Recommendations for anxiety screening in pediatric primary care

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A new narrative review presented at the 2025 NAPNAP National Conference on Pediatric Health Care underscores the growing need for early anxiety screening in pediatric primary care settings.

Conducted by researchers at the Columbia University School of Nursing, the review examines current anxiety screening practices and provides evidence-based recommendations to help pediatric primary care providers (PCPs) improve early detection and management of anxiety in children and adolescents.^1,2

Background and need for early screening

Mental health concerns among children and adolescents have sharply increased, particularly following the COVID-19 pandemic. A 2021 meta-analysis revealed that the global prevalence of depression and anxiety symptoms in children has risen significantly, highlighting an urgent need for improved mental health screening and management.³ According to the review, approximately 20.5% of children—equivalent to 1 in 5—experience anxiety symptoms. This surge in mental health challenges underscores the critical role of pediatric providers in recognizing and addressing these issues early.

“Pediatric primary care providers are uniquely positioned to assess children and adolescents at every visit to screen for mental health challenges,” the authors noted. PCPs often serve as the first point of contact for mental health concerns, making them essential in identifying early signs of anxiety and initiating appropriate care.

Methods and screening tools

To evaluate current practices and identify the most effective screening approaches, the researchers conducted a comprehensive search of PubMed, Cochrane, CINAHL, and EMBASE. The search focused on articles published within the last five years that were written in English and examined anxiety screening in pediatric primary care settings. The researchers used specific search terms, including "anxiety," "screening," "assessment," "primary care," and "mental health."

The review identified the Generalized Anxiety Disorder 7-item scale (GAD-7) as a validated and effective tool for screening anxiety in pediatric populations. The U.S. Preventive Services Task Force (USPSTF) recommends screening for anxiety starting at age 8, although data on screening younger children remain limited. The findings suggest that introducing anxiety screening at this age allows for earlier identification and treatment, which can improve long-term mental health outcomes.

Recommendations for clinical practice

The review recommends that pediatric providers integrate validated anxiety screening tools like the GAD-7 into routine primary care visits for children aged 8 and older. Early detection of anxiety symptoms can lead to better health outcomes and more timely access to mental health support.

When anxiety is identified, the authors recommend a combination of cognitive behavioral therapy (CBT) and pharmacological treatment as evidence-based interventions. Specifically, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have shown effectiveness in managing anxiety symptoms in adolescents. The American Academy of Child and Adolescent Psychiatry (AACAP) and USPSTF guidelines support these approaches as first-line treatments.

“Once a need for mental health support is identified, it is recommended to utilize a combination of therapy and medication as focused interventions,” the authors stated.

Addressing barriers and improving access

Despite the proven benefits of early screening and intervention, barriers remain in providing consistent mental health care. The review highlights challenges such as geographic disparities in access to primary care and limited training among PCPs in mental health screening and management.

To address these barriers, the authors recommend increasing access to primary care services through school-based health programs and expanding online training opportunities for pediatric providers. Enhanced training can improve PCPs’ confidence and effectiveness in conducting screenings and managing subsequent care.

“Pediatric providers should work towards addressing barriers that may prevent adequate screening for and treatment of mental health needs in pediatric patients,” the authors noted.

Future research directions

The authors emphasize the need for future research to address gaps in current knowledge. Specifically, they recommend expanding studies to include larger and more diverse pediatric populations to improve the generalizability of findings. Additional research into the effectiveness and safety of pharmacological treatments, particularly SNRIs, in younger children is also warranted.

“Future research should include a larger, more diverse sample of children and adolescents being screened for anxiety by pediatric providers,” the review concludes.

Conclusion

The findings from this narrative review underscore the critical role of pediatric primary care providers in identifying and managing anxiety in children and adolescents. Early screening using validated tools like the GAD-7 and evidence-based interventions such as CBT and medication can improve mental health outcomes and increase access to care. Expanding training and improving access to mental health services remain key steps toward addressing the growing mental health crisis among pediatric patients.

References:

1. Miller N, Velazquez J, Klein J. Anxiety Screening Tools and Recommendations for Clinical Practice in Pediatric Primary Care: A Narrative Review. Abstract. Presented at: 2025 NAPNAP National Conference on Pediatric Health Care. Chicago, Illinois.

2. Miller N, Velazquez J, Klein J. Anxiety Screening Tools and Recommendations for Clinical Practice in Pediatric Primary Care: A Narrative Review. Poster. Presented at: 2025 NAPNAP National Conference on Pediatric Health Care. Chicago, Illinois.

3. Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. 2021;175(11):1142-1150. doi:10.1001/jamapediatrics.2021.2482