The American Association of Nurse Practitioners National Conference 2021 (AANP 2021) highlighted current evidence-based guidelines for the management of pediatric anxiety in primary care. Dawn Garzon PhD, CPNP-PC, PMHS, FAANP, FAAN, discussed assessing anxiety with a developmental lens and pharmacological and non-pharmacological options for treating anxiety in children.
“Primary carers often treat mild to moderate illnesses in adults and are trained to identify and diagnose children and adolescents with symptoms of mental health problems,” said Dr. Garzon, a nurse at Advent Behavioral Health in St. Peters, Missouri. “What is often lacking is confidence in their ability to do this. Suicide is currently the second leading cause of death for our young people. It is therefore crucial to increase primary care competence and confidence in the treatment of children and adolescents in order to provide your children with another safety net. “
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Is it fear, phobia, or fear?
Dr. In her lecture, Garzon distinguished between fears (an urge to avoid a stimulus), phobias (irrational fears) and fear (a global discomfort). She found that anxiety is normal throughout childhood; for example, many toddlers fear anthropomorphism and many teenagers fear disfigurement or lack of acceptance by their peers.
About a third of children with anxiety have comorbid depression and 37% have behavior problems. Attention Deficit Hyperactivity Disorder (ADHD) is another common comorbidity of pediatric anxiety, noted Dr. Garzon firmly.
In order to optimally treat children with anxiety and ADHD, Dr. Garzon to refer to the Society for Developmental and Behavioral Pediatrics clinical practice guidelines for the assessment and management of complex ADHD.
“I love that these guidelines are available and help work out the threads of dealing with complex diseases,” she said. “It’s important to stick to the most serious problem, usually fear, but not in all cases. This requires the patient’s opinion as to which [condition] is worse.”
Risk factors for anxiety in pediatric patients include a parent with a psychiatric disorder; Living in a neighborhood with negative social determinants of health; Tendency to shy temperament or social withdrawal; sexual, physical, or substance abuse; Genetics; and bullying. In cisgender patients, girls are 2 times more likely to develop anxiety after puberty compared to boys of the same age. The reason for this difference, according to Dr. Garzon still not understood well.
“This suggests that differences in hormone and brain chemistry may play a role. However, the research on this is not as clear as many of us would like it to be. This is an important question because if we had a better understanding of it, we could possibly tailor treatment to these root causes, ”she said.
The anxiety rate is high among LGBTQIA + adolescents, largely due to the social and environmental pressures they face due to their identity, noted Dr. Garzon. “It’s hard to be a teenager! But the exposures of our LGBTQIA + youth are significantly higher and their suicide rates reflect this, ”she said.
Signs and symptoms of generalized anxiety in children and adolescents can include irritability, difficulty sleeping, difficulty concentrating, somatization, needing to relax, and self-consciousness. Common worries for children are school, athletics, and the fear that bad things will happen.
The most common subtype of anxiety in pediatrics is separation anxiety, defined as an abnormal response to an impending, imagined, or actual separation from an important caregiver, home, or familiar environment.
Screening tools for anxiety in children
Dr. Garzon recommended doctors consult multiple sources such as parents, teachers, and the child about symptoms. In patients aged 9 to 12, a 20-point self-report questionnaire known as the Spielberger State-Trait Anxiety Inventory for Children (STAIC) can be used to screen for anxiety. The Multidimensional Anxiety Scale for Children (MASC), a 39-point self-assessment scale, can be used for 8 to 18-year-old patients.
Cognitive behavioral therapy (CBT) was the main non-pharmacological treatment option for pediatric anxiety that was discussed in the presentation. Dr. Garzon also mentioned the Creating Opportunities for Personal Empowerment (COPE) program, which integrates CBT into a manual program designed to help children and adolescents manage stress, anxiety, and depression.
Both selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are pharmacological options for treating anxiety in children. Dr. Garzon recommended starting with the lowest possible dose of these drugs, and if the patient is stable after 6 to 12 months of use, reassess the dosage and consider slowly weaning off the drugs.
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reference
Garzon D. Pediatric Anxiety Disorder in Primary Care: When is Worry a Problem? Presented at: 2021 American Association of Nurse Practitioners National Conference; June 15 – June 2021.
This article originally appeared on Clinical Advisor
