Pandemic challenges may affect babies !

 The COVID-19 pandemic has been hard on so many people in so many ways. For babies born during this pandemic, a study published in JAMA Pediatrics suggests that the damage has potential to be lifelong.

The first three years of life are crucial for brain development. And it’s not just the health of babies that matters, but the interactions between babies and their caregivers. Babies need to be touched, held, spoken to, smiled at, played with. As they receive and respond to those interactions, in a "serve and return" kind of way, neural connections are built in the brain. When babies don’t have those interactions, or enough of them, their brains don’t develop as they should — and can even be literally smaller.

When you are a stressed or depressed parent or caregiver, it can be hard to find the time, let alone the energy or interest, to talk to and play with your infant. There are multiple studies showing that maternal depression, poverty, and other family stressors can change the development of a child forever.

Like many paediatricians, Dani Dumitriu braced herself for the impact of the SARS-CoV-2 coronavirus when it first surged in her wards. She was relieved when most newborn babies at her hospital who had been exposed to COVID-19 seemed to do just fine. Knowledge of the effects of Zika and other viruses that can cause birth defects meant that doctors were looking out for problems.

But hints of a more subtle and insidious trend followed close behind. Dumitriu and her team at the NewYork–Presbyterian Morgan Stanley Children’s Hospital in New York City had more than two years of data on infant development — since late 2017, they had been analysing the communication and motor skills of babies up to six months old. Dumitriu thought it would be interesting to compare the results from babies born before and during the pandemic. She asked her colleague Morgan Firestein, a postdoctoral researcher at Columbia University in New York City, to assess whether there were neurodevelopmental differences between the two groups.

A few days later, Firestein called Dumitriu in a panic. “She was like, ‘We’re in a crisis, I don’t know what to do, because we not only have an effect of a pandemic, but it’s a significant one,’” Dumitriu recalled. She was up most of that night, poring over the data. The infants born during the pandemic scored lower, on average, on tests of gross motor, fine motor and communication skills compared with those born before it (both groups were assessed by their parents using an established questionnaire)1. It didn’t matter whether their birth parent had been infected with the virus or not; there seemed to be something about the environment of the pandemic itself.

Dumitriu was stunned. “We were like, oh, my God,” she recalled. “We’re talking about hundreds of millions of babies.”

Lockdowns — which have been crucial for controlling the spread of the coronavirus — have isolated many young families, robbing them of playtime and social interactions. Stressed out and stretched thin, many carers also haven’t been able to provide the one-to-one time that babies and toddlers need.

How COVID is changing the study of human behaviour

“Everyone wants to document how this is impacting child development, and parent–child relationships and peer relationships,” says James Griffin, chief of the Child Development and Behavior Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Maryland. “Everyone has concerns.”

Some of the teams looking into these issues around the world are starting to publish their findings. New studies have begun. Firm answers are hard to come by, not least because many child-development research laboratories shut down during the pandemic.

Some babies born during the past two years might be experiencing developmental delays, whereas others might have thrived, if carers were at home for extended periods and there were more opportunities for siblings to interact. As with many aspects of health during the pandemic, social and economic disparities have a clear role in who is affected the most. Early data suggest that the use of masks has not negatively affected children’s emotional development. But prenatal stress might contribute to some changes in brain connectivity. The picture is evolving and many studies have not yet been peer reviewed.

Some researchers propose that many of the children falling behind in development will be able to catch up without lasting effects. “I do not expect that we’re going to find that there’s a generation that has been injured by this pandemic,” says Moriah Thomason, a child and adolescent psychologist at the New York University Grossman School of Medicine.

A precipitous drop in play

One lab that managed to stay open during the COVID-19 pandemic was Brown University’s Advanced Baby Imaging Lab in Providence, Rhode Island. In it, Sean Deoni, a medical biophysicist, and his colleagues use magnetic resonance imaging (MRI) and other techniques to study how environmental factors shape brain development in infants.

Although the pandemic changed how they conducted their research — fewer visitors and more cleaning — they continued inviting babies to their lab, to track motor, visual and language skills as part of a seven-year National Institutes of Health study on early childhood development and its effects on later health.

However, as the pandemic progressed, Deoni began hearing worrying comments from his colleagues. “What our staff began to tell me, anecdotally, was ‘Man, it’s taking these kids a lot longer to get through these assessments,’” Deoni recalled.

He was mystified, so asked his researchers to plot and compare the yearly averages and variances from the infants’ neurodevelopmental scores. That’s when they discovered that the scores during the pandemic were much worse than those from previous years (see ‘Development dip’). “Things just began sort of falling off a rock the tail end of last year and the beginning part of this year,” he said in late 2021. When they compared results across participants, the pandemic-born babies scored almost two standard deviations lower than those born before it on a suite of tests that measure development in a similar way to IQ tests. They also found that babies from low-income families experienced the largest drops, that boys were more affected than girls2 and that gross motor skills were affected the most.

In this study, part of an ongoing study of mothers and babies, researchers from Columbia University looked at the development of three groups of 6-month-old babies. Two of the groups were born during the COVID-19 pandemic; the mothers of one group had COVID-19, while the mothers of the other did not. The third group was a historical cohort (a group of babies who were born before the pandemic).

Mothers participating in the study used an Ages and Stages Questionnaire (ASQ-3) to record their babies’ development. The researchers noted no difference in the development of the two groups of babies born during the pandemic, suggesting that prenatal exposure to COVID-19 doesn’t affect development, which is great news. But the babies born during the pandemic scored lower in gross motor, fine motor, and social-emotional development than the babies born before the pandemic. Examples of developmental tasks for infants this age are rolling from back to tummy (gross motor), reaching for or grasping a toy with both hands (fine motor), and acting differently to strangers than to parents or familiar people (social-emotional development).

What does it suggest about infant development during the pandemic?

It’s just one study, and we need to do more research to better understand this, but the findings are not really surprising given what we know about infant development. The COVID-19 pandemic has caused a lot of stress — emotional, financial, and otherwise — for so many families. It has also markedly affected the number and kind of interactions we have with other people. Babies are on average interacting with fewer people (and seeing fewer faces because of masking) than they did before the pandemic.

Even though we need to do more research, this study should serve as an alarm bell for us as a society. The children of this pandemic may carry some scars forever if we don’t act now. We’ve been seeing the emotional and educational effects on children; we need to be aware of the developmental effects on babies, too. All of these could permanently change their lives.

What can we do to address these challenges?

We need to find ways to support families with young children, financially and emotionally. We need to be energetic and creative, and work every angle we can. While our government should play a role, communities and individuals can help too.

We need to refer families to and fund early intervention programs around the country that support the development of children from birth to 3 years of age. Because of the pandemic, many of these programs have moved to virtual visits, which can make them less effective. So we need to get creative here, too. We can’t just wait for the pandemic to be over.

And parents and caregivers of infants and toddlers need to know about this research — and ask for help. It’s understandable and natural for parents to think that babies are too small and unaware to be affected by the pandemic. But they are affected, in ways that could be long-lasting. Talk to your doctor about what you can do to help yourself, your family, and your baby’s future.