The health of children in the U.S. has worsened over the past 17 years, across multiple domains, including child mortality, chronic conditions, obesity, functional status and symptoms, according to a recent study published in JAMA.

Investigators Christopher B. Forrest, MD, PhD, et al., pooled data from five nationally representative surveys, 10 pediatric health systems (PEDSnet) and 18 comparator high-income nations (through the Organization for Economic Co-Operation and Development) to study child and adolescent rates of mortality, chronic illness and overall health.

Results from 2007 to 2022 showed that, compared with other high-income countries, infants less than one year old were 1.78-times more likely to die, driven by disproportionately higher rates of prematurity (rate ratio [RR], 2.22) and sudden unexpected infant death (RR, 2.39). And, youths aged one to 19 years, were 1.80-times more likely to die, driven by firearm-related incidents (RR, 15.34) and motor vehicle crashes (RR, 2.45), overall translating to 54 additional child deaths per day.

Moreover, from 2011 to 2023, among youth from ages three to 17, the prevalence of having one of 15 common chronic conditions rose from 40% to 46% (RR, 1.15) in the clinician-recorded PEDSnet data and from 26% to 31% (RR, 1.20) in parent-reported data. Within the PEDSnet data, among the 29 most common chronic conditions, 22 increased by rates of 10% or more from 2010 to 2023, with the largest increases in major depression, sleep apnea, eating disorders, anxiety, autism spectrum disorder, obesity, lipid metabolism disorders and developmental disorders. Notably, obesity now affects 20% of children. Early onset of menstruation, trouble sleeping, limitations in activity, physical symptoms, depressive symptoms and loneliness all increased during the study period as well.

"If children's health is declining across multiple health indicators as derived from diverse data sources, a more effective response may be to address underlying systemic factors that are influencing the health of children more broadly," recommend the authors, "improving the developmental ecosystems where children live and grow."

In an accompanying editorial comment, Elizabeth R. Wolf, MD, MPH; Frederick P. Rivara, MD, MPH; and Steven H. Woolf, MD, MPH, break down five areas of focus: access to health care, youth and parent behavior, social determinants of health, physical and social environments, and public policies, urging significant changes in public health strategy – including social media protections, anti-poverty measures, health insurance coverage, improved primary care and firearm safety laws.

"Without decisive action to change the trajectory, the U.S. health disadvantage is likely to worsen," they write. "Policymakers who are invested in enhancing children's health must intervene."