Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

Authors: Julie A. Hofheimer, Monica McGrath, Rashelle Musci, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

Why was this study needed?

Emotional and behavioral difficulties during early childhood can predict later problems such as anxiety, depression, attention deficits, and aggression. This study aims to describe children’s behavioral development from 18 to 72 months of age, examining risk factors for continuing behavioral problems that can inform early interventions to improve behavioral and emotional regulation.

What were the study results?

Children born preterm, males, and those exposed to more family hardships had more behavioral difficulties that persisted over time, including anxiety/depression, attention deficits, and aggression. Other factors that increased the risk for behavioral difficulties in children were prenatal substance exposure and higher maternal psychosocial and economic difficulties during pregnancy. Some children who experienced fewer family hardships showed improved behavior over time when receiving early support. The researchers were able to identify early life factors that may increase a child’s risk for experiencing behavioral and emotional difficulties later in childhood.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study suggested that support and services for families to help them cope with newborn health challenges and other family hardships may help improve young children’s behavioral and emotional difficulties. Specifically, preterm births and prenatal substance exposures may be used to identify children who may benefit from early support. Individualized support to meet the specific needs of children may prevent later behavioral problems and improve future outcomes for vulnerable children and their families.

Who was involved?

The study included 3,934 children born between 1990 and 2019 and their mothers from 20 ECHO cohorts across the United States. About 80% of the children were born at term (at or beyond 37 weeks of gestation), and about 20% were born preterm (before 37 weeks of gestation).

What happened during the study?

The researchers collected caregiver self-reports, demographics, and medical and social environment information about the mothers and children before and during pregnancy and from infancy through age 6. Caregivers also completed the Child Behavior Checklist at multiple study visits to describe their child’s behavior at different ages. Researchers compared the trajectory of children’s scores for dysregulation behaviors (anxiety, depression, attention, and aggression) across the first six years of life. Researchers described three patterns of behavioral trajectories observed in these children 1) high and increased dysregulation (2.3%); 2) borderline and stable dysregulation (12.3%); and 3) low and decreasing dysregulation (85.6%).

What happens next?

Future ECHO studies may examine how the behavior of children continues to develop after six years of age. These new studies could focus on identifying additional risk and protective factors for emotional and behavioral well-being and patterns across middle childhood and adolescence.

Where can I learn more?

Access the full journal article, titled “Psychosocial and Neonatal Risk Factors Associated with Behavioral Dysregulation Trajectories Among Young Children from 18 through 72 Months of Age,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published April 26, 2023

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Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

ECHO Study Links COVID-19 Stress, Slightly Earlier Births

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ECHO Study Links COVID-19 Stress, Slightly Earlier Births

Authors: Kim McKee, Sarah Comstock, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

Why was this study needed?

The effects of depression and stress during pregnancy and their relationship to poor birth outcomes, such as preterm birth, are well documented. This study evaluated how maternal stress during the pandemic may have contributed to newborn health outcomes.

What were the study results?

Babies born to ECHO participants who were pregnant during the pandemic had similar birth weights but were born slightly earlier compared to babies born to ECHO participants who were pregnant between 2016-2019, prior to the pandemic. The study also found levels of stress were similar for ECHO participants who were pregnant between March 2020 and May 2021 compared to those who were pregnant between 2016 and 2019. However, more participants who gave birth from March to September 2020 reported being distressed about changes to their prenatal care and delivery compared with those who delivered after September 2020.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

While other studies have noted increased levels of depression and anxiety among pregnant individuals during the COVID-19 pandemic, these trends were not observed in pregnant ECHO participants. These results suggest that many pregnant women in the United States may have already been experiencing stress before the pandemic that didn’t significantly increase following the start of the pandemic.

Who was involved?

This study included a total of 2,983 ECHO participants from 30 U.S. states and territories who delivered a baby between January 1, 2016 and May 31, 2021.

What happened during the study?

In this study, researchers evaluated medical records and maternal reports on birth weight, gestational age at delivery, and birth weight percentiles adjusted for gestational age at delivery among participants. Researchers also used data from pregnant participants across all time periods that measured depression and perceived stress. Participants who were pregnant during the pandemic reported on stress during the pandemic using a questionnaire developed during the pandemic for use with ECHO participants.

What happens next?

The study ended in May 2021 while the pandemic continued to create stressful and confusing conditions for pregnant women and their families. Similar analyses with data from additional pandemic periods could shed light on how the pandemic continues to affect pregnancy and infant health outcomes.

Where can I learn more?

Access the full journal article, titled “Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program,” in The American Journal of Perinatology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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ECHO Study Links COVID-19 Stress, Slightly Earlier Births

Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

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Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

Authors: Alison E. Hipwell, Irene Tung, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

What were the study results?

This study compared ECHO participants who were pregnant during the COVID-19 pandemic with participants who were pregnant before the pandemic. Participants who were pregnant during the pandemic reported more stress and symptoms of depression. Lower levels of physical activity were associated with more distress, and higher levels of emotional support were associated with less distress during pregnancy for both groups. The results also showed that pregnancies during the pandemic were slightly shorter on average but there was no impact on infant birth weight.

What was the study's impact?

This study highlights the importance of providing access to emotional support and mental health care during pregnancy and identifying ways to promote physical activity to help improve maternal health and well-being, regardless of external conditions like the pandemic.

Why was this study needed?

Previous studies on the effects of the COVID-19 pandemic on pregnancy outcomes have been mixed. This is partly because background information about pregnant participants has been missing and partly because the effects of the pandemic are different for different populations across the country. This study involved pregnant participants from across the United States and collected information about their mental health and well-being along with data on their pregnancy outcomes. The study also focused on positive factors that can be used to improve pregnancy health and birth outcomes, such as physical activity and emotional support.

Who was involved?

This study included 501 pregnant participants who gave birth during the COVID-19 pandemic (between March 12, 2020 and May 30, 2021) and 501 pregnant participants who gave birth before the pandemic (prior to March 11, 2020). Participants were 31 years old on average and enrolled in one of 16 ECHO research sites across the United States.

What happened during the study?

Participants answered questions about their experiences with stress and depression, reported on their physical activity, and described the emotional support they received during pregnancy. The researchers also collected information on participants’ birth outcomes from medical records and maternal reports.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

More research is needed to understand how social support and physical activity during pregnancy may protect pregnant women from stress or depression during difficult times. Future research may look for more details about the types of experiences during the COVID-19 pandemic that had the most influence on pregnancy health and well-being.

Where can I learn more?

Access the full journal article, titled “Impact of Sedentary Behavior and Emotional Support on Prenatal Psychological Distress and Birth Outcomes During the COVID-19 Pandemic,” in Psychological Medicine.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published March 8, 2023

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Women Pregnant During COVID-19 Pandemic Experienced More Stress, Depression Symptoms

ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

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ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

Authors: Marie Camerota, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health, and a career development award from the National Institute of Mental Health.

What were the study results?

ECHO researchers used the neurobehavioral scores to classify babies into one of six groups based on different patterns of behavior. While each group exhibited different characteristics, 4 of these groups contained infants with normal patterns of behavior. Only two of the six groups were characterized as poorly regulated. The first of these groups was hyper-aroused, or too excitable. The other group was hypo-aroused, or slow to respond.

Babies with poorly regulated behavior were more likely to be male, have younger mothers, and have mothers who were depressed or used tobacco during pregnancy. Babies born at all different gestational ages were found in each of the six groups.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study describes a possible link between demographic and health characteristics of mothers and babies with patterns of behavior in newborns. Previous studies conducted in single cohorts have described similar patterns of poorly regulated behavior in infants. The current study replicated those findings using a larger and more diverse population. If these patterns of behavior continue to be found in other large studies, this might suggest that these patterns could generalize to babies outside these studies. This information could be used to identify babies at risk for poorly regulated behavior who might benefit from early interventions and prevention services to help promote positive health outcomes for children.

Why was the study needed?

Behavior patterns in newborns can be used as indicators of long-term developmental outcomes. Previous studies have looked at the link between demographic and medical characteristics of mothers and their infant’s behavior shortly after birth, but these studies were conducted with smaller groups of babies who were very similar to one another (e.g., studies with babies who were all born full term). There is a need for studies that include a larger sample representing more diverse pairs of mothers and their babies, including babies who were born all across the gestational age spectrum.

Who was involved?

This study included 1,112 mother-infant pairs from 5 ECHO cohorts across the United States. Infants were born at gestational ages from 22 to 42 weeks.

What happened during the study?

The babies received a neurobehavioral exam shortly after they were born to test their responses to objects and people, their reflexes, and their movement. Either mothers reported information about their own and their babies’ demographic characteristics and health information or it was collected from their medical records. ECHO researchers looked at how the mothers’ demographic characteristics and health during pregnancy were related to their newborns’ behavior patterns.

What happens next?

More research is needed to determine which of the characteristics studied are stronger predictors of babies’ neurobehavior patterns, and whether the impact of these factors changes in babies born at different gestational ages. Further research is also needed to learn more about how babies’ neurobehavior shortly after birth is related to their health and development later in childhood.

Where can I learn more?

Access the full journal article, titled “Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program," in Pediatric Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 25, 2023

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ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

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Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

Authors: Monique Hedderson, Assiamira Ferrara, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

What were the study results?

Total screen time among children ages 4 to 12 increased during the early stages of the COVID-19 pandemic as lockdowns and school closures were widespread. Screen time remained higher in the later pandemic, even after several restrictions had been lifted. The study found that children used screens an average of 1.75 hours/day more during the early pandemic (December 2020 – April 2021) compared to before the pandemic (July 2019 – March 2020). During the later pandemic (May 2021 – August 2021), screen time remained on average 1.11 hours/day higher than the pre-pandemic average. Both recreational and educational screen time increased during the COVID-19 pandemic.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The study shows that increases in screen time among children persisted more than one year into the pandemic, after many COVID restrictions had been lifted. These findings can help inform clinical guidelines that could aid parents and their children in re-establishing healthy media use habits. Pediatricians can help parents reset family media use priorities and limits that may have changed during the early stages of the COVID-19 pandemic using tools like the American Academy of Pediatrics Family Media Plan.

Why was this study needed?

Excessive screen time among children may be associated with obesity-promoting health behaviors and adverse mental health. The COVID-19 pandemic initially led to widespread school closures, shelter-in-place laws, closures of recreational facilities and cancellation of youth sports, increases in number of parents working from home, and social distancing recommendations, all of which may have impacted screen time among children. Prior studies have reported screen time levels during the pandemic but were unable to document changes in screen time because most lacked pre-pandemic assessments. This study is among a handful of ECHO studies to include pre-pandemic assessments of screen use in order to document changes during the pandemic.

Who was involved?

The study included 228 parent-child pairs from three ECHO cohorts across the United States (Colorado, California, and South Dakota). Parents reported their children’s screen time. The geographically, racially, and ethnically diverse participants ranged in age from 4 to 12 at the start of the study.

What happened during the study?

ECHO researchers surveyed parents about their children’s media use before, during the early, and later periods of the pandemic. The study assessed total, educational (not including remote school), and recreational screen time and examined trends in screen use before and at two points during the pandemic.

What happens next?

Additional studies are needed to determine whether the increases in screen time among children during the pandemic impacted longer term obesity and mental health outcomes in children. Future studies can also clarify whether specific types of screen time adversely impacted children’s health during the pandemic.

Where can I learn more?

Access the full journal article, titled “Trends in screen time use among children during the COVID pandemic, July 2019 through August 2021” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 15, 2023

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Screen Time for Children Rose During COVID-19 Pandemic, Remained High After Restrictions Lifted

ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

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ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

Authors: Sara Nozadi, Johnnye Lewis, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

What were the study results?

In this study, up to 15% of infants and toddlers who were developmentally on track prior to the COVID-19 pandemic showed signs of developmental delays during the pandemic. Male children showed more delays than female children, and language was the most affected developmental area. Families from minority communities and those with lower socioeconomic status were more likely to experience pandemic-related hardships. However, financial and social pandemic-related hardships were not associated with the individual changes observed in children’s developmental progress.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study highlights the importance of early developmental screening during times of adversity, such as pandemics, in order to identify delays and connect children to supportive services. Previous studies have shown negative impacts of the pandemic on overall child development but have not looked at the effects of the pandemic on individual children’s development over time.

Why was this study needed?

Many studies have focused on the COVID-19 pandemic’s effects on the development of school-aged children, evaluating the effects of the pandemic on academic performance and behavior problems. Fewer studies have examined the pandemic’s effects on the developmental progress of infants and toddlers, whose needs are different than those of school-aged children. During this study, researchers examined whether the negative developmental effects observed in school-aged children over the course of the pandemic could also be seen in infants and toddlers.

Who was involved?

The study included 684 children between the ages of 2 months and 4 years from 8 ECHO cohort research sites across the United States. Researchers included children whose parents had filled out the Ages and Stages Questionnaire (ASQ), which uses parent-reported information to pinpoint a child’s developmental progress, within the 18-month period before and after March 2020. Parents of participating children were also asked about financial hardship, defined as at least one parent experiencing job loss or change, or social hardships, defined as families’ quarantining from household members or extended family and friends, during the pandemic.

What happened during the study?

Parents answered 30 questions before and during the pandemic to determine whether their child had achieved developmental milestones in language, motor, cognitive or problem solving, and socioemotional development. Researchers also used the ECHO COVID-19 survey that was developed in April 2020 to gauge pandemic-related financial and social stress on families.

What happens next?

Future research can follow the developmental patterns in these children over time to determine if COVID-19 related delays are lasting or reversible. Studies may also focus on pandemic-related stressors that could particularly effect infants and toddlers, such as family dynamics, parent-child interactions and parental stress.

Where can I learn more?

Access the full journal article, titled “Effects of COVID-19 financial and social hardships on infants’ and toddlers’ development in the ECHO program,” in the International Journal of Environmental Research and Public Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published January 5, 2023

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ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

ECHO Study Finds Associations Between Neighborhood Social Vulnerability at Birth With Higher Childhood Body Mass Index

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ECHO Study Finds Associations Between Neighborhood Social Vulnerability at Birth With Higher Childhood Body Mass Index

Author(s): Izzuddin M. Aris, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

What were the study results?

The study found that children who lived in higher opportunity or less vulnerable neighborhoods early in life had lower average BMI and lower risk of obesity from childhood to adolescence. The neighborhoods children lived in at birth affected these health outcomes more than the neighborhoods they lived in later in childhood. These associations were not affected by individual and family sociodemographics or by prenatal risk factors for childhood obesity.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This research focuses on how community resources can enhance children’s health outcomes. The Child Opportunity Index, Social Vulnerability Index, and other measures of neighborhood characteristics could help inform efforts to reduce neighborhood barriers and improve access to community resources so families can better support their children’s health and well-being.

Why was this study needed?

The physical and social characteristics of neighborhoods may influence how children grow and develop. Children’s body mass index (BMI)—an estimation of their overall body fat—and childhood obesity are significant risk factors for heart disease later in life. The associations between neighborhood characteristics and children’s BMI and risk of obesity remains understudied. This study compared neighborhood-level measures of opportunity and social vulnerability with BMI and obesity patterns in children from birth to adolescence.

Who was involved?

This study included 20,677 children from 54 ECHO cohorts located across the United States.

What happened during the study?

ECHO researchers collected each child’s home address and weight at birth, infancy (6 months‒1.5 years), early childhood (2‒5 years), and mid-childhood (5‒10 years). The researchers linked participants’ addresses throughout childhood to data from the Child Opportunity Index and Social Vulnerability Index. The Child Opportunity Index measures neighborhood conditions and resources that may affect child health outcomes including education, health and environment, and social and economic factors. The Social Vulnerability Index identifies communities with high numbers of public health emergencies and other stressors by looking at demographics, socioeconomic status, type of housing, access to transportation, and other factors.

The researchers used these data to examine links between children’s neighborhood-level opportunity and social vulnerability and their BMI and obesity over time.

What happens next?

More research is needed to determine how changes to specific aspects of neighborhood environments might influence weight gain and obesity in children.

Where can I learn more?

Access the full journal article, titled “Associations of Neighborhood Opportunity and Vulnerability with Trajectories of Child Body Mass Index and Obesity Among U.S. Children,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: December 22, 2022

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ECHO Study Finds Associations Between Neighborhood Social Vulnerability at Birth With Higher Childhood Body Mass Index

Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

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Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

Authors: Tracy Bastain, Amy Margolis, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

What were the study results?

The study identified two groups of mothers based on their pandemic experiences. One of these groups experienced more changes to their daily life routines, more isolation from friends and family, and more changes to their health behaviors, when compared to the other group who experienced fewer pandemic-related changes in their lives.

Mothers who reported more life changes also reported more symptoms of traumatic stress due to the pandemic. The mothers who fell into the group that experienced more changes and reported more symptoms of traumatic stress tended to be women with higher incomes and higher education. Sixty-six percent of the women in the high change group were white. The women in the high change group were more likely to report financial concerns as a cause of stress. They were also more likely to report that the pandemic affected their healthcare.

In contrast, the group that reported fewer changes tended to have lower education and lower income. The women in this group were primarily Black and Native American. Hispanic women were split evenly between the two groups.

Both groups reported similar rates of COVID-19 infection in the household and similar work changes.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

Impact

As compared to fathers, during the COVID-19 pandemic more mothers have been affected by job and income losses, taken on more childcare burdens related to remote schooling, and have made major adjustments to their daily routines. This study found that mothers who had the most changes to their work, health, and social support systems also reported the highest amounts of traumatic stress due to the pandemic. These findings suggest that the association between sociodemographic, stressful life events, and mental health should be considered in future studies examining the long-term outcomes of the COVID-19 pandemic.

Why was this study needed?

The goal of this study was to better understand the mental health impacts of the COVID-19 pandemic on mothers in the United States and Puerto Rico.

Who was involved?

This study included 11,473 mothers from 62 ECHO cohorts across the U.S. and Puerto Rico.

What happened during the study?

ECHO researchers investigated the potential impacts of the COVID-19 pandemic on maternal mental health, from April 2020 through August 2021. The researchers looked for patterns of pandemic-related changes in maternal health and health behaviors, healthcare visits, work and finances, and coping strategies. They then used these data to group the mothers by those who had more or fewer pandemic-related changes to examine whether these groups reported higher or lower symptoms of traumatic stress related to the pandemic.

What happens next?

Future studies could examine how changes over the course of the pandemic affect mothers’ stress and well-being.

Where can I learn more?

Access the full journal article, titled “COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 16, 2022

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Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

During the COVID-19 Pandemic, Children’s Sleep Schedules Changed, But Their Time Asleep Stayed the Same

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During the COVID-19 Pandemic, Children's Sleep Schedules Changed, But Their Time Asleep Stayed the Same

Authors: Maristella Lucchini, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

During the COVID-19 pandemic, children in the United States went to bed later, woke up later, and took longer to fall asleep, but their overall time spent asleep did not change. Interviews with caregivers revealed that they prioritized routines to maintain their children’s amount of sleep but were more flexible about bedtime. Across all time periods studied, children from racial and ethnic minority communities went to bed later, slept less, and napped more often.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This is one of the first studies investigating changes in childhood sleep habits in the United States during the COVID-19 pandemic using data collected before and during the pandemic. The researchers found significant changes in children’s sleep habits, as well as differences in children’s sleep behaviors between racial/ethnic groups. These results highlight potential areas for future research and support the need to examine and address root causes of racial/ethnic sleep disparities in childhood.

Why was this study needed?

Sleep health during childhood is important for overall health and brain development. Poor sleep can increase a child’s risk for chronic illnesses, behavioral problems, and poor memory. Factors that affect sleep health may have been significantly impacted by the COVID-19 pandemic due to lockdowns and curfews, increased stress, and changes in social support. Many studies have shown that, due to systemic and structural inequities, the pandemic has affected the health behaviors of children differently based on their socioeconomic status, race, and ethnicity. These differences may worsen existing gaps in children’s health.

Several studies have reported on how the pandemic has affected childhood sleep habits, but few of these studies involved children in the United States. Most previous studies have relied on self-reported or time-limited data and have focused primarily on early stages of the pandemic. The goal of this study was to investigate changes in nighttime sleep habits and frequency of daytime naps during the COVID-19 pandemic.

Who was involved?

This study included 528 children aged 4 to 12 from 14 ECHO cohorts across the United States. The caregivers of 38 participants provided additional information about how they thought their children’s sleep habits may have been affected by the COVID-19 pandemic.

What happened during the study?

The researchers compared data from before the pandemic with data collected at two different time periods during the pandemic. They used this data to examine the length of time it took children to fall asleep, time spent asleep at night during the week and on weekends, and the frequency of later bedtimes and daytime naps. They also collected sociodemographic information (child sex, age, race and ethnicity, maternal education) from self-reports and medical records.

What happens next?

ECHO researchers are currently analyzing and publishing results on changes in diet, physical activity, and screen time during the COVID-19 pandemic from the same cohort of children.

Where can I learn more?

Access the full journal article, titled “Impact of the COVID-19 pandemic on children’s sleep habits: an ECHO study,” in Pediatric Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published October 4, 2022

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During the COVID-19 Pandemic, Children's Sleep Schedules Changed, But Their Time Asleep Stayed the Same

During the COVID-19 Pandemic, Children’s Screen Time Increased

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During the COVID-19 Pandemic, Children's Screen Time Increased

Authors: Traci Bekelman, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

The study found that overall children’s screen time increased significantly during the pandemic with Hispanic children and non-Hispanic Black children having the most noticeable increase in screen time. The study didn’t find any significant increase in the amounts of sugary drinks and unhealthy snack foods children consumed during the pandemic, but it did find a more noticeable increase among Hispanic children and older children. The amount of time children spent asleep increased but only among children whose sleep time was below the recommended range before the pandemic.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study shows how the disruptions caused by the COVID-19 pandemic affected children’s daily lives. The results of this study suggest that the pandemic may have worsened sociodemographic disparities for some child health behaviors, particularly in relation to the amount of time children spent looking at screens. This research suggests that families may need more support to re-establish healthy routines and reduce the negative effects of the pandemic on their children’s health behaviors.

Why was this study needed?

For many children, public health measures to mitigate the spread of the COVID-19 pandemic disrupted their daily routines, and prevented them from using community resources, such as parks and organized sports. During the first few months of the pandemic, there were changes in children’s health behaviors—such as diet, screen time, physical activity, and sleep habits. However, there are limited data on what happened to children’s health behaviors after the earliest, most restrictive lockdown period. This is an important topic because children’s health behaviors have been linked to their overall mental and physical health, academic achievement, and quality of life.

Who was involved?

The study included 347 children between the ages of 4 to 12 years and their caregivers recruited from ECHO cohorts in California, Colorado, North Dakota, and New Hampshire. Of those participants, 47% percent were female, and 62% were non-Hispanic White.

What happened during the study?

ECHO researchers collected data on children’s diet, physical activity, screen time, and sleep habits before and during the pandemic. The researchers also surveyed caregivers on how they thought their children’s health behaviors had changed during the pandemic. This study also explored how sociodemographic factors affected children’s health behaviors to identify children who are more likely to experience less recommended changes in behaviors.

What happens next?

This research may help us identify ways to support families with children in future public health emergencies. The ECHO Program is currently working to study changes in other related health behaviors. This includes changes in how well children follow national dietary guidelines, use of social media, and bedtimes/wake-up times.

Where can I learn more?

Access the full journal article, titled “Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children,” in the International Journal of Environmental Research and Public Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 19, 2022

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During the COVID-19 Pandemic, Children's Screen Time Increased