A pair of analyses on the effects of COVID-related public health measures on children ties lockdowns and physical distancing to developmental delays among toddlers in Scotland and school reopenings to improved mental health in California students.

Need for more support for kids

A University of Edinburgh–led study links COVID-19 pandemic lockdowns and physical distancing measures with developmental delays in areas such as speech and language, physical movement, and emotional growth among toddlers.

The researchers analyzed data from routine well-child visits at ages 13 to 15 months and 27 to 30 months among 257,532 toddlers in Scotland from January 2019 to August 2023. The team assessed changes in the weekly proportion of parent-identified developmental concerns from the start to the end of public health measures (March 2020 to August 2021). 

Early child developmental outcomes can be influenced greatly by factors such as their caregiver’s capacity to provide responsive caregiving, their opportunities for early learning and playing activities, and parental mental health.

The studied outcomes were any developmental concerns, as well as domain-specific concerns about speech, language, or communication; problem solving; gross motor; personal-social; emotional-behavioral; and fine motor development amid public health/social distancing measures (PHSM).

“Early child developmental outcomes can be influenced greatly by factors such as their caregiver’s capacity to provide responsive caregiving, their opportunities for early learning and playing activities, and parental mental health,” the authors wrote.

The findings were published in The Lancet Regional Health Europe.

PHSM that began in March 2020 were tied to a weekly slope change increase in the proportion of children with any developmental concern (+0.091 percentage points at 13 to 15 months, 4.7 percentage points per year, or 6.6 percentage points across the study period). The increase at 27 to 30 months was +0.076 percentage points, 4.0 percentage points per year, or 5.5 percentage points across the study period.

The increase was higher for children who experienced physical distancing measures for a longer period (up to a 6.6% increase).

In a University of Edinburgh news release, lead author Iain Hardie, PhD, said, “COVID-19 public health and social measures played a vital role in curbing the spread of infections during the pandemic. However, the findings of our study suggest that they also appear to have been associated with increased early childhood development concerns.”

The end of PHSM in August 2021 was associated with a weekly slope change decrease in the proportion of children with any developmental concern at 27 to 30 months (−0.067 percentage points per week) but not at 13 to 15 months (−0.010 percentage points per week). Results were broadly consistent in all developmental areas.

The authors noted that concerns at 13 to 15 months continued to climb even after PHSM were lifted, but concerns at 27 to 30 months stopped rising but remained above pre-pandemic levels.

“Our findings highlight the need to target additional support towards children impacted by COVID-19 PHSM, and to continue to monitor their developmental outcomes over time as they get older and more data becomes available,” they wrote. “In addition, future pandemic planning should consider possible impacts of PHSM on child development.”

Odds of new diagnosis fell 43% after reopening

California children whose schools reopened during the COVID-19 pandemic had significantly fewer mental health diagnoses than those whose schools remained closed, with girls deriving the most benefit, according to a new study in Epidemiology.

Led by researchers from health insurer Elevance Health, the study used data from schools and from 185,735 insurance claims to estimate the effects of staggered implementation of school reopenings on diagnoses of depression, anxiety, and attention-deficit hyperactivity disorder (ADHD) and related health care spending from March 2020 to June 2021.

School closures during the COVID-19 pandemic disrupted children’s education, socialization, and access to mental health resources, raising concerns about long-term effects on children’s mental health.

In California, schools remained closed longer than almost any other state and reopened on a staggered schedule.

“School closures during the COVID-19 pandemic disrupted children’s education, socialization, and access to mental health resources, raising concerns about long-term effects on children’s mental health,” the authors wrote.

Rates of new mental illness rose from 2.8% to 3.5% over the study period, but those whose schools reopened had fewer diagnoses than those whose schools stayed closed. By the ninth month after reopening, the probability of a mental diagnosis had fallen 43%, non-drug medical spending had dropped 11%, spending on psychiatric drugs had declined 8%, and spending on ADHD drugs had decreased 5%. Girls benefited more from school reopenings than boys.

The large impact of school closures on children’s mental health may stem from changes in social interaction, disrupted sleep, more screen time, less-balanced diets, learning difficulties, economic hardship or increased family time at home, and less access to mental health services normally provided through school.

Senior author Rita Hamad, MD, PhD, MPH, of the Harvard T.H. Chan School of Public Health, said in a Harvard press release, “Our results provide solid evidence to parents, educators, and policymakers that in-person school plays a crucial role in kids’ wellbeing. The findings offer lessons for future public health emergencies and provide insight into why mental health worsened for children during the pandemic.”