The practice of pediatrics has profoundly changed throughout my career. I have had the privilege of caring for children from birth through college, forming close relationships with families over the past 25 years. These relationships place pediatricians at the forefront of supporting and treating mental health issues. We now routinely screen for anxiety in children ages 8 and up and for depression in those ages 11 and above. Mental health concerns including anxiety, depression, and OCD exist across gender, socioeconomic, and age as younger kids are manifesting symptoms along with our teens. A 2023 study of US high school students found that 40% reported feeling persistent anxiety or sadness, 20% reported seriously considering suicide and 9% had attempted suicide in the previous year.

Experts agree that the current mental health crisis has multiple contributing factors. Technology has changed the way we all interact with the internet and each other. Both adults and teens admit that it is often distracting, time consuming, and addictive. In addition to games and apps, social media platforms have evolved offering "connection." Unfortunately with filters, followers, and like/comments users often feel more lonely, as comparison and polarity are isolating. In a study of screen use in children and teens, researchers found that 8-10 year olds spent an average of 6 hours on screens; 11-14 year olds 9 hours and 15-18 year olds 7 1/2 hours daily. These numbers excluded school use. Screen time limits other activities and sleep and has significant impacts on interpersonal relationships. The COVID pandemic worsened these trends and many of our prior social interactions remain fragmented.

Moreover, an achievement pressure has emerged within our culture in the past several years and kids are absorbing and contorting this message to mean that their achievements alone determine their worth. One study found that students in high achieving schools were 2-6x more likely to suffer from anxiety, depression, and substance abuse. Teens fear disappointing others and failing to be "good enough." More than 50% of teens believe that achievement would increase their parents' love for them. As both a parent and pediatrician, it is heartbreaking to see the tears of relief when I reassure them that their parents love does not have to be earned and cannot be lost. As parents we feel like our children already know this. It is a statement of how powerful this achievement messaging is that teens are often unsure. These pressures of school and society are magnified by social media.

It is critical that we talk openly about mental health as all too often children and teens with anxiety or depression feel like they are alone which only magnifies their loneliness or exhausts them as they try to maintain appearances. We need to support alternatives to technology that foster connection through the arts, music, nature, sports or just simply time spent together. We as parents must be the loud voices at home teaching inherent worth and creating a feeling of belonging. Mental health has long been underfunded and resources for treatment and counseling are often scarce. We must push for resources within our schools and communities. I hope that in my final decade of practice we transition to a time of connection where our youth can thrive.