Pandemic led to some developmental milestone delays in infants and toddlers

While infants and toddlers five years of age or younger experienced some delays to developmental milestones due to COVID-19 pandemic disruptions and restrictions, these delays are typically modest, a study led by Johns Hopkins Children’s Center has found.

To reach their conclusions  investigators evaluated possible links between pandemic-related disruptions to everyday life and changes in developmental milestone screening scores, using data from the Comprehensive Health and Decision Information System (CHADIS), a web-based screening platform caregivers use to complete surveys about their children’s development. 

Using the Ages and Stages Questionnaire-3 (ASQ-3), a caregiver-completed measure of child development routinely collected as part of pediatric care, researchers say they found only small decreases in communication, problem-solving, and personal-social skills, and no changes in fine or gross motor skills among children in the study.

“We found, overall, that while there are some changes, the sky is not falling, and that is a really important and reassuring finding,” corresponding author Professor Sara Johnson said. 

Numerous studies, the researchers say, found the COVID-19 pandemic and related lockdown restrictions disrupted the lives of many people, including families with young children. Everyday life and daily routines were upended, as schools and early childhood settings closed, many people began working from home and social contacts diminished. Many experienced increased stress, anxiety and social isolation due to these changes and activity cancellations.

Research has also shown the pandemic is linked to lower child health-related quality of life, increased mental health concerns, decreased sleep and increased risk of obesity. However, the impact of the pandemic on developmental milestones among young children in the U.S. remained unclear, in part because studies designed to address them were done outside the United States, or in small samples. 

For the new study, Children’s Center researchers looked at the developmental milestone status of 50,205 children, ages birth to five years of age, drawn from a sample of more than half a million children whose parents or caregivers completed the ASQ-3. 

The ASQ-3 assesses children’s developmental milestones in five skill domains: communication, gross motor, fine motor, problem-solving and personal-social.

Researchers compared the children before and during the pandemic from 2018 to 2022 and found ASQ-3 score decreases in the communication (about 3 per cent), problem-solving (about 2 per cent) and personal-social (about 2 per cent) skill domains. They found no changes in fine or gross motor skill domains. When looking specifically at infants 0–12 months old, similarly modest effects were observed, and there were only decreases in the communication domain (about 3 per cent) and problem-solving domain (about 2 per cent).

“We thought it was possible infants might experience less impact than the older children, given that many caregivers may have spent more time at home with their very young children,” Professor Johnson. “But we generally saw the same things in infants as we did for older children.”

Also, given an increase in parent and caregiver worry and stress, researchers investigated whether parents and caregivers reported more worries about their child during the pandemic, regardless of milestone achievement, and found worries about their child only increased slightly during the pandemic, compared to before the pandemic.

While the researchers say the findings are reassuring, they add that the implications for children’s long-term development remain unclear.

“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,” Professor Johnson said.

Researchers hope their findings will aid in planning for future public health crises, and also demonstrate the importance of shoring up the clinical infrastructure of overburdened health systems in the U.S., particularly developmental behavioural pediatricians, who are specially trained to evaluate and treat developmental concerns. These resources will be essential to respond to the developmental needs of children now and in the future.

Access the findings in full here.