in 2021.

As the COVID-19 pandemic continues to surge across the country and stay at home orders, travel bans, and other restrictions remain in place, the Emergency Use Authorization of 2 COVID-19 vaccines brings a most welcomed glimmer of hope to obtaining some control over this pandemic. The start of large COVID-19 vaccine trials in children are planned for these next several months, with the hope of vaccine availability for children by the 4th quarter of 2021. This month’s issue has several “must read” articles:

, which provides a comprehensive review of different aspects of COVID-19 in the pediatric population.

The pandemic has fostered the exponential growth of social media outlets and the creation of many social media challenges, some of which present significant danger to a person’s health and well-being. The pediatric pharmacology article in this issue addresses the 

 that is trending on TikTok and discusses the dangers of and treatment for this challenge.

The pandemic has created nutritional challenges for persons of all ages. The nutrition article looks at the nutritional needs of children during the winter months and the importance of 

Best wishes for a peaceful, healthy, and happy New Year. As Oprah Winfrey states “Cheers to a New Year and another chance to get it right”. Please stay safe and well. And as always, I welcome your suggestions, comments, and questions.

New Year’s greetings!

Looking at the variations in catching hearing loss

Catching hearing loss early is key to helping a child achieve optimal outcomes. However, a new report examines the variations that can occur for diagnosing and treating.

During the evaluation of a healthy 7-year-old boy, an asymptomatic brown “dirt-like” rash is found on the anterior neck. It has progressed over the last 2 months and does not clear with routine bathing and aggressive scrubbing by his mother with soap and water.

Age of exposure to household dysfunction could be linked to future adverse outcomes

A report examines whether the age a child is exposed to dysfunctional behavior in their homes was linked to future adverse outcomes.

Study examines if ASD increases substance use disorder risk

An investigation examines whether children with autism spectrum disorder (ASD) are at increased risk of substance use disorder.

In case you missed it: January 11 to January 15

 more members to be appointed to the White House COVID-19 Response team, who will work to implement the Biden administration’s COVID-19 plan, which includes rapidly vaccinating as many Americans as possible, increasing testing rates, and restoring the public’s trust in the scientific information disseminated by the federal government.

David A. Kessler, MD, has been selected to be the Chief Science Officer of the COVID Response team. Kessler is currently a professor of pediatrics and epidemiology and biostatistics at the University of California, San Francisco and has served as the dean of medical schools at both Yale and University of California, San Francisco. He has previously served as the commissioner of the US Food and Drug Administration from 1990 to 1997 and was chair of the boards for both the Center for Science in the Public Interest and the Elizabeth Glaser Pediatric AIDS Foundation. He’s also an author of several books on public health.

In the press release for the announcement, President-elect Biden stated, “The individuals announced today will bolster the White House’s COVID-19 Response team and play important roles in carrying out our rescue plan and vaccination program. At a time when American families are facing numerous challenges I know these public servants will do all that is needed to build our nation back better.”

1. President-elect Joe Biden and Vice President-elect Kamala Harris announce additional members of the White House COVID-19 response team. President-Elect Joe Biden. Published January 15, 2021. Accessed January 15, 2021. 

https://buildbackbetter.gov/press-releases/president-elect-joe-biden-and-vice-president-elect-kamala-harris-announce-additional-members-of-the-white-house-covid-19-response-team/

The Biden transition team has named more members of the COVID-19 response team, including pediatrician and lawyer Dr. Kessler.

Is staying at home increasing the risk of myopia?

Using peers to help teens with mental health

Are people with autism more at risk of suicidality?

Using telemedicine for contraceptive counseling

Pandemic pediatric tips for mental health

Looking at outcomes a year after concussion

What's new on Contemporary Pediatrics: January 18 to January 22

New Year’s greetings!

In case you missed it: January 11 to January 15

David A. Kessler, MD, named Chief Science Officer of the COVID Response team

State of the union on COVID-19

Early language ability predicts future language outcomes

Why parents choose not to enroll in clinical research

Red papulonodule with central crusting on a neonate’s cheek

Study examines if ASD increases substance use disorder risk