Is COVID causing developmental delays in kids?

Alex, a happy, smiling, nearly 2-year-old boy, was born in February 2020. By the time he turned 1, his development was noticeably behind.

His older siblings, 5 and 7, tried to play with him, but he couldn’t do much. His muscles were weak, and he wasn’t babbling much. Still their exchanges would make Alex laugh, delighting all three kids.  

The pregnancy and delivery had followed the same pattern as his siblings. The big difference was that Alex was born during the early throes of COVID-19, just two weeks before the WHO declared a global pandemic.

“When COVID started, everyone was staying home, including baby (Alex), said the boy’s father. “He didn’t go to day care like the other kids, who started at 3 months.” (The family asked to not use their full names to protect Alex’s privacy.)

The boy had minimal contact with anyone outside of his nuclear family, and his parents worried that missing the enriched environment of day care and company of other children might set him back.

While it’s impossible to pinpoint the causes of Alex’s developmental delays, the pandemic-era concerns voiced by his parents are shared by a growing number of child health experts.

“When parents are depressed or preoccupied like we’ve seen with COVID, they’re not as emotionally available,” said Carol Berkowitz. “It’s not a criticism; it’s the reality.” 

Berkowitz is a pediatrician with expertise in child growth and development at Harbor-UCLA Medical Center. (Full disclosure: Dr. Berkowitz and I are colleagues.)

With safer-at-home mandates, lockdowns and persistent fears about the coronavirus, everyone’s environment at home changed dramatically over the past two years. 

Parents and their infants lost support systems, including extended family, friends, and health care professionals. Some caregivers were absent due to illness or death due to COVID-19. Others were consumed with stress, anxiety or financial woes with unemployment. Some parents, including Alex’s, had to manage an abrupt switch to work-from-home, with the added duties of caring for a baby and kids who were doing remote school. 

Those long stressful days at home can deplete the emotional energy parents need to fully engage with children.  

That really matters, since parent responsiveness is critical for an infant’s healthy maturation. Stress, physical or mental illness, or anything that hampers a caregiver’s interactions with an infant can hinder a baby’s growth and development. 

The pandemic’s impact upon infant and early childhood development, especially long term, is not yet known. The research is nascent and the early results are conflicting, but there are some signals for concern.

One study found that children born during the pandemic had a 22 point drop in their average cognitive score (similar to IQ). From an average of 100 for children born before COVID-19, the scores dropped to an average of 78 for those babies born during the pandemic. The findings stem from a longer-term study in which researchers at Brown University compared the verbal, motor and overall cognitive skills of infants born in 2020 and 2021 with those born from 2011 to 2019. Males and children with mothers with lower educational attainment, used as a proxy for socioeconomic status (SES), suffered greater losses. The researchers postulated that the environmental changes, especially less parental availability, contributed to the decline.

One big caveat: The study is a preprint and the paper has not completed peer review. 

In another trial from the Babylab at Oxford Brookes University in England, 600 children, ages 6 to 36 months, were followed online to monitor their vocabulary and cognitive development during COVID-19, from spring to the winter of 2020. They found that children who continued to attend high-quality early childhood education centers had enhanced development, compared to those children quarantined at home. The authors said larger benefits were noted for children from lower socioeconomic backgrounds.

Some parents are worried that even among kids who attend preschool, masks will impede their children’s development. But the early data suggest that masking and the obscuring of facial expressions may not be as detrimental to young children’s development as feared. One reason is that children do not rely solely on facial expressions for gauging the emotions of adults.

In addition, infants and young children at home generally have unmasked caregivers, their main models for learning facial expressions. By 5 months, the majority of infants can identify emotional expressions, such as a sad face. By the time they’re 5 years old, children can identify emotions on par with adults.

But, masks do appear to hinder young children’s recognition of some emotions, according to a recent report in JAMA Pediatrics. In that study, Swiss researchers tested the ability of 276 children ages, 3 to 5, to recognize joy, sadness and anger in photos of adult faces with and without masks. More children were able to identify joy and sadness in unmasked compared to masked adults, but there was no difference when it came to recognizing anger.

In another study, University of Wisconsin researchers tested older children’s abilities to read emotions. Eighty children, ages 7 to 13, were shown photos of adults with uncovered faces, wearing surgical masks or wearing sunglasses. The children were better at inferring emotions of uncovered faces but could still recognize emotions in photos of adult faces with masks — more accurately than for those wearing sunglasses.

One reason masks may not be as big a hindrance as feared is that the area around the eyes, including the eyes, eyelids, eyebrow, upper cheeks, and forehead, is essential for conveying emotions, as psychologist Robyn Koslowitz writes in Psychology Today. Even, young children are able to identify fake smiles, explaining that “it doesn’t reach the eyes.”

“I am not despondent about them, but they need more attention, modeling and opportunities for social interactions,” said Berkowitz of kids living through COVID-19.

Alex had those opportunities. He participated in early intervention at Regional Center and quickly caught up on his motor and language skills. His parents think having some return to normalcy, including starting a day care program last August, was also important in his rapid improvement.