Mental Health Promotion and Problem Prevention: Pediatric Mental Health Minute Series

Mental health in infants and children is about how young children begin to organize their feelings and connect with other people. It includes their growing capacity to regulate and express their emotions and behavioral responses, to form secure relationships with others, and explore the environment in the context of their family, community, and cultural expectations (Zero To Three).

Scope in Pediatrics

• 1 in 6 US children have been diagnosed with a mental health condition, making it one of the most prevalent set of categories of child health problems. Even more children have mental health symptoms that do not meet full diagnostic criteria for a specific mental health condition. 

• Many biological, family, and social risk factors for child mental health problems are present early in life, offering opportunities for identifying children who may be at risk for developing mental health problems.

• Pediatricians are in a unique position to use systematic approaches to identify children and families at risk, offer early intervention efforts in the practice through community supports and services.

Teaching Points

• The prevalence of mental health problems is 1 in 6 children in the US.  While mental health problems can affect anyone, they often develop in the context of some interaction among biological and social factors and rates of mental health problems are higher in practices serving children who have experienced higher rates of individual, family, and community adversity.  
• Pediatric mental health problems can begin at any age, and diagnostic criteria for some disorders have been validated in children as young as 2.    
• Early interventions focused on children with identified child, family, and community risk factors show powerful effects.   
• Innovative models in pediatric primary care practices can reduce family and child mental health symptoms.   
• Rigorous studies of early childhood home visiting and high-quality child care services demonstrate impacts on adolescent substance use and other health behaviors.   
• Early intervention approaches also show reductions in maternal depression, a risk factor for a host of child physical and mental health problems.   
• For adolescents at risk of depression because of parents’ depression, preventive approaches reduce the child’s own depression risk.   
• In general, children’s mental health symptoms are under identified.  Although the rates vary widely, published rates range from 14-54%.
• Unfortunately, even children with identified mental health symptoms often receive no mental health treatment.  Generally, fewer than 50% of identified children receive treatment, and these rates also vary dramatically by child, pediatric clinician, and community factors.
• Pediatricians are the experts in child health promotion activities across a range of health outcomes and intentionally identifying and mitigating mental health risks enhances the positive health outcomes of pediatric care.