American children’s health has declined profoundly over the past few decades, a new study shows, and the issues are so serious that children in the US are dying at a much higher rate than those in similar high-income countries.
What’s particularly frustrating is that the bulk of the health problems are avoidable, said Dr. Chris Forrest, co-author of the study published Monday in the journal JAMA. There isn’t a genetic defect unique to American children and it’s not about socioeconomics within the United States, he said: The results were applicable to the total pediatric population.
“I think we all should be disturbed by this,” said Forrest, a professor of pediatrics at Children’s Hospital of Philadelphia and director of the Applied Clinical Research Center. “Kids in this country are really suffering.”
From 2007 to 2022, children ages 1 to 19 were 1.8 times more likely to die than children in other high-income countries, the study found. The biggest disparities were in deaths from gun violence and traffic accidents; kids in the US were 15 times more likely than their counterparts in other countries to die by firearms and more than twice as likely to die in motor vehicle crashes.
But US children are also sicker because of chronic conditions, Forrest said, and that’s a newer phenomenon. In the ’90s, when he started taking care of children, he said, he hardly ever saw one with a chronic condition. Today, nearly half of children are getting medical care for a chronic health problem, the study says.
The researchers, who analyzed hundreds of millions of health records from five nationally representative surveys and electronic health records from 10 pediatric health systems, found that a child in 2023 was 15% to 20% more likely to have a chronic condition than a child in 2011.
Asthma was the one chronic condition for which rates improved in the studied time period, but it was an outlier. Rates of mental health problems such as depression, anxiety and loneliness increased, as did rates of autism, behavioral conduct problems, developmental delays, speech language disorders and attention-deficit hyperactivity disorders.
Rates of physical issues also increased significantly, including problems with obesity, difficulties with limitations in activity, problems with sleeping and early menstruation. A period before age 12 is associated with immediate health problems including type 2 diabetes, but in the long term, it may also raise the risk of heart and blood pressure problems, studies show.
Chronic conditions were the focus of a recent federal government report from the Make America Healthy Again Commission that said chronic disease had made children “the sickest generation in American history.” That report blamed ultraprocessed food, exposure to chemicals in the environment, pervasive technology use and the overprescription of medicine.
The new study doesn’t pinpoint what’s driving the increase in chronic conditions, but Forrest doesn’t believe it’s just what’s on the MAHA list. Rather, he believes the nation’s entire approach toward caring for children needs to change.
“Our kids are being raised in a very toxic environment, and it’s not just the chemicals. It’s not just the food and the iPhones. It’s a much broader. It’s much deeper. It’s what we call the developmental ecosystem, and it makes it very challenging to change it,” Forrest said. “That’s a hard answer for people who want a pithy message that tells them how to fix the issues. It’s about where they’re growing up, where they’re going to school, they’re playing, where their families live, their neighborhoods, and it’s not just one population. It’s the whole nation that needs help.”
In the 1960s, children in the US were dying at about the same rate as in countries with similar incomes, but that started to change in the 1970s. The US now has about 54 excess child deaths per day compared with 18 other wealthy countries.
“This means the same kid born in this country is much more likely to die than if they were born in Germany or Denmark. Why are we allowing this to happen?” Forrest asked.
In an editorial that published alongside the study, pediatricians from Virginia and Washington wrote that there’s reason to worry the health of US children will continue to fall behind, and political winds are shifting in the wrong direction.
“While the administration’s Make America Healthy Again movement is drawing welcome attention to chronic diseases and important root causes such as ultra-processed foods, it is pursuing other policies that will work against the health interests of children,” they wrote, noting massive budget cuts at the US Department of Health and Human Services, including injury prevention, cancelled funding for safe sleep programs, Medicaid reductions, shrinking mental health funding and new initiatives that fuel vaccine hesitancy among parents.
The study found that from 2007 to 2022, babies in the US were 1.78 times more likely to die than children in 18 other high-income nations. The biggest disparities in deaths were from prematurity and sudden, unexpected infant death, which is accidental suffocation and strangulation in bed and other deaths from unknown causes.
But it’s not just children who are at risk, Forrest said. “Kids are not getting great start in life because women are also suffering in this country.”
Maternity deserts, where pregnant people don’t have easy access to a doctor, have become a growing problem. According to the March of Dimes, about 35% of counties in the US are maternity deserts, a number likely to grow as states pass stricter abortion laws, driving doctors toward states where it’s less complicated to provide care. In 2020-22, there were an excess of over 10,000 preterm births among people living in maternity care deserts or limited-access counties, the group says.
Dr. Colleen Kraft, a pediatrician at Children’s Hospital Los Angeles who did not work on the research, said the study provides good data on broad problems.
“Nothing here surprises me at all,” said Kraft, former president of the American Academy of Pediatrics, who wasn’t involved in the new research.
Over 35 years of practice, she has seen the change in her own patients. At the beginning, she treated mostly infectious disease, but vaccines for conditions like meningococcal disease changed that. Now, she fears that anti-vaccine sentiment could erode much of that progress.
She also treats a lot more children now for chronic conditions that the community can help prevent, she said.
For example, schools could restrict mobile phones so kids interact more, easing problems with loneliness, anxiety and depression. Families can implement a media plan where all devices are plugged into a central location – not a bedroom – so children can get more sleep. Parents can also encourage kids to play outside and engage in more unstructured time to be social and develop their imaginations.
“There are some very common-sense things families can do,” Kraft said.
To see major improvement in childhood health in the US, Forrest believes the country will need to undergo a major transformation. In other countries, for example, day care workers are professionals who get paid a living wage, so kids get quality care. Parents also get more time off when they have a child.
“It’s time to rethink how we treat kids and how we’re supporting families,” Forrest said. “Children in our nation our like the proverbial canary in the coal mine. When their health is deteriorating, that means the foundation of our nation is also deteriorating.”
