Study notes small decline in preschool developmental milestones during pandemic

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Today in JAMA Pediatrics, researchers from the Johns Hopkins Children's Center published a study demonstrating small declines in developmental milestones in children 5 years old and younger during the pandemic in the United States. 

The authors of the study said the findings were reassuring for the short term but may mean behavioral and development pediatric care will be strained in the coming years. 

"We found, overall, that while there are some changes, the sky is not falling, and that is a really important and reassuring finding," said Sarah Johnson, MD, PhD, the corresponding author of the study, in a press release from Johns Hopkins Medicine.

Researchers used results from the Comprehensive Health and Decision Information System (CHADIS) and the Ages and Stages Questionnaire-3 (ASQ-3), which assesses communication, gross motor, fine motor, problem-solving, and personal-social skills. ASQ-3 scores from a total of 50,205 children were included in the final study.

To capture the effects of the pandemic, researchers compared ASQ-3 results from 2018, 2020, and what they called an intrapandemic phase from 2020 through 2022. Caregivers completed developmental screening at US pediatric primary care practices participating in CHADIS.

No changes in motor skills 

Pre- and post-pandemic, there were no significant changes in fine or gross motor skill domains. But the remaining three categories, communication, problem-solving, and personal-social skills, all saw a dip of single percentage points after 2020, suggesting that the pandemic's interruptions to childcare, work, and school left a mark on young children.

In total, mean score decreases were observed  from 2018 to 2020-2022 in communication (−0.029; 95% confidence interval [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) areas. 

Even in young infants aged 0 to 12 months, 2% to 3% declines in these three areas were observed, but caregiver concerns about children's behavior didn't rise in 2022 compared to 2018. Caregivers did, however, report worrying more about a child's well-being during the pandemic years (rate ratio, 1.088; 95% CI, 1.036 to 1.143).

The authors of the study said these findings have important implications for the country's pediatricians and nurse practitioners. "While changes in developmental screening scores were modest (2%-3%), nationwide, this could translate to more than 1500 additional recommended developmental referrals over baseline each month," they wrote. 

It is important for us to continue to keep an eye on kids of all ages in terms of development.

"It is important for us to continue to keep an eye on kids of all ages in terms of development, so we can understand whether these changes have longer-term implications for children or if new challenges emerge as children age," said Johnson.