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Infant development and COVID, Vol. 2

We’re here to help you stay on top of the latest research findings and provide pointers for how to discuss them with families.

December 11, 2022

As we approach the 3-year anniversary of the pandemic(!), just about all the children on our EI caseloads were born during the pandemic or in its immediate wake. That means that we’re often fielding questions about how they are faring. We’ve covered this topic previously, but research continues to emerge. First, we’ll go over what new research has come out, and then we’ll give you some pointers for how to approach these conversations with families and colleagues.

 

Frequently asked questions

 

#1: How are “pandemic babies” faring developmentally?

 

“Pandemic-associated social isolation appears to have impacted social communication skills in babies born during the pandemic compared with a historical cohort.”

 

– Byrne et al., 2022

 

The results we’re seeing vary a lot, depending on the study design and sampling. This was true for previous findings, and remains true for new research:

  • Byrne et al. (see news coverage here) found that children born during the pandemic were less likely to have achieved the milestones of waving, saying one meaningful word, and pointing by their first birthday, compared to children born before the pandemic.
  • Sperber at al., on the other hand, didn't find significant differences between the length of pandemic exposure and infants’ language or social-emotional development at 12 or 24 months.

While it can be frustrating to try to make sense of the conflicting findings, the complexity of the research represents the complexity of the question. It does appear that the pandemic affected infants’ language and social development, but to what extent, in what ways, and for whom isn't well understood yet.
 

#2: Does caregiver masking affect vocabulary development?

 

Most likely yes to some extent, but the research hasn’t (and likely won’t be able to) give us a clear answer on that. Remember, causation is incredibly tricky to demonstrate in these scenarios. Morag et al. published a small (n=50) study utilizing parent surveys that found children who spent more time with masked adults had smaller expressive vocabularies but didn’t differ in receptive vocabularies. We would need a lot bigger and more robust studies to make any large-scale conclusions on this topic. We do know, however, that mask use helps to limit the spread of COVID-19, and should be used as needed to protect children and their caregivers.

 

#3: Is being exposed to COVID in utero a risk factor for later developmental delays?

 

So far, the results seem encouraging, but different studies contradict each other and are inconclusive:

  • Ayed et al. found that only 10% of their sample of infants exposed to COVID in utero showed developmental delays on the ASQ-3. This is on par with a demographically similar cohort born pre-pandemic (in which 15% of the sample showed delays on the ASQ). The prevalence was higher for infants exposed in the first or second trimesters, compared to the third.
  • Martonot et al. did not find any adverse outcomes at 10 months for infants exposed to COVID in their last two weeks in utero.
  • Edlow et al., on the other hand, found that in-utero exposure was associated with a higher rate of neurodevelopmental disorders at 12 months and that the prevalence was higher for exposure during the third trimester. This study had significant methodological limitations, as were raised in this commentary.

A question to consider for all of these studies, as was raised by the commentary, is: Is in-utero exposure causing delays, or is it all of the swirling factors surrounding the pandemic that are at play? We likely won’t ever have a study that can tell us this with any degree of certainty.
 

Pointers for talking with parents and colleagues

 

We can help to shape dialogue from fear-driven conversations to productive lines of thinking about how we can support children and meet them where they’re at. Here are three pointers to help us do that:

 

#1: Encourage science literacy

 

Understanding these general rules of thumb can go a long way in making sense of all of the different information out there.

  • Proving what-causes-what is notoriously tricky. The pandemic affected nearly every area of our public and private lives, so any claim of “x caused y” is going to be an oversimplification of very complex relationships.
  • Population-level findings have limited implications for individual children. They can tell us about trends, but each child’s experiences are unique.
  • The pull to make extreme claims and conclusions is strong, especially for media outlets. All studies have strengths, weaknesses, and limitations, though, and there is always more nuance than what can be discussed in a news article.

 

#2: Be wary of excessive focus on milestones

 

One theme that often comes up in these conversations is the idea of needing to help kids “catch up.” This can reinforce the idea that there is a specific benchmark that children need to hit in order to “be OK.” But milestones (ah, remember when we deep-dived into those this past January?) are just one part of the picture and tell a limited story of children’s development.

 

#3: Focus on what parents can do

 

We can approach these conversations from a couple different lines of thinking: aversive and appetitive, which Callahan highlights in his work around goal-setting. The terms are a little weird, but bear with us—we think the concepts behind them are helpful:

  • Aversive - where we try to avoid negative outcomes. (e.g. Oh no, a whole generation might be delayed and we can’t let them fall farther behind!)
  • Appetitive - where we orient towards the positive outcomes we want and hope for children. (e.g. We want children to thrive, so how can we help them do that, given the experiences they have had?)

Consider the following examples:

  • Parent comment: My child is late on some milestones and I’m afraid they will be way behind in school! (aversive)
  • Possible response: Of course you want your child to be prepared for school. Let’s brainstorm things you can do now to help with that. Reading books together at home, like you do, is a step in the right direction. (appetitive)

 

  • Parent comment: My child hasn’t had many chances to interact with other children. What if that means they struggle to make friends? (aversive)
  • Possible response: Of course you want your child to be able to play well with other children and make friends. I wonder what support they’ll need as they start to spend more time with other children in order to feel comfortable. Tell me about how they currently interact with other kids. (appetitive)

Rather than being driven by fear, let’s focus our energy and efforts towards meeting children where they are at. We can’t change the past, but we can work together to offer the opportunities and support that these children need.


 

Ayed, M., Embaireeg, A., Kartam, M., More, K., Alqallaf, M., AlNafisi, A., Alsaffar, Z., Bahzad, Z., Buhamad, Y., Alsayegh, H., Al-Fouzan, W., & Alkandari, H. (2022). Neurodevelopmental outcomes of infants born to mothers with SARS-CoV-2 infections during pregnancy: A national prospective study in Kuwait. BMC Pediatrics. https://doi.org/10.1186/s12887-022-03359-2

 

Byrne, S., Sledge, H., Franklin, R., Boland, F., Murray, D. M., & Hourihane, J. (2022). Social communication skill attainment in babies born during the COVID-19 pandemic: A birth cohort study. Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2021-323441

 

Edlow, A. G., Castro, V. M., Shook, L. L., Kaimal, A. J., & Perlis, R. H. (2022). Neurodevelopmental outcomes at 1 year in infants of mothers who tested positive for SARS-CoV-2 during pregnancy. JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2022.15787

 

Martenot, A., Labbassi, I., Delfils-Stern, A., Deruelle, P., & Kuhn, P. (2022). Medical and neurodevelopmental outcomes at 10 months of age in infants born at 34 weeks plus to mothers with COVID-19. Acta Paediatrica. https://doi.org/10.1111/apa.16570

 

Metz, T. D. (2022). Is it exposure to the pandemic or to maternal SARS-CoV-2 infection that is adversely affecting early childhood neurodevelopment? JAMA Network Open. https://doi.org/10.1001/jamanetworkopen.2022.15793

 

Morag, I., Berezin, A., Zivan, M., & Horowitz-Kraus, T. (2022). Children exposed to masked adults in the first year of life demonstrated lower expressive vocabulary. Acta Paediatrica. https://doi.org/10.1111/apa.16505

 

Sperber, J. F., Hart, E. R., Troller-Renfree, S. V., Watts, T. W., & Noble, K. G. (2022). The effect of the COVID-19 pandemic on infant development and maternal mental health in the first 2 years of life.  Infancy. https://doi.org/10.1111/infa.12511

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