Longitudinal effects of the COVID-19 pandemic on infant and toddler development: a retrospective cohort study

Objective To determine if developmental outcomes differed at 24 months between US children born before and during the pandemic. Design This retrospective cohort study included children completing a 24-month well visit between 1 March 2019 and 31 December 2022. Setting : a university-affiliated primary care clinic Patients Children were born at term and divided into three cohorts: prepandemic (born on or after 14 January 2017 and before 1 March 2018), transitional (born on or after 1 March 2018 and before 1 March 2020), and pandemic (born on or after 1 March 2020 and before 1 January 2021). Main outcomes/measures Main outcomes included 24-month Ages & Stages Questionnaire (ASQ-3) domain scores, total score and percentage of children classified as atypical (≥1 SD below the domain mean). Multivariable regression adjusted for child age, sex and insurance. For the transitional cohort, regression models assessed relationships between ASQ-3 measures and duration of pandemic exposure. Results Of 604 children, most were Hispanic/Latino (37%) or Black (26%) and on government-sponsored insurance (77%). Compared with prepandemic, pandemic children scored lower for total ASQ-3 (250 vs 262, p=0.03), communication (45 vs 49, p=0.02) and personal-social (49 vs 52, p=0.03) and had higher odds of atypical scores for fine motor (2.2, 95% CI 1.2 to 4.2; p=0.01), with males more likely to have atypical scores for communication (2.2, 95% CI 1.2 to 4.0; p=0.03) and fine motor (2.3, 95% CI 1.0 to 5.0; p=0.04). For the transitional cohort, pandemic exposure was negatively associated with total ASQ-3 (p=0.048), communication (p=0.02) and personal-social (p=0.03). Conclusions Findings suggest a negative association of the COVID-19 pandemic with early child development, especially for emerging language and socioemotional skills, with males likely affected more than females.