Pandemic's impact on early childhood development may have been minimal

Investigators are observing modest decreases in age-specific pediatric development in domains including communication, problem-solving, and personal-social domains since the COVID-19 pandemic.

New cohort analysis data suggest the pediatric developmental behavioral infrastructure may have been slightly impacted by the effects—and public health responses to—the COVID-19 pandemic, relative to trends in pediatric development screening scores in the years prior to 2020. The findings provide a slight amount of reassurance that the temporary closure of public infrastructures including schools, as well as a robust reliance on telecommunication, did not significantly harm the development of young children at pivotal stages during COVID-19.

All the same, investigators stressed further assessment—and long-term monitoring—is key for this population.

Led by Sara B. Johnson, PhD, MPH, the investigators from the department of pediatrics at Johns Hopkins School of Medicine sought to determine the trend of young US children development per age-standardized Ages and Stages Questionnaire (ASQ) domain scores across 5 domains prior to and during the pandemic in 2020; they additionally sought to rate parents’ and guardians’ concerns regarding children’s behavior or worries about children per ASQ relative to their scores. The 5 key domains assessed in ASQ were communication; personal-social; problem-solving; gross motor; and fine motor.

“The COVID-19 pandemic disrupted many social systems and routines on which families with young children rely,” the team wrote. “Family stress theory predicts that pandemic-associated social isolation, economic hardship, changes to routines, and psychosocial stress would result in poorer child well-being and worse developmental outcomes.”

Indeed, Johnson and colleagues noted that COVID-19 was associated with worsened pediatric health-related quality of life (QoL) relative to mental, sleep and obesity-related outcomes. Though research has supported poorer development and education progression in school-age children during the pandemic, less analysis has gauged the development of younger children.

The team conducted a cohort, interrupted time series study of US children aged 0 – 5 years old across 3 periods:

• Prepandemic (March 2018 – February 2020)
• Interruption (March 2020 – May 2020)
• Intrapandemic (June 2020 – May 2022)

The population included 50,205 children whose parents or guardians completed a developmental screening during primary pediatric care visits. ASQ is a screening tool designed to assess developmental progress in children aged 1 month to 5 and a half years old.

Mean patient age was 18.6 months old; a majority (51.5%) were male, and 134,342 ASQ observation scores were included. After adjusting for confounding factors, the team observed significant age-specific mean score decreases in 3 domains among children from the prepandemic to intrapandemic stages:

• Communication (-0.029; 95% CI, -0.041 to -0.017)
• Problem-solving (-0.018; 95% CI, -0.030 to -0.060)
• Personal-social (-0.016; 95% CI, -0.028 to -0.004)

Investigators observed no changes in young children’s fine or gross motor domains between these periods. Among infants aged 0 – 12 months old, the team observed significant changes in communication and problem-solving from prepandemic to intrapandemic.

Relative to the age-standardized ASQ results, Johnson and colleagues observed a slight increase in caregiver worries from prepandemic to intrapandemic stages (rate ratio [RR], 1.088; 95% CI, 1.036 – 1.143), but no change in the caregivers’ concerns over children’s behaviors.

The team noted changes to each domain score for pediatric development ranged in the approximate 2% - 3% range; though small in relative rate, it could translate to approximately 1500 more recommended referrals for development-based intervention based on pediatric guidelines nationally per month.

“Continued attention to developmental surveillance is critical since the long-term implications of these modest developmental changes remain unclear,” the team wrote. “It is particularly important to engage families in primary care who were disconnected during the pandemic Research is needed to understand whether children catch up after slower development or whether developmental insults manifest later (eg, at school entry).”

Though a lack of available covariates, as well as risk of selection bias, may have caused limitations in this assessment, investigators concluded their data provide clarity on the potential impact the COVID-19 pandemic may have had on young US children’s development.

“Our findings provide reason for cautious optimism about the development of a generation of children exposed to the pandemic,” they wrote. “Modest declines in ASQ communication, personal-social, and problem-solving scores for children of all ages, and in fewer domains during infancy, offer qualified encouragement that any developmental gaps may be closed with early identification and support.”

References

1. ^{Johnson SB, Kuehn M, Lambert JO, et al. Developmental Milestone Attainment in US Children Before and During the COVID-19 Pandemic. JAMA Pediatr. Published online April 22, 2024. doi:10.1001/jamapediatrics.2024.0683}
2. ^{Muthusamy S, Wagh D, Tan J, Bulsara M, Rao S. Utility of the Ages and Stages Questionnaire to Identify Developmental Delay in Children Aged 12 to 60 Months: A Systematic Review and Meta-analysis [published correction appears in JAMA Pediatr. 2022 Oct 17;:]. JAMA Pediatr. 2022;176(10):980-989. doi:10.1001/jamapediatrics.2022.3079}