Legislative remedies to mitigate the national emergency in pediatric mental health

The coronavirus disease (COVID) pandemic not only unmasked the growing pediatric mental health crisis but also placed it firmly in the national spotlight. In this issue, Sarid et al. review the prevalence of psychiatric outcomes in infants who received antenatal corticosteroid treatment for threatened preterm delivery but ultimately delivered at late preterm or term gestation.¹ Though acknowledged bias exists in the three studies included in the review, the work proposes an association between antenatal corticosteroid exposure and later mental health morbidity and suggests the need for greater investigation into the long-term sequela of babies born to mothers who receive this common treatment. In the largest study reviewed, antenatal steroid treatment with subsequent term delivery increased risk of diagnosis with any mental health/behavioral disorder through early childhood.²

The prevalence of mental health conditions in childhood has increased over time.³ Even prior to the onset of COVID-19, pediatricians were the first to draw attention to the incoming wave of mental health challenges facing children. From 2003 to 2012, rates of children ever receiving a diagnosis of anxiety or depression increased in the United States from 5.4 to 8.4%.⁴ Just prior to the pandemic, an estimated 5.8 million children (9.4% of the population of children aged 3–17 years) had anxiety and 2.7 million (4.4%) carried a diagnosis of depression.⁵ But mental health risks are not evenly distributed across age groups in the United States. Adolescents bear the majority of mental health comorbidity. From 2018 to 2019, almost 37% of 12–17 year olds reported feelings of sadness or hopelessness, 15% experienced a major depressive disorder, and 1 in 25 suffered from a substance use disorder.^5,6 More frightening, almost 9% attempted suicide, with 15.7% having made a suicide plan.⁵ Limited access to care compounded these mental health risks. Twenty to forty percent of children with depression and anxiety respectively were not able to access treatment.⁶

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