Two new clinical reports from the American Academy of Pediatrics (AAP) offer advice for clinicians in managing pediatric mental health emergencies. The AAP has issued previous recommendations for treating children with mental health issues, but these are the first that focus on mental health emergencies.
The two clinical reports, “Evaluation and Management of Children and Adolescents with Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients with Mental Health and/or Behavioral Emergencies” and “Evaluation and Management of Children with Acute Mental Health or Behavioral Problems. Part II: Recognition of Clinically Challenging Mental Health Related Conditions Presenting with Medical or Uncertain Symptoms,” are published in the September 2016 Pediatrics and published online Aug. 22. The reports—and two accompanying executive summaries—cover a wide variety of childhood mental health disorders that may present to emergency physicians.
Part one of the reports emphasizes the importance of ensuring patients are medically stable and that there is not a medical condition exacerbating a mental health condition. It also reviews when to conduct diagnostic testing, such as toxicology, pregnancy and sexually transmitted infection tests. The report offers guidance on evaluating pediatric patients for
suicide risk and management of patients who have attempted suicide, including outpatient management, hospitalization and coordinating care with the medical home care.
Part two discusses evaluating somatic illnesses, including communicating with the patient and family. It also addresses adverse effects from
psychiatric medications as well as recommendations in managing children with special needs, including autism and developmental disorders and the unique challenges their conditions bring in crisis situations.