We don't have to tell you that virtually everyone feels anxious about the spread of COVID-19. An appropriate level of anxiety can be helpful if it inspires people to follow CDC recommendations on hygiene and social distancing. An unnecessary level of anxiety, however, can impair both mental and physical health. Many of your patients and families are suffering from unhealthy anxiety--whether they present with possible COVID-19 symptoms or come in for an unrelated complaint.

According to the National Center for Education Statistics, 92% of public schools had formal active shooter plans in 2016, and 96% conducted lockdown drills. These measures are intended to keep children safe, but they may do as much harm as good. The title of a September 4 New York Times article sums it up: "When Active Shooter Drills Scare the Children They Hope to Protect." We asked REACH faculty member Jasmine Reese, MD, MPH, about how students react to active shooter drills and what pediatric primary care providers (PCPs) can do. Dr. Reese is Director of the Adolescent and Young Adult Specialty Clinic at Johns Hopkins All Children's Hospital in St. Petersburg, Florida. "We have yet to see data on whether these drills are causing more anxiety and other mental health issues among students," said Dr. Reese. "But it seems clear in practice that they can either cause anxiety and depression or exacerbate existing issues."

"Pediatric primary care providers can have a big impact on child mental health simply because we see children early and often," said Dana Kornfeld, MD, REACH board member and associate clinical professor of pediatrics at George Washington School of Medicine. Dr. Kornfeld, who practices at Pediatric Care Center in Bethesda, MD, endorses the use of cognitive behavioral therapy (CBT) techniques in primary care to nip potentially crippling anxiety in the bud.