Children's Emergency Visits Fell in 2020, but More of Them Were for Mental Health

When the pandemic arrived in the spring of 2020, American families stayed away from emergency departments. Children's mental health visits fell too — by 43 percent from mid-March. But they fell less than everything else, and from April on, a larger share of the children who did come to an emergency department came for their mental health, a pattern that lasted through October.

The numbers

CDC compared emergency department (ED) data for children under 18 from January 1 to October 17, 2020, with the same weeks of 2019.

Compared with 2019, the mental health share rose about 24 percent for children aged 5–11 and 31 percent for adolescents aged 12–17. Adolescents made up the largest share of these visits in both years, followed by children aged 5–11. Girls had a higher share than boys in both years, and both rose in the same way from mid-March.

Mental health–related share of children's ED visits by week and age group, 2019 and 2020. Credit: CDC.

What happened in the spring

• In the first 11 weeks of 2020, before the pandemic's effects, the number of children's mental health visits was higher than in 2019, but their share of visits was similar.
• From week 12 (mid-March), as mitigation measures such as school closures took hold, the number of mental health visits fell sharply until early April, then rose steadily through October.
• Overall ED visits fell further. A previous report found that from March 29 to April 25, 2020, ED visits for all ages fell 42 percent, and for children under 14 about 70 percent. Visits for asthma, ear infections and sprains dropped while visits for psychosocial factors rose 69 percent.

That the share rose while nonemergency visits were being discouraged suggests children's mental health was serious enough to bring families in.

Why it might have happened

Many children get mental health care through clinics, community agencies and schools. Pandemic stress and the side effects of mitigation — anxiety about illness, social isolation, lost connection to school — may have added to their needs just as those services were cut back or changed, pushing more routine and crisis care into EDs. Most EDs lack adequate capacity to treat children's mental health, adding strain to systems already stretched by COVID-19.

Read with care

• A small share of a shrinking total. Mental health visits were only 1.1 percent of pediatric ED visits in 2019 and 1.4 percent in 2020, so the big drop in other visits inflates the percentage increase.
• Not nationally representative. The National Syndromic Surveillance Program covers a subset of hospitals in 47 states — about 73 percent of U.S. ED visits — and the hospitals reporting varied.
• Visits, not children. One child can make several visits, and the definition covered conditions that rise after disasters, such as stress, anxiety, acute posttraumatic stress and panic, not every mental health condition. Most mental health care happens outside EDs, so these data likely undercount the need.

What the report recommends

Keep monitoring children's mental health beyond the ED; make sure developmentally appropriate services are available outside the emergency room, including telemental health and mobile apps; and help children and families build healthy coping and resilience.

Sources

Based on "Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic — United States, January 1–October 17, 2020," by Rebecca T. Leeb, Rebecca H. Bitsko, Lakshmi Radhakrishnan, Pedro Martinez, Rashid Njai and Kristin M. Holland, Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain. Data: CDC's National Syndromic Surveillance Program.