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How to Mitigate Pandemic Fallout for Babies and Toddlers

Mental health professionals can partner with pediatrics.

Prevention is worth a pound of hand soap. Just as we must wash our hands to prevent the spread of the novel coronavirus, we also need to focus on our youngest children during this unprecedented time, to foster healthy mental health for the next generation.

As Jack Shonkoff, MD has said, “Age 3 is middle age when it comes to brain development,” suggesting that the prevention train has indeed left the station if we wait for the school-age child to be diagnosed with anxiety or the adolescent to qualify for a major depression disorder.

My brother-in-law, a tech professional whose days with infants and toddlers are far behind him, is even thinking this way. Maybe all those family dinners, where he’s heard me imploring everyone to understand how key these early years are actually took hold. He said to me last night, “But, shouldn’t we be most worried about those infants and toddlers, at home now with parents under huge amounts of stress, and how they’re going to be in 15 or 20 years?” Indeed, brother. Prevention is key.

With schools closed across the country (and most children ages 0-3 not in school anyway), where should we turn to bring prevention to bear? Nearly all families in the United States regularly visit pediatric primary care. It’s the only system that has a consistent, positive connection to young children and their caregivers—there are 12-13 well-child visits in the first three years of life.

That’s at least a dozen opportunities to connect with adults and their young children about their mental health and well-being. Whose, you ask, children's mental health or their parents'? Well, that's another advantage of this system—when team-based care is well implemented, bringing in mental health professionals to the primary care pediatric team, the answer is, potentially, both!

 Copyright ZERO TO THREE. All rights reserved.
Mental health professionals can parter with pediatric primary care to support families.
Source: Copyright ZERO TO THREE. All rights reserved.

It’s a perfect platform to build on to support the healthy development of young children, especially now when all of our lives have been upended by the COVID-19 pandemic. As a child psychologist focused on babies and toddlers, I’ve always been focused on prevention. Right now, I see a window of opportunity amid this crisis to support families and prevent the short- and long-term effects of this pandemic, not just on our physical health, but on our mental health, as well.

Health professionals in outpatient care across the country are not conducting business as usual, and many have had to shut their doors or drastically cut back on services deemed non-essential, leading to layoffs across health care. Across the entire health system, pediatric primary care for children ages 0-3 is the outpatient service still operating (as close to) business as normal either via drive-thru visits or reduced office hours. Why are they proceeding with these visits at all, when we’re all being told to shelter in place? Because there is no time in life more important than ages 0-3. These early years lay the critical foundation for long-term development and health.

The American Academy of Pediatrics and Centers for Disease Control and Prevention have advised that children who do not need essential services avoid coming into a pediatric office but that well-visits continue for children under age 3. Babies and toddlers receive myriad essential services, and families are still bringing in their young children to the pediatric office—even during a pandemic.

Numerous lifesaving and critically important vaccines are given to babies and toddlers, important health checks are conducted to ensure that newborns are gaining weight appropriately, developmental screenings occur, and mothers are screened for depression or even Adverse Childhood Experiences.

Food insecurity, employment worries, depression, anxiety, domestic violence and a host of other concerns are often shared during a routine pediatric visit because it's a safe space for caregivers. Sadly, these concerns have ballooned in the wake of coronavirus, especially for those already living in poverty and facing health inequality, and we won’t know the true and complete fallout of this crisis on the mental health and well-being of our country for months and years to come.

 Copyright ZERO TO THREE. All rights reserved.
A HealthySteps Specialist visits with a family during a well-child visit.
Source: Copyright ZERO TO THREE. All rights reserved.

Mental health professionals interested in mitigating the fallout of COVID-19 on young children and their families, or who want to focus on prevention, can partner with a pediatric primary care team to address these challenges in a safe and accepted setting. Parents are under a great deal of stress right now and frankly, just want to get through the day. Team-based care, including pediatric and mental health providers, may be part of a support team to help parents yes, get through the day, and to also provide safe, stable and nurturing relationships with their children, ensuring healthy development for the next generation.

Infant and early childhood mental health professionals can address complex and common concerns—pandemic-related or not—with parents that pediatric primary care providers often lack time to address in a 15-minute well-child visit. Integrating a mental health professional into the health care team yields benefits for children, families and the providers and practices that serve them as demonstrated by HealthySteps, a program of ZERO TO THREE.

To be clear, adults and children of all ages and backgrounds will need mental health support beyond the pediatric office, now and for weeks, months, maybe even decades to come as people work through grief, survivor's guilt, and even post-traumatic stress disorder. The need for high-quality, affordable, accessible mental health services in this country was already dire and is now even more urgent. We should and will need to focus on prevention. We can start with families and meet them where they already are—the pediatric office.

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