1 in 3 children with mental health needs only see a pediatrician

 JAVIER SÁNCHEZ MINGORANCE

A significant percentage of kids with mental health conditions such as ADHD and anxiety are treated only by pediatricians, a new study finds.

According to the study by scientists at MassGeneral Hospital for Children in Boston, close to 35 percent of children who go for mental health care in an outpatient setting are treated by a primary care physician only, while 26 percent saw a psychiatrist, and 15 percent saw a psychologist or social worker.

The researchers, whose study appears in Pediatrics, analyzed data from about 43,000 children ages 2 to 21 who had been seen for mental health issues in outpatient settings between 2008 and 2011.

More children with ADHD saw a primary care physician than kids with anxiety and mood disorders ­- 42 percent compared to 17 percent. The study showed that pediatricians also prescribed medications to a higher percentage of children compared to psychiatrists. Children seeing a pediatrician for ADHD were more likely to receive psychotropic medications than those with ADHD who were seeing psychiatrists (74 percent versus 61 percent). Almost a quarter of children saw more than one provider.

Millions of children in the United States live with depression, anxiety, ADHD, autism spectrum disorders, Tourette syndrome and other mental health issues, according to the U.S. Centers for Disease Control and Prevention.

"We've been supporting and nurturing children with mental health problems for years," said Dr. Wendy Sue Swanson, executive director of Digital Health at Seattle Children's Hospital and a pediatrician at The Everett Clinic in Mill Creek, Washington. "We know with ADHD or anxiety that it's likely they'll be talking with their pediatrician, but I was surprised that half of kids aren't being seen for these diagnoses by their PCPs."

Swanson, who was not involved with the study, told CBS that for many families, a PCP is the first stop for mental health care and there may then be additional care recommended with a specialist.

As a pediatrician who sees children with mental health needs, she said she also relies on the expertise of other physicians, nurse practitioners, and specialists in her practice.

"I consult with my own network of specialists for support and that's not captured in this study. For many children, I manage their ADHD and anxiety with and without medicine and I may consult with a pediatric psychiatrist. I may pick up the phone and say, 'How can we help this child?'" said Swanson, but the child may not see the psychiatrist.

She said some general physicians and nurses also create a specialty niche in behavioral health. For example, a nurse practitioner in Swanson's practice at The Everett Clinic has seen a lot of children with ADHD and has a particular interest and expertise in this area, so she may consult with her on some cases.

Seven percent of children in the United States receive mental health services annually, the Pediatrics study authors wrote. Since more see a pediatrician than a specialist, they say their study results suggest more emphasis should be focused on collaborative care between mental health specialists and primary care doctors.

"Further research regarding timeliness and family satisfaction with this care among various groups should be pursued," they concluded.

Swanson said strategies that put into place a multifaceted plan that includes support in the home, the school, and within the medical system provide a comfort zone for families. "It can get complicated with multiple providers. We need to empower families to partner with their pediatricians and encourage them to use other resources, such as suicide hotlines, telehealth services, and other online resources. And if a parent doesn't feel comfortable with the care, they need to communicate that," Swanson said.

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Study: Cesarean delivery won't harm children's health

New research found that delivery by c-section was not linked to a higher risk of health issues in childhood.

 

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In a study of more than 5,000 children, Australian researchers said they found that cesarean section delivery was not linked with a higher risk of health problems in childhood.

"This study suggests that some of the previously reported associations between birth by cesarean delivery and adverse childhood health outcomes may be explained by influences other than mode of birth," said lead researcher Elizabeth Westrupp, a research fellow in the School of Nursing at La Trobe University in Melbourne.

The researchers concluded that cesarean delivery was associated with a mix of positive and negative outcomes through early childhood, and few were consistent.

For example, the association between cesarean delivery and childhood obesitymight actually be explained by the mother's obesity, Westrupp said.

"These findings should be reassuring to women and their doctors," she added.

The report was published online Oct. 12 in the journal Pediatrics.

For the study, Westrupp and her colleagues used data on more than 5,100 kids born in Australia in 2003 and 2004. The children were followed to the age of 7 years.

Specifically, researchers looked at overall health and conditions such as asthmaand body weight. They also looked at medications children were taking, any disabilities or medical problems, and social and economic circumstances.

The researchers then adjusted their findings to take into account the mother's social environment and weight, and whether the child was breast-fed.

Initially, Westrupp's team found that children born by C-section were more likely to have a medical condition at age 2 or 3, use prescribed drugs at age 6 or 7, and to weigh more at age 8 or 9.

However, the child's excess body weight reflected the mother's obesity, not being born by C-section, Westrupp said.

And cesarean delivery was linked with better overall health at age 2 or 3 and better social skills at age 6 or 7, the researchers reported.

When Westrupp's group took into account factors not related to delivery method, the association between childhood health and C-sections tended to weaken even further.

"When we took into account factors related to birth, social disadvantage, maternal weight and breast-feeding, we found few associations between cesarean birth and child outcomes," she said.

Dr. Aaron Caughey, chair of the department of obstetrics and gynecology at Oregon Health & Science University in Portland, said, "I don't think we should be doing cesarean deliveries without a medical indication. But just because you ended up needing a C-section I don't think that you should be worried that your child can suffer some long-term consequences."

Scant evidence exists to support the idea that C-sections can be bad for the health of the infant, he added.

However, Caughey said that although a C-section might not hurt the infant, it can be problematic for the mother.

"If you make a hole into someone's body all sorts of bad things can happen," he said. These can include damage to organs, excess bleeding and infection. After a C-section, a woman also experiences a lot of pain.

That doesn't mean that there aren't good reasons to have a cesarean delivery, Caughey said. "In some cases, it is absolutely lifesaving for both the baby and the mother," he said.

Medical reasons for a C-section include having had a previous cesarean delivery, situations where the baby is not correctly positioned in the womb and problems with the infant's heart function.

Still, Caughey believes that too many women are having their babies delivered by C-section. For the past several years, groups like the American Congress of Obstetricians and Gynecologists have been advocating for fewer C-sections, he said.

"We have encouraged doctors to be thoughtful and not do C-sections willy-nilly," Caughey noted.

Since 2010, the number of C-sections has leveled off, he said. "In 2014, it was 0.5 percent lower than in 2013, dropping from 32.7 percent to 32.2 percent. It's the biggest drop we've seen in 20 years -- that's 20,000 fewer C-sections."

Among women who have never had a cesarean delivery, the rate of C-sections shouldn't be above 15 percent, Caughey said. "In most hospitals, it's above 20 percent," he said.

"A woman should work with her doctor and midwife and think about the process and what's best for her," Caughey said. "We think that it's generally safe to have a vaginal delivery."

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