Screen time, chronic conditions, and missed care all contribute to the health decline in U.S. children, study says.
A new research study has found that the health of U.S. children has declined significantly since 2007. In the U.S. specifically, children were found to be 15% to 20% more likely to have a chronic condition in 2023 than in 2011.
In particular, the prevalence of depression, anxiety, sleep apnea and obesity in children all increased during the “Trends in US Children’s Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms” study period (2007-2023), as did rates of autism, behavioral problems, developmental delays and attention-deficit hyperactivity disorder.
To foster better health outcomes for children, the basics of good nutrition, proper sleep and adequate exercise remain essential.
Recently, however, the rising use of cell phones, the internet and social media among younger generations have been contributing factors to a decline in mental and behavioral health for children.
“The past decade has been uniquely impacted by the ubiquitous presence of hand-held electronic devices and nearly unfettered internet access for almost all children in the developed world regardless of race or socio-economic status,” said Dr. Michael Artigues, president of the American College of Pediatricians (ACPeds).
In the past five years, internet access and social media use have been a significant trend affecting children’s health. A 2019 report found that 8-to 12-year old’s experience almost five hours of screen exposure each day, and teens view screens for an average of nearly seven and a half hours each day, excluding screen time for completing schoolwork.
Excessive exposure to screens at a young age is associated with lower academic performance, sleep disturbances, obesity, attention deficit, increased aggression, lower self-esteem, depression, and increased rates of high-risk behaviors among children, according to ACPeds.
“This includes social media and the challenges it presents, particularly in mental health, interpersonal relationships and the previously mentioned need for proper sleep/exercise,” said Dr. Artigues.
Getting regular checkups
Regular pediatric checkups can help identify and address childhood health issues. The most common conditions detected during routine annual pediatric visits include developmental issues, vision and hearing problems, and developmental disorders such as autism and attention-deficit/hyperactivity disorder.
At a child’s well visit, a pediatrician checks vision and hearing, evaluates mental health or recent changes in mental health, provides immunizations for childhood diseases, gets to know a child’s sleeping, nutrition, and physical activity habits and assesses if a child is meeting age-based developmental milestones.
“General annual exams with the typical associated screening tools are often able to pick up problems with vision, blood pressure and common physical/mental health issues such as obesity and anxiety and/or depression,” said Dr. Artigues.
Regular well-child visits provide the opportunity for pediatricians to answer parents’ and caregivers’ questions and to provide age-appropriate guidance on an individual basis, promoting positive long-term health outcomes for children.
“When diagnosed and addressed early on, problems diagnosed during checkups are more likely to be successfully addressed as the underlying causes are often initially treated with basic measures such as changes in diet, screen use and sleep hygiene,” said Dr. Artigues.
Pediatricians are often frontline providers for children and are instrumental in addressing the rise in mental health issues for children and adolescents. These providers play a key role screening children, providing early intervention, and referring children and their families to the appropriate medical professionals.
“The first step of any problem is its diagnosis,” said Dr. Artigues. “From there, decreases in risk factors and, when needed, active treatment or referral to mental health professionals can be initiated.”
ACPeds recommends that all adolescents be screened for depression and treated appropriately. ACPeds also encourages adolescents and families to develop habits that support mental health and decrease the likelihood of developing depression.
Healthy habits include improving family connections – such as eating meals together, volunteering together, and participating in religious activities as a family. Keeping a gratitude journal and limiting social media use may help both in preventing and mitigating depressive symptoms in children, according to ACPeds.
The ACPeds “Benefits of the Family Table” abstract reinforces the importance of regularly eating together as a family as a way to improve family well-being, and encourages pediatricians to communicate with parents to make every effort to regularly gather around the “Family Table” for meals.
Childhood vaccination
Annual checkups and well-being visits for children also have an important role in keeping children on track with vaccinations and preventing transmissible diseases.
“Since most vaccines cannot be given to feverish or seriously ill children, the best time to review and address vaccination needs is during a well visit,” Dr. Artigues.
Vaccine hesitancy is believed to be responsible for decreasing vaccine coverage and an increasing risk of vaccine-preventable disease outbreaks and epidemics, especially among children, according to a National Library of Medicine study titled “Vaccine Hesitancy.”
While there has always been a small but significant subset of parents who desire to either make personal adjustments to the recommended vaccine schedule or forego preventive vaccination altogether, the study noted many pediatric offices have seen an increase in such vaccine hesitancy following the pandemic and its emphasis on the Covid vaccine for the general population.
The National Institutes of Health continues to recommend immunizations as a safe and effective way to protect children from disease. Regular vaccination at children’s well visits not only safeguards each child but also plays a crucial role in preventing outbreaks and promoting public health.
Reducing screen time
Technology – particularly visual media – has become increasingly influential in shaping the lives and health outcomes of children, adolescents and families in the United States.
The American Academy of Pediatrics guidelines recommend that screen time be avoided for all children younger than 18 months and limited to one hour per day for children two to five years of age.
To address growing concerns around technology use, in the “Media Use and Screen Time—Its Impact on Children, Adolescents, and Families,” abstract, ACPeds encourages parents to become media literate and limit screen time for their children. ACPeds also affirms limiting children’s exposure to screen time due to the negative effects of excessive use and its long-term impacts on the health of young children and adolescents.
ACPeds also asserts that parents must lead by example and restrict their own personal screen time to foster a healthy relationship with their children. The organization encourages pediatricians to regularly warn families about the negative impacts of media during well-child visits, and calls upon the media industry, sponsors, educators and policymakers to act responsibly to protect the physical and emotional health of children and families.
Facing barriers to care access
Many children in the U.S. often face significant barriers to accessing care, similar to those experienced by adults, and these obstacles can be more detrimental during a child’s developmental years.
Barriers to healthcare access for children include financial concerns and caretaker inability to access care, provider shortages, and/or previous negative experiences, less family-centered communication, lower trust, and less partnership between families and providers, increased rates of adverse events and provider bias, according to the National Institutes of Health.
In fact, nearly half of U.S. children with a treatable mental health disorder did not receive treatment from a mental health professional in 2022, according to a NIH study. Poverty and an uneven geographic distribution of resources may also contribute to inequities in access and disparities in outcomes for mental and behavioral health conditions for children.
“There will always be financial barriers to recommended pediatric care, even in developed nations such as our own, including access to comprehensive health insurance, transportation needs and the lack of access to quality pediatric-specific healthcare providers,” said Dr. Antigues.
Despite these challenges, preventive health services and annual pediatrician visits are important to the development of all children, and parents play a key role in facilitating access to these types of services, according to the NIH.
Parents provide the foundational role of support and guidance for their children, including the fundamental right to direct the child’s upbringing, according to ACPeds’ abstract on the “Roles, Responsibilities, and Rights of Parents.”
Ensuring the health and wellbeing of children consequently requires a multifaceted approach between parents, healthcare professionals, pediatricians and the community to prioritize and improve children’s health into 2025 and beyond.