Five-Year Trends in US Children’s Health and Well-being, 2016-2020

Abstract

This survey study examines data from the US National Survey of Children’s Health to identify trends in children’s health from 2016 to 2020, including significant changes that might be attributed to the COVID-19 pandemic.

Key Points

Question

What are the recent trends in children’s health, including significant changes that might be attributed to the COVID-19 pandemic?

Findings

Between 2016 and 2020, there were significant increases in children’s diagnosed anxiety and depression, decreases in physical activity, and decreases in caregiver mental and emotional well-being and coping with parenting demands. After the onset of the pandemic specifically, there were significant year-over-year increases in children’s diagnosed behavioral or conduct problems, decreases in preventive medical care visits, increases in unmet health care needs, and increases in the proportion of young children whose parents quit, declined, or changed jobs because of child care problems.

Meaning

Study findings point to several areas of concern that can inform future research, clinical care, policy decision making, and programmatic investments to improve the health and well-being of children and their families.

Abstract

Importance

Ensuring the well-being of the 73 million children in the United States is critical for improving the nation’s health and influencing children’s long-term outcomes as they grow into adults.

Objective

To examine recent trends in children’s health-related measures, including significant changes between 2019 and 2020 that might be attributed to the COVID-19 pandemic.

Design, Setting, and Participants

Annual data were examined from the National Survey of Children’s Health (2016-2020), a population-based, nationally representative survey of randomly selected children. Participants were children from birth to age 17 years living in noninstitution settings in all 50 states and the District of Columbia whose parent or caregiver responded to an address-based survey by mail or web. Weighted prevalence estimates account for probability of selection and nonresponse. Adjusted logistic regression models tested for significant trends over time.

Main Outcomes and Measures

Diverse measures pertaining to children’s current health conditions, positive health behaviors, health care access and utilization, and family well-being and stressors.

Results

A total of 174 551 children were included (annual range = 21 599 to 50 212). Between 2016 and 2020, there were increases in anxiety (7.1% [95% CI, 6.6-7.6] to 9.2% [95% CI, 8.6-9.8]; +29%; trend P < .001) and depression (3.1% [95% CI, 2.9-3.5] to 4.0% [95% CI, 3.6-4.5]; +27%; trend P < .001). There were also decreases in daily physical activity (24.2% [95% CI, 23.1-25.3] to 19.8% [95% CI, 18.9-20.8]; −18%; trend P < .001), parent or caregiver mental health (69.8% [95% CI, 68.9-70.8] to 66.3% [95% CI, 65.3-67.3]; −5%; trend P < .001), and coping with parenting demands (67.2% [95% CI, 66.3-68.1] to 59.9% [95% CI, 58.8-60.9]; −11%; trend P < .001). In addition, from 2019 to 2020, there were increases in behavior or conduct problems (6.7% [95% CI, 6.1-7.4] to 8.1% [95% CI, 7.5-8.8]; +21%; P = .001) and child care disruptions affecting parental employment (9.4% [95% CI, 8.0-10.9] to 12.6% [95% CI, 11.2-14.1]; +34%; trend P = .001) as well as decreases in preventive medical visits (81.0% [95% CI, 79.7-82.3] to 74.1% [95% CI, 72.9-75.3]; −9%; trend P < .001).

Conclusions and Relevance

Recent trends point to several areas of concern that can inform future research, clinical care, policy decision making, and programmatic investments to improve the health and well-being of children and their families. More analyses are needed to elucidate varying patterns within subpopulations of interest.