A study today in JAMA Network Open involving nearly 3,500 US toddlers suggests that they had fewer parent-reported behavioral problems amid than before the COVID-19 pandemic.
New York University (NYU)–led researchers parsed data from the Environmental Influences on Child Health Outcomes (ECHO) cohort from nine sites from September 2009 to July 2023. Parents completed the 99-item Preschool Child Behavior Checklist, which asks about child anxiety, sadness, and aggression.
A total of 3,438 children with an average age of 2.3 years (range, 18 to 39 months) were categorized into three groups: the prepandemic group, who were born and evaluated for behavioral problems before March 13, 2020 (1,323 children); the pandemic-assessed group, born before that date but assessed after (1,690); and the pandemic-born group, born and evaluated on or after that date (425).
Just over half (51%) of participants were boys, 50.1% were Hispanic, 44.7% were White, and 16.2% were Black. Most mothers (52.3%) held a bachelor's degree or greater, and 51.2% had either no insurance or public insurance.
"The COVID-19 pandemic has profoundly impacted family dynamics and broader environmental spheres, which are crucial for children’s neurodevelopment," the researchers wrote. "Early childhood is a period of heightened brain plasticity and sensitivity to environmental influences, making the early social environment pivotal for children’s health and well-being."
Small but meaningful changes
Both the pandemic-assessed and pandemic-born groups had slightly but significantly lower checklist scores for internalizing problems (eg, anxiety, sadness; 1.5 to 2 points) and externalizing problems (eg, aggression, hyperactivity; 1.7 to 3.2 points) than the prepandemic group. The link was stronger among pandemic-exposed toddlers whose mothers had less than a bachelor's degree.
Although individual-level differences between prepandemic and pandemic-exposed groups may appear small, even modest shifts in group-level scores can signal meaningful changes in behavioral or emotional functioning, with significant public health implications, especially when sustained across large populations.
"Although individual-level differences between prepandemic and pandemic-exposed groups may appear small, even modest shifts in group-level scores can signal meaningful changes in behavioral or emotional functioning, with significant public health implications, especially when sustained across large populations," the study authors wrote.
In an ECHO news release, senior author Lauren Shuffrey, PhD, also of NYU, said, "These findings suggest that some families may have adapted in ways that buffered young children from behavioral challenges during the pandemic, highlighting the importance of identifying and strengthening those protective supports."
Lead author Anahid Akbaryan, of NYU, said the findings suggest that even during pandemic-related disruptions, toddlers may have had "opportunities for resilience."
"Future research should explore within-home factors that may have supported child mental health outcomes during this time, such as consistent caregiving routines, household stability, and positive parental coping strategies to identify potential protective influences during times of instability," she said.
Protective factors for infant development
In a commentary in the same journal, Tim Hurley, PhD, of Children's Health Ireland, and colleagues said that the study adds to mounting evidence that pandemic exposure altered early infant development.
"While the pandemic was associated with worse maternal mental health, it was also associated with an increase in potential protective factors for infant development, such as greater time for parent-child interaction, greater family flexibility with remote working, and increased time for enriching activities with infants," they wrote. "On the whole, infants spent more time in their home with fewer potential social and societal stressors."
