How kids’ mental health suffered as we managed COVID: Mid-pandemic hospital data paints striking picture

Infants and young children were hit hard by COVID-19 and other respiratory illnesses in the second year of the pandemic compared to the previous year, leading to a spike in hospitalizations, while older kids and teens required hospital care for mental health conditions, new Canada-wide hospital data shows.

Figures collected by the Canadian Institute for Health Information (CIHI) showing the most common reasons for hospitalizations offers a broad look at the effect the pandemic's second year had on Canadian children, experts say.

The data reveals the number of kids aged 4 and under requiring hospital care for COVID increased by 600 per cent in the second pandemic year. Between April 1, 2021 and March 31, 2022, some 2,315 kids aged four and under with COVID needed hospital care, compared to just 325 children the previous year.

In all age groups, COVID accounted for the second-most hospital admissions nationwide behind only childbirth.

The report, released Thursday, also shows mental health disorders, including anxiety and mood disorders, were among four of the top ten reasons kids and teenagers aged 5 to 18 required hospital care during this time period.

It's not a surprise to see in the pandemic's second year that there was a large increase in hospitalizations across all age groups for COVID," said Dr. Amol Verma, a clinician-scientist at St. Michael's Hospital, a part of Unity Health Toronto. He noted the CIHI data reflects a time period that included the Delta variant, which caused more severe disease, the arrival of the highly infectious Omicron variant, which led to a greater number of overall infections, and the easing of public health measures.

The mental health-related hospitalizations in older children highlight some of the trade offs that were made in managing the pandemic," Verma said. We now know that some of the public health interventions ... likely did exacerbate some mental health issues."

Dr. Stephen Freedman, professor of pediatrics and emergency medicine at the University of Calgary, said the surge in COVID hospitalizations in infants and young children in 2021-22 speaks to the fact that there was lots of COVID circulating, a lot of COVID circulating in children and a lot of children under four years of age being infected by COVID."

He said children in the zero-to-four year old age group had neither natural immunity to COVID nor vaccine-induced immunity during this time period putting them at high risk for being infected by COVID-19 should they be exposed."

Children between the ages of six months and five years were not eligible to receive the vaccine in Canada until the summer of 2022.

The CIHI data shows the top reason for hospitalizations in children four years old and under was neonatal jaundice, followed by other acute lower respiratory infections, such as bronchiolitis, then disorders related to short gestation times and low birth weight. Asthma and pneumonia round out fourth and fifth place, respectively, followed by COVID.

For older children and youth, mental health conditions were among the top reasons for hospitalization during the time period, a signal that experts say shows what could be the unintended effects of necessary public health measures and an overall lack of access to proper mental health supports, a problem that existed even before the pandemic.

The data show that other mental health disorders" - a category that includes a range of disorders, such as obsessive compulsive disorders, impulse control and conduct disorders and eating disorders - was the top reason for children and teens ages 5 to 18 needing hospital care. Mood and anxiety disorders ranked third and fourth and symptoms and signs involving emotional state" was the tenth most-common diagnosis leading to hospitalization for this age group.

First presentations of mental health problems often show up in adolescence, so these statistics aren't surprising, but they're deeply concerning," said Dr. David Gratzer, attending psychiatrist and medical doctor at the Centre for Addiction and Mental Health (CAMH) in Toronto, noting that even before the pandemic there were already problems with access to mental health services, particularly for younger people. With the pandemic, it's probably worsened."

Gratzer noted that we tend to think about the response to COVID in terms of implications for physical health.

For some, particularly elderly individuals, especially earlier in COVID, the disease experience was potentially life threatening. But one can't forget the mental health implications. My suspicion is that we'll need a mental health response long after the last patient is discharged from hospital and ICU for physical problems related to COVID-19."

Dr. Joe Wiley, pediatric hospitalist and chief of pediatrics at Oak Valley Health, which includes hospitals in Markham and Uxbridge, said they have been seeing children and adolescents presenting with symptoms related to anxiety and depression throughout the pandemic. He said, at least anecdotally, the return to in-person school seemed to contribute to the rise in such symptoms.

That seemed to be a difficult transition for many of the patients we're seeing in the clinic. Symptoms that started while they were at home, are coming to the surface during in-person learning," he said.

During the previous year, other mental health disorders" was also the top reason for hospitalization for children ages 5 to 18, said Nicole Loreti, program lead for clinical administrative databases operations at CIHI.

Data from 2019-20 showed mood disorders ranked third for hospitalizations - the same as in 2021-22 - however anxiety disorders ranked seventh, compared to fourth, and symptoms and signs involving emotional state" was not included in the top 10 reasons for needing hospital care.

Notably, the new report shows COVID did not crack the top-10 reasons for hospitalization in Canada's eastern provinces, which implemented strict travel restrictions early in the pandemic, known as the Atlantic bubble." The bubble took on various forms and had different levels of public health measures into mid-late 2021.

Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie or reach her via email: mogilvie@thestar.ca

Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: kwallace@thestar.ca