J Emerg Med. 2025 Sep 22;80:104-111. doi: 10.1016/j.jemermed.2025.09.028. Online ahead of print.
BACKGROUND: The rising influx of young children in emergency departments (ED) for behavioral concerns represents a current crisis requiring immediate intervention. These children face heightened risks of emotional impairments and mood disorders.
OBJECTIVE: This study identifies factors contributing to disruptive behavior and examines baseline characteristics associated with ED visits to highlight the urgent need for targeted action.
METHODS: We conducted a retrospective review of ED records (2015-2021) at an inner-city hospital, focusing on pediatric patients who presented with behavioral symptoms and received psychiatric evaluations. Data included demographics, psychiatric comorbidities, social history, adverse childhood experiences (ACEs), and ED length of stay. Patients were categorized into the no-prior-ED group and the prior-ED group. Reviewed overall characteristics and statistical tests analyzed differences between subgroups.
RESULTS: The records of 184 children (with an average age of 9.4 years, 65% male) revealed that 49% were Hispanic, 39% were Black, and 12% were from other racial backgrounds. Behavioral issues included aggression (51%), suicidal ideation (34%), and acting out (22%). Children were brought in to ED, mainly, from home (59%) and school (33%). Notably, 52% had no prior psychiatric diagnosis, with attention-deficit/hyperactivity disorder (40%) as the most common diagnosis. ACEs were identified in 42% of cases. Compared to the no-prior-ED group, children in the prior-ED group showed higher ACEs scores, longer ED stays, and increased rates of disabilities and suicidal thoughts (p < 0.05).
CONCLUSION: This study underscores the cyclical nature of ED visits among children with mental and behavioral health and high ACEs. These findings highlight the need for further investigation into early identification strategies and coordinated care to interrupt this cycle.
PubMed:41274022 | DOI:10.1016/j.jemermed.2025.09.028