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Young children who lived through the COVID-19 pandemic demonstrated modest changes in developmental screening scores, according to a cohort study of more than 50,000 U.S. children.

Among kids age 5 and under, there were significant mean score decreases from the pre-pandemic to intra-pandemic periods in communication (−0.029, 95% CI −0.041 to −0.017), problem-solving (−0.018, 95% CI −0.030 to −0.006), and personal-social (−0.016, 95% CI −0.028 to −0.004) domains as measured by the Ages and Stages Questionnaire (ASQ), according to Sara Johnson, PhD, MPH, of Johns Hopkins School of Medicine in Baltimore, and colleagues.

At the same time, there were no changes in fine or gross motor scores between the pre-pandemic and intra-pandemic periods, they reported in .

"Communication scores decreased approximately 3% and personal-social and problem-solving scores decreased approximately 2%," the researchers wrote. "Applied at the population level, a change of this magnitude would translate to 1,541 more recommended referrals per month across the U.S. over baseline."

Johnson said in an email to MedPage Today that there has been "a lot of uncertainty about what being isolated from friends and extended family, closures of schools and childcare, job loss, and other family stresses might mean for children's development. Until now, though, there hasn't been a large study of children across the U.S. to help answer this question."

As to potential mechanisms, she noted that the affected domains were "areas of development that children practice through interacting with others -- so these outcomes might be influenced by caregiver stress during lockdowns, childcare closures, and social distancing. On the other hand, we didn't see any differences in gross or fine motor development, which don't rely so much on interactions."

Overall, the study used an interrupted time series analysis comparing time periods classified as pre-pandemic (March 1, 2018 to Feb. 29, 2020), interruption (March 1, 2020 to May 31, 2020), and intra-pandemic (June 1, 2020 to May 30, 2022).

Ultimately, 50,205 children were included from a randomly sampled population of 502,052 children ages 0 to 5 years whose parents or caregivers completed developmental screening during pediatric visits at primary care practices participating in a web-based clinical process support system. Most respondents were mothers. However, the proportion of non-parent respondents increased over time from 9.1% during the pre-pandemic period to 20% during the intra-pandemic period.

The children had a mean age of 18.6 months, and the mean age for infants was 5.1 months.

Among infants specifically, there were similar effect sizes for communication (−0.027, 95% CI −0.044 to −0.011) and problem-solving (−0.018, 95% CI −0.035 to −0.001). However, there were no significant changes in personal-social, fine motor, or gross motor scores from the pre-pandemic to intra-pandemic periods.

Additionally, during the study period, 51% of caregivers completed two questions on worries and concerns about their children. "Overall, we saw limited evidence that caregivers' worries and concerns about their children changed over the study period," Johnson and colleagues wrote.

Rates of behavioral concerns were less prevalent (range 5.1% to 6.2%) than worries about the child (range 15.3% to 17.4%). After controlling for ASQ scores and changes, there was a small increase in caregiver worries in the intra-pandemic period compared with the pre-pandemic period (rate ratio 1.088, 95% CI 1.036-1.143).

Limitations of the study included that some covariates like prenatal substance use, prenatal or postnatal SARS-CoV-2 infection, and comorbidities were unavailable, Johnson and colleagues noted. Additionally, the ASQ was caregiver reported, and infants born preterm were excluded from the study.

Furthermore, primary care clinics in communities hard hit by COVID-19 might not have offered health supervision for portions of the follow-up period, they added. And there was no contemporaneous pandemic-unexposed comparison group possible.

"It will be important for future studies to continue to follow these large samples of children from across the U.S. to help us understand the long-term implications of our findings," Johnson said. "It's possible that after the pandemic, these changes in development will disappear for most children as families get back to more normal routines and experiences. It's also possible that new challenges will emerge as children age, for example when they enter kindergarten, or these deficits will get larger over time if changes in routines that were prompted by the pandemic, like greater reliance on screen time or school absenteeism, persist."

"Future studies should also look at variation in the pandemic's developmental impact among subgroups," Johnson added, "for example in preterm infants (who weren't included in our study) or in families living in poverty, who may have had the fewest resources to rely on during this time."

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