Some Younger Kids May Need Screening for Anxiety in Primary Care

Some children aged 7 years and younger may benefit from screening for anxiety in primary care, according to an editorial published in JAMA by John Walkup, MD, Chair of Pritzker Department of Psychiatry and Behavioral Health at Ann & Robert H. Lurie Children’s Hospital of Chicago, and colleagues. The authors respond to the US Preventive Services Task Force recommendation that children be screened for anxiety at 8-18 years of age.

The authors underscore that the onset of anxiety disorders can be as young as age 4 to 5 years, and some subclinical manifestations may present even earlier. Also, anxiety disorders are common in youth, occurring in up to one in 10 children and adolescents.  

“Given the early onset and high prevalence of anxiety disorders, some children younger than 8 years may need to be screened by their pediatrician, especially if they present with anxiety-related physical symptoms, such as abdominal pain,” said Dr. Walkup, who also is the Margaret C. Osterman Board Designated Professor in Child & Adolescent Psychiatry at Lurie Children’s and Professor of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine. “Earlier identification and effective treatment for anxiety are important to reduce distress, impairment and morbidity associated with delayed recognition and treatment.”

Dr. Walkup and colleagues also stress that pediatricians are best positioned to identify family history of anxiety early in the child’s life. Family history is one of the risk factors for anxiety in children and may enhance screening efficacy.

“Parents with anxiety disorders confer genetic risk to their children but also may have parenting beliefs and approaches that inadvertently support the development or maintenance of anxiety disorder symptoms in children,” said Dr. Walkup. “Recognizing family history of anxiety can inform the pediatrician’s screening and monitoring strategy specific to the child and family and may prevent the development of an anxiety disorder.”

To help pediatricians conduct timely screenings for common mental and behavioral health conditions in children and initiate evidence-based treatment, Lurie Children’s has been offering training on addressing anxiety, depression and ADHD in primary care.

“We are committed to expanding capacity for early identification and management of highly prevalent psychiatric disorders among pediatric primary care providers,” said Dr. Walkup. “With the national shortage of child mental health providers, training pediatricians is a key strategy to improve access to care, especially during the current youth mental health crisis.”

Ann & Robert H. Lurie Children’s Hospital of Chicago is ranked as one of the nation’s top children’s hospitals by U.S. News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine.