708 - Crying for Help: Impact of the COVID-19 Pandemic On Our Youngest Patients

Although already rising, pediatric mental and behavioral health (MBH) problems have escalated exponentially during the COVID-19 pandemic. Research shows increases in eating disorders and suicide attempts in school-aged youth, but there is little research on the emotional impact on our youngest patients.

Objective: This study examines the impact of the COVID-19 pandemic on the emotional and behavioral health of young children.

Design/Methods:

We conducted a retrospective chart review of children < 6 years seen in primary care during the first year of the pandemic (study period) compared to an equivalent period in a previous year (control period). To achieve 80% power to detect a 10% difference, 200 charts per group were randomly selected for review. We recorded patient and visit details, then reviewers blinded to group reviewed charts for keywords indicating distress in one of five domains: sleep, behavior, mood, feeding, and toileting. Differences in prevalence were analyzed with the chi square; in addition, we used multivariable logistic regression for each domain, adjusting for age, gender, and insurance type, to look for differences within groups.

Results:

Study groups were similar in age, gender, and new vs return, but different in proportion of public insurance (20% study vs 10% control, p=0.003). Sleep difficulties were more prevalent during COVID for all age groups (14% vs 6.5%, p=0.013), even when adjusted for all other covariates (OR=2.56, 95% CI [1.27, 5.15], p=0.009). Within the study period, mood (p=0.019) and feeding (p=0.014) difficulties were more prevalent in infants (0-12 months), whereas toddlers (13-36 months) were more likely to present with behavior concerns (OR=13, 95%CI [2.82, 60.43], p=0.001). Of patients with distress in any domain, more patients in the study period had two or more positive domains (42.5% vs 29%, p=0.078).

Conclusion(s):

Though signs of stress appeared in both groups, more children experienced sleep disturbance during COVID. More children in the study period had multiple domains affected suggesting higher overall stress, however that stress presented differently across age groups. Study limitations include limited geographic distribution, and reliance on provider documentation. Differences in insurance type are consistent with contract changes but could impact results. This is one of the first studies to examine the impact of the COVID-19 pandemic on the emotional health of young children, showing the MBH effects are not limited to school-aged children. This has important implications for care of young children as the pandemic evolves.