Supporting mental health in pediatric primary care with Victor Carrion, MD

Victor Carrion, MD, director of the Stanford Early Life Stress Research Program and professor of child and adolescent psychiatry at Stanford University, emphasized that pediatric providers are central to recognizing and responding to early mental health concerns in children and adolescents.

“Fifty percent of individuals that develop mental illness would have developed these signs and symptoms by age 14,” Carrion explained. “Seventy-five percent of them would develop signs and symptoms by age 24. Access continues to be the main mental health problem in our discipline. It is difficult to find therapists, and sometimes the wait can be prolonged.”

In the meantime, pediatricians can play a proactive role by monitoring severity and safety while patients wait for specialized care. Carrion suggests anchoring evaluations in day-to-day function, rather than focusing solely on diagnosis.

“How is the individual doing at school or at work? How is the individual doing in their personal relationships, with family, with friends, with others? And are these symptoms causing any distress?” If a child is maintaining their function and relationships without distress, it may not indicate a mental health disorder, noted Carrion.

For those who are struggling, Carrion recommends that clinicians assess whether symptoms are worsening and be prepared to escalate care if safety becomes a concern. “If it seems that the condition is getting to a degree where the individual may injure themselves or others, it is very important to refer to emergency services.”

In the absence of immediate access to therapy, pediatricians can also direct families to existing support tools. Carrion points to free online resources hosted by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry’s “Facts for Families Guide” page.¹ His own program at Stanford also offers a variety of self-guided materials²: “We have a number of exercises in our pages that are based on mindfulness and breathing that really help the individual cope.”

Symptom presentation varies widely by age group, Carrion noted. Preschoolers may show regressive behaviors like thumb-sucking or bedwetting while school-aged children often present with somatic complaints such as headaches or stomachaches, and adolescents may withdraw socially. Regardless of presentation, it is vital for caregivers to reinforce open communication.

“They may not want to talk at that moment,” Carrion said, “but at least they know that if they want to talk, they can actually go and talk to someone.”

Editor's note: Victor Carrion, MD, has disclosures with Oxford Press, APA Press, and Ellipsis Health.

References:

1. Facts for families guide. American Academy of Child & Adolescent Psychiatry. Accessed May 21, 2025. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Layout/FFF_Guide-01.aspx

2. Early Life Stress and Resilience Program. Stanford Medicine. Accessed May 21, 2025. https://med.stanford.edu/elspap/Resources.html