ImportanceRestrictions related to the COVID-19 pandemic disrupted the lives of young children, but the association between the pandemic and any changes in early childhood developmental milestone achievement in the US remains unclear.ObjectivesTo determine the association between the COVID-19 pandemic and changes in developmental screening scores among US children aged 0 to 5 years and to investigate whether caregivers self-reported more worries about their children or concerns about children’s behavior during the pandemic, regardless of milestone achievement.Design, Setting, and ParticipantsThis was a cohort study using an interrupted time series analysis comparing prepandemic (March 1, 2018, to February 29, 2020), interruption (March 1 to May 31, 2020), and intrapandemic (June 1, 2020, to May 30, 2022) periods among 50 205 children (randomly sampled from a population of 502 052 children) aged 0 to 5 years whose parents or caregivers completed developmental screening at pediatric visits at US pediatric primary care practices participating in a web-based clinical process support system.ExposureCOVID-19 pandemic period.Main Outcomes and MeasuresAge-standardized Ages and Stages Questionnaire, Third Edition (ASQ) domain scores (communication, personal-social, problem-solving, gross motor, fine motor), and rate of caregivers’ concerns about the child’s behavior or worries about the child as measured on the ASQ.ResultsA total of 50 205 children (25 852 [51.5%] male; mean [SD] age, 18.6 [16.0] months) and 134 342 ASQ observations were included. In adjusted models, significant age-specific mean score decreases from prepandemic to intrapandemic were observed in communication (−0.029; 95% CI, −0.041 to −0.017), problem-solving (−0.018; 95% CI, −0.030 to −0.006), and personal-social (−0.016; 95% CI, −0.028 to −0.004) domains. There were no changes in fine or gross motor domains prepandemic to intrapandemic. For infants aged 0 to 12 months, similar effect sizes were observed but only for communication (−0.027; 95% CI, −0.044 to −0.011) and problem-solving (−0.018; 95% CI, −0.035 to −0.001). After accounting for age-standardized ASQ scores, caregiver worries about the child increased slightly in the intrapandemic period compared with the prepandemic period (rate ratio, 1.088; 95% CI, 1.036-1.143), but there were no changes in caregiver concerns about the child’s behavior. While changes in developmental screening scores were modest (2%-3%), nationwide, this could translate to more than 1500 additional recommended developmental referrals over baseline each month.Conclusions and RelevanceModest changes in developmental screening scores are reassuring in the short term but may tax an already overburdened developmental behavioral pediatrics infrastructure. Continued attention to developmental surveillance is critical since the long-term population- and individual-level implications of these changes are unclear.

中文翻译：

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COVID-19 大流行之前和期间美国儿童实现的发育里程碑

重要性与 COVID-19 大流行相关的限制扰乱了幼儿的生活，但该流行病与美国幼儿发育里程碑成就的任何变化之间的关联仍不清楚。 目标确定 COVID-19 大流行与发育变化之间的关联对美国 0 至 5 岁儿童的筛查分数，并调查看护者是否自我报告对他们的孩子有更多的担忧或对大流行期间儿童行为的担忧，无论里程碑成就如何。 设计、设置和参与者这是一项使用中断的队列研究时间序列分析比较了 50 205 名儿童的大流行前（2018 年 3 月 1 日至 2020 年 2 月 29 日）、中断（2020 年 3 月 1 日至 5 月 31 日）和大流行期间（2020 年 6 月 1 日至 2022 年 5 月 30 日）时期（随机样本来自 502 052 名 0 至 5 岁的儿童，其父母或看护者在参与基于网络的临床流程支持系统的美国儿科初级保健机构的儿科就诊中完成了发育筛查。暴露于 COVID-19 大流行期间。主要成果和测量年龄标准化年龄和阶段问卷，第三版 (ASQ) 领域分数（沟通、个人社交、解决问题、粗大运动、精细运动），以及测量的看护者对孩子行为的担忧或担心的比率结果共有 50 205 名儿童（25 852 [51.5%] 为男性；包括平均 [SD] 年龄，18.6 [16.0] 个月）和 134 342 个 ASQ 观察结果。在调整后的模型中，从大流行前到大流行期间，在沟通（-0.029；95% CI，-0.041至-0.017）、解决问题（-0.018；95% CI，-0.030至-0.006）方面观察到特定年龄平均得分显着下降）和个人社交（-0.016；95% CI，-0.028 至 -0.004）域。在大流行前和大流行期间，精细运动或粗大运动区域没有变化。对于0至12个月大的婴儿，观察到类似的效应大小，但仅针对沟通（-0.027；95% CI，-0.044至-0.011）和解决问题（-0.018；95% CI，-0.035至-0.001）。考虑到年龄标准化 ASQ 分数后，与大流行前相比，大流行期间看护者对孩子的担忧略有增加（率比，1.088；95% CI，1.036-1.143），但看护者对孩子的担忧没有变化。孩子的行为。虽然在全国范围内，发育筛查分数的变化不大（2%-3%），但这可能意味着每月比基线增加 1500 多个推荐的发育推荐。 结论和相关性 发育筛查分数的适度变化在短期内令人放心，但可能会给已经不堪重负的发育行为儿科基础设施增加负担。持续关注发育监测至关重要，因为这些变化对人口和个人水平的长期影响尚不清楚。