When Dr. Christopher Forrest began his career in pediatrics some 25 years ago, he says it was pretty uncommon to see children come in with chronic conditions. But that's changed. Nowadays, he says anecdotally, more children come into the hospital and even primary care practices with chronic disease.
"They just seem to be sicker. And it turns out they are," says Forrest, a professor of pediatrics at Children's Hospital of Philadelphia.
In a new study in the journal JAMA, Forrest and his colleagues report that the health of America's children has significantly worsened across several key indicators since 2007.
They found that a U.S. child was 15% to 20% more likely to have a chronic condition in 2023 than a child in 2011. In particular, the prevalence of depression, anxiety, sleep apnea and obesity all increased, as did rates of autism, behavioral problems, developmental delays and attention-deficit hyperactivity disorder.
Reports of problems such as poor sleep, limited physical activity, early-onset menstruation and loneliness also rose.
"I think the overall message is that children's health in the United States has been declining for almost two decades," Forrest says. He says the researchers consulted eight comprehensive data sets, including nationally representative surveys and millions of electronic pediatric health records.
The researchers also looked at mortality rates for American infants, young children and teenagers and compared them to their peers in other high-income countries over time. Forrest says that back in the 1960s, "the chance that a child was going to die in the United States was the same as European nations." But that's no longer the case, he says.
"What we found is that from 2010 to 2023, kids in the United States were 80% more likely to die" than their peers in these nations, he says.
Among infants, these disparities in mortality were driven largely by sudden unexpected infant death and prematurity. In older children and adolescents, the gap was fueled by gun violence, motor-vehicle crashes and substance abuse.
"In 2020, firearm mortality overtook motor vehicle crashes as the leading cause of death in U.S. youth," the authors write.
Dr. Frederick Rivara is a professor of pediatrics at the University of Washington. He co-wrote an editorial that accompanies the new study in JAMA. He says health care coverage is one major reason why American kids seem to fare worse than their peers in other rich nations. He notes that unlike Canada or the United Kingdom, the U.S. does not offer universal health care coverage.
"And now that's going to get worse with kids being removed from Medicaid," Rivara says, because of huge cuts to the Medicaid program for low-income Americans that were included in the tax and spending bill President Trump signed into law last week.
According to the Pew Research Center, an estimated 41% of all U.S. children were enrolled in Medicaid as of January.
"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," Rivara and his co-authors wrote. That includes massive budget cuts at the Department of Health and Human Services, including to injury prevention programs and the elimination of the team that ran the Safe to Sleep campaign for babies, aimed at reducing incidents of sudden infant death syndrome, and initiatives that question the safety of childhood vaccines.
Edited by Jane Greenhalgh
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