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In March 2020, the World Health Organization declared that the outbreak caused by the new crown virus met the criteria of a "pandemic". Fast forward almost two years, and the first babies born during the pandemic are now more than 650 days old.
"The first 1,000 days of life are the early foundations that are crucial for a child's development." Many pediatric experts, including UNICEF Senior Adviser Dr Jennifer Requejo, agree. As a result, babies born during the pandemic have attracted their attention and concern.
Image credit: 123RF
These children, known as the "COVID generation", begin to be under unprecedented stress in the womb, almost all strangers seen after birth wear masks, hear nursery rhymes that may often come from screens, and don't even know that the opportunities to play with their friends could have been more... Do these changes delay neurodevelopment? If so, how big is the impact? How long will it last? Can it be remedied after the end of the epidemic?
Drawing conclusions from large-scale analysis can take years or even decades. But over the past two years, the results of some small-scale studies are revealing that the generation born during the epidemic has been affected by many sources, even if it is not infected with the virus.
This month, an in-depth article in the journal Nature explores how the pandemic has shaped children's brains and behaviors. In this article, we'll take a look at some of the existing results.
Decreased prenatal stress and communication skills
Some pediatricians at Morgan Stanley Children's Hospital in New York-Presbyterian Church have been concerned with the neurodevelopment of infants and young children since before the pandemic, particularly communication and motor skills within the first six months of life.
After the outbreak, they first looked at whether viral infections caused neurodevelopmental delays in newborns. The good news is that babies who were exposed to the coronavirus in their mother's belly don't seem to have their concerns after birth. However, they soon discovered unexpected problems.
When the researchers compared babies born during the pandemic to pre-pandemic data, they found that these "COVID-19" babies generally scored low on the big motor, fine motor and communication skills tests. This trend has nothing to do with whether the parents of infants are infected with COVID-19, which means that the pandemic environment may be the problem.
Based on their recent results, published in JAMA Pediatrics, a top journal in pediatrics, the researchers analyzed that the enormous stress that mothers experience during pregnancy may be a major factor in negatively impacting fetal brain development.
Researchers at the University of Calgary in Canada surveyed more than 8,000 pregnant women during the outbreak. Nearly half reported symptoms of anxiety, and one-third had depressive symptoms — a much higher proportion than in the years before the coronavirus outbreak.
After an MRI scan of the baby's brain 3 months after birth, they found that mothers with more anxiety or depression during pregnancy seemed to affect the neural connections in the fetal brain.
Researchers looked at connections between the amygdala (the brain area involved in emotional processing) and other brain regions in the baby's brain (Credit: Kathryn Manning)
Other studies have found similar associations between prenatal stress and child development. Italian psychologist Dr. Livio Provenzi and colleagues have observed that babies born to mothers who are more stressed and anxious during pregnancy have more problems regulating mood and attention at three months of age, such as the inability to maintain attention to social stimuli and less easily appeased.
One perhaps reassuring piece of news is that while intrauterine pressure can be detrimental to the baby, some historical studies suggest that the effects may not be long-lasting. The state of Queensland, Australia, experienced flooding in 2011, and some pregnant women were under enormous stress during this period. When they gave birth to children who were six months old, they showed problem-solving and social skills deficits compared to the control group; but by 30 months, the results showed that prenatal stress was related to this, and the more acutely the parents responded to their needs after birth, the better the toddler's performance.
Lack of interaction with motor skill deficiencies
Another concern may be after birth: Infants and toddlers do not interact as much with their parents and caregivers as they did before the pandemic. Especially during the period of isolation and lockdown, many small families have reduced their entertainment time and social interaction, and people in care roles may not be able to fully interact with infants and young children due to great stress or poor physical condition.
Sean Deoni, Ph.D., an associate professor of pediatrics at Brown University, and colleagues develop and apply techniques such as magnetic resonance imaging (MRI) to study infants' cognitive development and track the development of motor, visual, and language skills. Over the past two years, however, they have come to notice that it takes longer for children to pass the assessment than in the past when they come to the institute to test their development.
They measured the neurodevelopment of infants and young children in a similar way to IQ tests. Compared to babies born in the decade before the outbreak (2011-2019), they found that babies born in these two years had significantly reduced speech, movement and overall cognitive abilities. Among them, low-income families have the largest decline in infants, boys are more affected than girls, and large motor skills are most obviously affected. The study has been published on a preprint server and is currently being reviewed in peer-reviewed journals.
Dr. Deoni and colleagues evaluated more than 600 children between the ages of 3 months and 3 years and found that babies born in 2020 and 2021 had lower scores on cognitive development tests (Image source: Reference[1])
According to Dr. Deoni's analysis, these problems stem primarily from a lack of interaction. In a follow-up study that has not yet been published, his research team documented parent-child interactions at home, where parents have talked to their children less than in previous years in the past two years. In addition, infants and toddlers can't get as many big exercise exercises as they used to have because they can't often play with other children or go to the playground.
The idea that a lack of interaction with peers can hinder the neurodevelopment of some children is supported by a number of other studies. For example, in a paper published in May 2021, researchers in the UK surveyed 189 local households, where parents reported whether children between the ages of 8 and 3 in their families had received daycare or preschool during the pandemic, while the researchers assessed the language and executive function skills of these children. They found that children who received group care during the pandemic had stronger skills.
The study also found that the benefits of collective care are more pronounced for children from low-income families, who often have a harder time providing a supportive learning environment at home and more difficult for parents to allocate time between caring for young children, educating other children and working at the same time.
The impact of masks
The potential impact of wearing masks on children's development has also caught the researchers' attention. Experiments by psychologists have shown that wearing a mask is as easy as wearing sunglasses to misidentify people and misunderstand the multiple emotions conveyed by the face. In addition, for young children who are learning languages, when the opaque mask covers the movement of the mouth, it will not affect their understanding of what adults say, which is also a problem for parents.
Professor Edward Tronick, a psychologist at the University of Massachusetts boston, did a classic experiment in the 1970s: When parents interact face-to-face with their babies, if they suddenly have no expression, they will make the babies panic and reduce interaction.
During the pandemic, he and his colleagues conducted a new experiment to see if masks had a similar effect. They used videos recorded by parents with mobile phones to evaluate parents' interactions with babies, and found that babies would briefly change their expressions after noticing that their parents were wearing masks, shifting their gaze or finger masks, etc., but did not interrupt their interaction with their parents, which seemed to indicate that masks did not completely block the child's perception of emotions.
Another study looked at the effects of different masks on 2-year-olds recognizing speech. The experimental results showed that wearing an opaque mask and saying words familiar to the child did not affect the child's understanding, which was the same as the recognition result when not wearing a mask. Study author Dr Leher Singh, a psychologist at the National University of Singapore, argues that children "make up for information deficits more than we thought" in children. However, the researchers found that when wearing a transparent mask to speak, because the transparent medium brings some interference to visual observation, it will affect the child's recognition of spoken language.
How to make the new generation grow better?
Many researchers believe it is too early to draw conclusions from these early studies on the impact of the pandemic on their lives for babies born in these two years. A number of large studies involving multinational research institutions have been launched, and researchers are sharing data to learn more about how to make the COVID-19 generation better grow.
Some researchers hold positive ideas, arguing that many underdeveloped children are able to catch up and have no lasting effects. Professor Moriah Thomason, a child and adolescent psychologist at NYU's Grossman School of Medicine, for example, said some of the findings pointing to negative trends may be more likely to attract attention, "but I'm sure this generation won't end up hurt by this pandemic." ”
Her ongoing research is also evaluating how maternal prenatal stress affects babies, but she stresses: "Children are adaptable and resilient. We'd love to see that as things get better, kids are able to 'bounce back' on a lot of things. ”
Another pediatrician, Dr. Dani Dumitriu, agrees that even if children's brains are really affected by the pandemic, it's not too late: "The brains of six-month-olds are so malleable that we can intervene to change their trajectory." ”
These existing studies suggest that it makes sense to gain more support during pregnancy, such as from a partner or close friend, to reduce stress in pregnant women.
The researchers also advocate that some interventions be taken to support families immediately after the birth of the child. Parents can play and talk to their younger children on a regular basis, giving them the opportunity to play with others in a safe environment. A number of policies designed to support families and children will work better for this particular generation.
Resources:
[2] Meet 'Gen C,' the Covid generation. Retrieved Jan. 13, 2022, from https://edition.cnn.com/2021/03/11/us/covid-generation-gen-c/index.html
[3] Lauren C. Shuffrey et al., (2022) Association of birth during the COVID-19 pandemic with neurodevelopmental status at 6 months in infants with and without in utero exposure to maternal SARS-CoV-2 infection. JAMA Pediatrics Doi:10.1001/jamapediatrics.2021.5563
[4] Deoni, S. C. L., Beauchemin, J., Volpe, A., D’Sa, V. & the RESONANCE Consortium. (2021) Impact of the COVID-19 Pandemic on Early Child Cognitive Development: Initial Findings in a Longitudinal Observational Study of Child Health. Preprint at medRxiv https://doi.org/10.1101/2021.08.10.21261846
[5] Davies， C. et al. (2021) Early childhood education and care (ECEC) during COVID-19 boosts growth in language and executive function. Infant Child Dev. Doi: https://doi.org/10.1002/icd.2241
[6] Leher Singh et al., (2021) Infants recognize words spoken through opaque masks but not through clear masks. Dev Sci. DOI: 10.1111/desc.13117
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