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Pediatric mental health emergencies are frequently encountered in emergency medical practice and comprise a substantial and growing component of pediatric emergency medical care.1–10


Pediatric mental health emergencies encompass a range of conditions, including psychological disorders such as depression, suicidal ideation, aggressive behavior, conduct disorders, bipolar disease, and post-traumatic stress syndrome, as well as substance abuse, attention-deficit/hyperactivity disorder, autistic spectrum disorders, and mental retardation. The psychological and sometimes physical aftermath of child maltreatment, mass casualty incidents and disasters, and exposure to violence and unexpected deaths are also likely causes of mental health emergencies in children presenting to the ED.9–11


The role of the emergency physician in the care of children with mental health emergencies includes achieving medical stabilization, differentiating organic from psychiatric disease, performing a psychosocial interview, and initiating therapy. Initial management may include pharmacologic therapy, implementation of physical restraint, and referral for inpatient admission or outpatient counseling.9,10


About one in five children between the ages 9 and 17 years in the U.S. have a diagnosable mental or addictive disorder according to the Surgeon General’s Report on Mental Health.12 Over 13 million children in the U.S. are thought to need mental health or substance abuse services.13


According to a study conducted at Boston Children’s Hospital, there has been a sixfold increase in the number of patients with mental health disorders presenting to the ED over 15 years.2 At Cincinnati Children’s Hospital, mental health disorders were the tenth most common reason for coming to the ED and accounted for 3.7% of all pediatric ED visits, which was comparable to the rate for other common diagnoses such as vomiting and diarrhea (4.8%) and asthma (4.7%).8 A similar rise in the number of visits related to psychosocial problems has been observed in the outpatient setting, with an increase from 7% to 18% between 1979 and 1996 among children 4 to 15 years of age.1 The percentage of mental health hospitalizations has also been rising: over a 10-year period in Washington State, the number one cause for hospitalization of 5- to 19-year-olds was mental health disorders, accounting for one third of all hospital days.6 In addition to these general trends, pediatric psychiatric emergencies show seasonal variation and are more common during the school year.5


Prehospital providers also encounter children with mental health disorders frequently. A study of almost 60,000 EMS pediatric transports (age ≤14 years) in four states reported that almost 1 out of 10 transports (9.2%) were for mental health disorders, including behavioral/psychiatric disorders (2.4%) and poisoning or overdose (6.8%).14 These data may underestimate the EMS burden, because older adolescents were not included.14 Although some of the overdoses included accidental ingestions in toddlers and young children, the majority were likely intentional.14 Another study of EMS transports in Albuquerque, New Mexico over a 3-year period also found a 9% incidence of transport for mental ...

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