As restrictions return due to the rising numbers of COVID-19 cases, the U.S. Centers for Disease Control and Prevention has published new research that shows the negative impact of the pandemic on the mental health of children and adolescents.

Researchers found that the proportion of emergency department visits related to mental health were up 24% for children aged 5 to 11 and 31% for children aged 12 to 17 from April through October, compared with the same time period last year. The findings, published last week, add to existing research suggesting that COVID-19 has had a negative effect on children’s mental health.

The U.S. data track with findings in other countries. Data from China suggest that children in the Hubei province experienced serious mental health symptoms from quarantining — after an average of 33.6 days, a shorter period than how long many American children have quarantined, 22.6% reported depressive symptoms, and 18.9% reported experiencing anxiety.

Jeremy Esposito, a physician in the emergency department at the Children’s Hospital of Philadelphia, said the CDC findings reflect the distress kids experienced after schools closed and activities such as sports were put on hold.

“Patients and parents already dealt with barriers to accessing mental health before COVID-19, such as stigma, concerns for the cost of mental health care, lack of insurance, transportation barriers, and shortage of providers," Esposito said. “COVID-19 may have compounded those barriers as mental health services have had to adapt.”

Because some community mental health services have had to reduce staff and cancel in-home visits to reduce the spread of the virus, some parents may use the emergency department as a “safety net” to figure out the first steps of accessing mental health care under the circumstances of COVID-19, Esposito said. When that happens, the ED often becomes where families go when they’re dealing with a mental health crisis, he said.

“That’s why at CHOP, we’ve asked our primary care providers to reach out to patients and family and let them know that telehealth appointments with psychiatry and behavioral health specialists are available to them,” Esposito said.

At Nemours/Alfred I. duPont Hospital for Children in Wilmington, all children who go through the emergency department receive a screening for mental health issues. Emergency-room social workers said they have noticed an uptick in visits related to mental health, compared with last year.

“What we’re seeing is that this time of uncertainty is hard for kids,” said Karen Wohlheiter, a pediatric psychologist at Nemours. “It’s hard for them to picture things getting better and what that’s going to look like. That’s driving a lot of distress surrounding the pandemic, especially with isolation and loneliness.”

Wohlheiter said that when providers switched to telehealth at the beginning of the pandemic, many families didn’t feel comfortable with those services, which may have decreased access. Without regular wellness checks with pediatricians and in-person classes, it’s challenging for professionals to identify when kids are struggling with mental health, she said.

Wohlheiter said that if parents suspect their child is having a mental health crisis or in an unsafe situation, go to the emergency department. Signs that a child is having a crisis include rapid mood swings, severe agitation, and threats to themselves or others. But she also said reaching out to mental health providers or even a child’s primary care physician to establish a support network before a situation like that arises can be helpful.

“Many community mental health-care centers are still taking patients, either in person or over telehealth,” Wohlheiter said. “There are also a lot of resources online that talk about managing stress and anxiety.”

It’s important for families to have open conversations about mental health, Esposito said.

“We should be acknowledging that even before COVID-19, mental health has been a crisis for decades, and it’s important that we use what we’re learning during the pandemic to help us adapt and prepare for after the pandemic ends,” Esposito said. “All emergency rooms should be taking a look at how they address mental health in youth.”