Impact of Public Health Crises on Pediatric Emergency Care

Emerging public health crises, such as viral illnesses, pandemics, and natural or man-made disasters, are increasing the demands faced by our already strained emergency care systems. While emergency department (ED) visits have declined by more than 40% for general EDs and 65% for pediatric EDs since the onset of the COVID pandemic in the United States (US), a greater proportion of patients are presenting with high acuity illnesses. It has been suggested that this decline in patient visits for serious conditions could result in complications or death. As these situations continue to unfold, children are placed at increased risk due to: 1) decreased access to emergency and other healthcare providers as capacity and capability of communities are overwhelmed, 2) enhanced focus on the critically ill diverting resources away from non-critically ill children, and 3) redirection of resources away from efforts to optimize and build resiliency in systems for the provision of high-quality care for children.

  • Children less than 14 years of age account for the greatest decrease in ED visits since March 2020 (over 70% decrease in visits)
  • Social distancing, school closures, and socioeconomic setbacks are associated with increased mental health issues, suicide, substance abuse, and child maltreatment
  • Children requiring regular health services and medications may suffer gaps in care and treatments due to clinic closures or decreased availability

Target Populations

Children or Youth with Special Health Care Needs (CYSHCN)

Those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.

  • CYSHCN account for >15% of all US children
    • Over 20% of CYSHCN rely on EDs for services
    • 3 million CYSHCN have complex medical conditions
  • Families often face higher medical costs, inadequate health insurance coverage, and increased stress on families
  • Viral illnesses may pose a greater risk to CYSHCN due to underlying comorbidities
  • Public health crises may cause the postponement of treatments due to exposure risk, clinic closures, or access, which can result in clinical deterioration

Children with Behavioral Health Emergencies

Children and youth with mental health, substance abuse, or other behavioral health issues requiring emergency care or other appropriate interventions.

  • Pediatric ED visits remained stable, yet visits for all mental health disorders increased by 60% from 2007 to 2016
  • ED visits increased for:
    • Intentional self-harm - 329%
    • Substance use disorders - 159%
  • Visits to low-volume, rural EDs increased by 12%
    • Suicide rates 2X higher in rural communities compared to urban communities
  • Variability in pediatric readiness of EDs

Telehealth's Impact

Telehealth, one form of electronic health (e-health) strategies, offers an alternative approach to meeting the needs of these children. The use of this virtual technology offers the same standard of care that would otherwise be provided for a given condition during an in-person visit yet offers this care remotely. Various types of telehealth exist (teleconsultation, tele-education, telepsychiatry, telemonitoring). Each has utility in addressing healthcare needs.


  • Bring expertise to low-resourced areas
  • Avoid transfers
  • Off-loading of patient care to less-overwhelmed EDs
  • Immediate access without risking exposure, patient travel


  • Licensing, credentialing and liability
  • Competency criteria for telehealth practitioners
  • Billing/reimbursement uncertainties
  • Technical/connection issues in patient home
  • Integration of visits into EHR
  • Perceived cost of implementation
  • Lack of knowledge about availability

Recent Developments

  • CONNECT Act: regulatory, privacy and reimbursement changes
  • Telehealth licensure compacts
  • Available funding