By routinely screening for mental health concerns and promoting healthy development through anticipatory guidance, pediatricians can better focus on children’s mental and emotional well-being, according to a recent clinical report in Pediatrics.

The American Academy of Pediatrics in 2021 declared mental health in children and adolescents a national emergency. Despite publicly available resources, some clinicians are still hesitant to approach mental and emotional development in their practice, said Jennifer Poon, MD, who helped author the report.

“If families are taking their children to the pediatrician regularly, there’s this nice, lovely, established relationship that occurs that creates this sense of someone who gets to know and see a child develop and grow over time, and therefore also understand…some of the things that could influence one’s mental and behavioral health,” said Poon, who is also chief of developmental and behavioral pediatrics at the Medical College of Georgia in Augusta, Georgia.

The report notes that while pediatricians are well versed in regularly assessing motor and language milestones, they may also consider doing the same for mental and emotional functioning. For instance, autonomy and awareness of others’ feelings are typical for toddlers between 24 and 36 months. Clinicians might advise caregivers to provide opportunities for children to pick their own clothing and to identify and label their feelings.

Heather Joyce, MD, pediatrician at Mercy Kids in O’Fallon, Missouri, said she coaches parents on how to handle infant and toddler behavioral milestones.

“In that toddlerhood era, it’s about parenting through tantrums and learning how to set boundaries and how to support your child,” Joyce said.

If a toddler is having tantrums, clinicians can explain that tantrums are a normal part of developing self-regulation and model behavior for caregivers to use with their children, such as saying, “I need to take a few breaths to calm down,” the report advised.

As children grow, Poon said she uses some of what the report advises by refocusing on reframing child characteristics that a parent views as weakness. A 10-year-old labeled as “shy” or “rude” by their parents because they are quiet during a well visit might instead be thought of as cautious and observant by their pediatrician, thereby removing the negative connotation of other labels.

Poon said she also asks probing questions, such as “In what settings does the behavior occur?” and “How is this affecting you?” when a parent says their child is exhibiting problematic behavior or traits.

“Just don’t automatically assume when a parent tells you that their child is anxious that automatically they need therapy,” she said. “Find out what’s the next layer and what type of problem it is, and where the severity of the problem is.”

Although Joyce said most pediatricians ask about their patients’ mental health during every visit, finding the time to properly address any issues in a busy clinic can be challenging. Referrals to a mental health clinician are key, but so are follow-up visits to discuss more thoroughly the mental health concern.

While the steps in this framework can be implemented by individual clinicians, Joyce said a lack of resources can prevent successful partnerships with families and patient follow-through on referrals.

“It takes time out of a school day — often for a kid who’s already maybe not doing well in school — to be able to see a therapist or counselor or specialist,” Joyce said.

Poon recommended clinicians familiarize themselves with their local ecosystem of free and low-cost resources.

“Pediatricians want to do this work,” Poon said. “I think sometimes it just might feel a little bit overwhelming.”

Poon and Joyce reported having no relevant financial relationships. The report received no external funding.

Kelsey Mesmer, PhD, is a freelance journalist and journalism professor at Saint Louis University in St. Louis, Missouri.