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The Decline in Children’s Health in the United States

(Originally published October 2025)

A recently published JAMA study, “Trends in US Children’s Mortality, Chronic Conditions, Obesity, Functional Status and Symptoms,” by Forrest, et al, compares trends in US children’s health from 2007-2023 with children’s health in 18 high income nations from the Organization for Economic Co-operation and Development (OECD18). The study utilized mortality statistics from the US and OECD18, five nationally representative surveys and electronic health records from ten pediatric health systems (PEDSnet). The sample included individuals younger than 20 years old. Sample sizes ranged from 1,623 to 95,677 across surveys; 1,026,926 to 2,114,638 for PEDSnet; 81.9 million to 83.2 million in the U.S. and 118.4 to 121.1 million in the OECD18 for mortality statistics.

The authors state: “From 2007 to 2022, infants (<1 year old) in the US were 1.78 … times more likely to die as infants in the OECD18. During the same period, 1-to 19-year-old individuals were 1.80 times as likely to die in the US … Across the16-year period, the US experienced 315,795 excess deaths compared with the OECD18, which is equivalent to 54 excess child deaths per day.” Furthermore, “a child in the US in 2023 was 15% to 20% more likely to have a chronic condition compared with a child in 2011. Annual prevalence rates of 15 chronic conditions for 3-to 17-year-old individuals increased from 25.8% to 31.0% for parent-reported data from the NSCH (National Survey of Children’s Health), and from 39.9% to 45.7% for 97 chronic conditions for clinician recorded data from PEDSnet.”

Forrest, et al comment: “Asthma rates significantly increased” and “The 8 conditions with the largest increases were major depression (RR, 3.30), sleep apnea (RR, 3.22), eating disorder (RR,3.30), autism spectrum disorder (RR, 2.62), obesity (RR, 2.37), disorders of limpid metabolism (RR. 2.06) and developmental disorder (RR, 2.05). The increase in obesity is particularly noteworthy as the US children’s obesity rate for 2- to 19-year-olds was 5.2% in 1971-1974 compared to 19.3% by 2017-2018 and 20.9% in 2022. For some conditions, the increase in prevalence rates began decades before 2007-2023. According to Forrest, et al, “childhood mortality rates in the US were comparable with those of OCED nations during the 1960s, but became consistently higher in the1970s.”

Perhaps from the researchers’ perspective the decision to use 2007 as the baseline was coincidental, but in 2007 the use of smart phones began to be widespread. The decline in children’s mental health has been associated with smart phone technology and with large amounts of screen time use for children 10-19, though some scholars insist that addictive use of smart phones is different and more damaging than the amount of screen time per se.

The authors assert: “Depressive symptoms (feeling sad or hopeless) significantly increased from 26.1% of 9th to 12th graders in 2009 to 39.7% in 2023. Loneliness feelings … among 12-to-18-year-old individuals significantly rose from 20.2% in 2007 to 30.8% in 2021.” Forrest, et al, comment: “Temporal trends also showed deterioration in sleep health and increasing limitations in activity, alongside worsening of an extensive range of physical and emotional symptoms.”

There is more bad news discussed in “The New Crisis of Increasing All -Cause Mortality in US Children and Adolescents,” by Woolf, et al (JAMA, 2023). Suicide rates of children and adolescents 10-19 increased by almost 70% from 2007 to 2019. Child homicide rates increased from 2013 to 2019 by 32.7%. “Between 2019 and 2020 the all-cause mortality rate for ages 1-19 years increased by 10.7%, and it increased by an additional 8.3% between 2020 and 2021.” Woolf, et al comment: “These increases, the largest in decades, followed a period of great progress in reducing pediatric mortality rates. Although most of the upsurge in pediatric mortality was attributable to deaths among older children (ages 10-19), all-cause mortality in younger children (ages 1-9) also increased in 2021 (by 8.4%).”

The author’s comment: “this reversal in pediatric mortality trajectory was caused not by COVID-19, but by injuries …. COVID-19 mortality rates at ages 1-19 nearly doubled in 2021 but explained only 20.5% of that year’s increase in all-cause mortality.” Mortality for all causes of pediatric mortality other than COVID-19 and injuries declined in 2021, these researchers state.

One might expect that a deterioration in children’s physical and mental health of this magnitude would have led to intense concern and discussion of causes and possible solutions, but the social response has been remarkably muted. Forrest, et al, do not discuss possible causes of the decline in children’s health they describe except to say: “It is probable that many of the negative health trends in the US are being driven by race and ethnicity and socioeconomic disparities.”

Woolf, et al assert, “All youths did not face an equal risk of injury deaths.” … “non-Hispanic Black youths accounted for two-thirds (62.9%) of homicide victims, 10-19 years; in 2021, the homicide rate among non- Hispanic Black youths aged 10 to 19 years was 6 times that of Hispanic youths and more than 20 times than that of Asian/Pacific Islander non- Hispanic youth and White youths.” Forrest, et al, assert that “US children were 15 times more likely than their counterparts in the OECD18 to die by a firearm.” Suicide rates for American Indian and non-Hispanic Black youth in 2019 were more than twice the rate for non- Hispanic White youth, Woolf, et al state.

Guidelines for causal explanations

Given the information in these two articles regarding the decline in children’s health and increase in all-cause mortality, cogent causal explanations should do the following:

Explain why the decline in children’s physical and mental health affects so many chronic conditions. Forrest, et al assert: “Within the PEDSnet data, among the 29 most common chronic conditions, 22 significantly increased from 2010 to 2023 by 10% or more,” and several conditions and symptoms (such as chronic pain) doubled or tripled in prevalence during recent years.
Explain why children’s health in the OECD18 has improved while US children’s health has dramatically worsened. What public policy differences could account for the marked divergence of child health indicators between the US and OECD18?
Identify differences in causes for infants, young school age children and adolescents.

Infant Mortality

The infant mortality rate per 1000 live births “is widely recognized as a critical indicator of a nation’s overall health and development.” (Worldostats, 2025) The U.S. infant mortality (IM) rate has steadily declined for decades, but not to the extent of IM rates in Iceland, some Western European countries (e.g., Finland, Norway), Japan and Singapore, the country with the lowest rate (1.5) in 2025. The U.S rate of 5.2. per 1000 is 2-3 times higher than the ten countries with the lowest IM rates.

According to Worldostats: “It (IM rate) reflects the quality of healthcare systems, the accessibility of medical services, maternal health, and the broader socioeconomic conditions that can affect a child’s survival in the early stages of life.” As such, a country’s IM rate is influenced by its overall wealth, poverty rate (including rate of severe poverty), family structure and kinship systems and by its maternal health policies and support for mothers during their baby’s first year of life.

Four Mothers: An Intimate Journey through the First Year of Parenthood in Four Countries (2025) by Abigail Leonard follows mothers of infants in Japan, Kenya, Finland, and the U.S. Leonard contrasts the supports mothers of infants receive in Japan, a country with one of the world’s lowest IM rates, with the absence of supports in the U.S. Regarding American mothers she states:

“They were encouraged to succeed at work and at home with no commensurate support system; they had professional opportunity but lacked the public framework to make it reasonably attainable without significant wealth or full-time family support.”

“It was the inverse of the problem Japanese mothers had. Here, mothers were expected to be professionals, but there was no universal daycare, no immaculate community centers where volunteer grandmothers sang to small children – no real infrastructure for young families. After so many years abroad, I could see the negative space where those programs should have been and the suffering their absence caused.”

In these comments, Leonard is discussing the predicament of professional women in her social class, but the challenges facing mothers employed in low wage jobs, or on welfare, or without income from welfare or work, are much greater. One in eighteen American families are severely poor, i.e., annual incomes less than half the federal poverty standard. (Desmond, 2023); but the percentage American Indian and Black families who are severely poor is much higher. In addition, Black Americans have the highest rate of single parenting among racial/ethnic groups. The combination of elevated rates of poverty and severe poverty, a relatively high percentage of single parent families and public policies that do little or nothing to support mothers during an infant’s first year of life has led to a Black IM rate double the White rate and triple the rate of Asian Americans. (2024 March of Dimes Report Card)

Leonard describes more parent friendly public policies that include 6-12 months of paid maternity leave, free or low-cost high quality child care, universal medical care and ample community support. In addition to lowering the IM rate, “A more parent friendly system would also produce healthier children, according to the philosophy espoused by the Finnish maternity system, which has had some of the best child health outcomes in the world for over a century,” Leonard asserts. One straightforward guideline for reversing the decline in US children’s health is to strengthen supports for mothers of all social classes, per the model of Finland, Norway and Japan. However, the US is currently doing the exact opposite, i.e., eliminating or weakening a wide range of essential services for women of infants and other young children.

Social disconnection

Extreme income inequality and a disregard in public policy for the needs of low-income families are one dimension of the decline in US children’s health, but are only a part of the story. It would be difficult to overestimate the damaging effects of misuse of smart phone technology on American youth of all social classes. It is common in the US to refer to technology as an agent of change; but this is a misleading way of pointing out the misuse of technology. Smart phones are not a causal agent, but using the technology to facilitate social disconnection has had disastrous effects on children’s mental health.

It is true that other factors such as changes in parenting practices that have encouraged the extension of childhood and delayed the emotional growth of adolescents also contributed to the following developments discussed by Jean Twenge in her book, iGen (2017):

Children grow up more slowly based on indicators of independent functioning such as engaging in activities outside the home without parental supervision.
Children and youth are less likely to hang out with friends outside the home
Adolescents are less likely to date and less likely to have sex by the 12th grade.
Adolescents are less likely to work outside the home
Adolescents are less likely to read for pleasure.

Twenge asserts: “Adolescence is now an extension of childhood rather than the beginning of adulthood,” as “more parents are attempting to create the conditions of perfect childhood in which all of children’s needs and wants are met within the family and because of new technology, the smartphone.” Twenge stated in 2017: “The average teen checks her phone eighty times a day,” and spends six hours per day on their phone outside of school texting, on social media, or watching TV or movies. Has adolescent use of smart phones declined since 2017? An AI summary I found online asserts that the average American teenager spends 7 hours per day on their smart phone and other screens, half texting and on social media, and that usage increases on weekends. The AI summary recommends that adolescent screen time should be limited to 1-2 hours per day.

In The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness, the social psychologist, Jonathan Haidt, points out that use of smart phones has not only reduced the time adolescents spend with their friends, it has changed the nature of in- person social interaction:

“With so many new and exciting virtual activities, many adolescents (and adults lost the ability to be fully present with the people around them, which changed social life for everyone …”

Haidt refers to the “Great Rewiring of Childhood” in which “the social lives of American teens moved largely into smartphones” leading to “a tidal- wave of adolescent mental illness” that includes large increases in anxiety, depression, self-harm and suicide. Young girls, 10-14 have been especially hard hit by these developments.

Haidt also discusses the marked reduction in unsupervised free play of school age children outside the home based on parents’ concerns for child safety. Haidt views this change in parenting practices as the “beginning of the end of play-based childhood.” American children as a whole are far less physically active than they were in past generations because a) a higher percentage have chronic conditions that limit their physical activity; b) they spend so much time on smart phones c) many parents limit out- of- home unsupervised activities to a minimum; even children who are physically active in sports often depend on parents to organize their activities. Lack of physical activity, in turn, worsens chronic conditions such as obesity, that rate of which has quadrupled among American children since 1970.

Haidt recommends the following guidelines:

No smartphones before high school
No social media before 16 years of age
Phone free schools
Far more unsupervised play and childhood independence.

These are sensible suggestions, and an increasing number of school districts no longer allow students to have access to their smartphones during school hours. However, it can be difficult for parents to enforce restrictions on smartphones and access to social media when doing so excludes their adolescent from online social interactions with their friends. What is needed is a cultural change that gives precedence to in-person social interaction over participation in the virtual world, a cultural shift that would require a large change in adult behavior. Instead, the world seems to be moving in the opposite direction.

Summary

The precipitous decline in US children’s health has two main clusters of causes:

The failure of public policy to support maternal health and well-being with paid maternal leave following birth for at least six months, universal health care, free or affordable child care, and other concrete assistance when required.
Social disconnection and much reduced physical activity among school age children resulting from addictive use of smartphones, along with widespread adoption of parenting practices that restrict children’s unsupervised free play outside the home.

Next month’s commentary will discuss the increase in children’s all-cause mortality resulting from the large increase in child homicide and suicide.

References

Desmond, M. Poverty, By America (2023), Crown Publishers, New York City, NY.

Forrest, C., Koenigsberg, L., Harvey, F., Maltenfort, M. & Halfon, N., “Trends in Children’s Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms,” JAMA 2025, 334(6), 509-516., published online, July 7, 2025.

Haidt, J., The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness (2024), Penguin Press, New York City, NY.

“Infant Mortality Rate by Country (2025), Highest and Lowest,” Worldostats, available online.

Leonard, A., Four Mothers: An Intimate Journey through the First Year of Parenthood in Four Countries (2025), Algonquin Books of Chapel Hill & Little, Brown & Company, New York City, NY.

“2024 March of Dimes Report Card for United States,” March of Dimes peristats, available online.

Woolf, S., Wolf, E. & Rivera, F., “The New Crisis of Increasing All-Cause Mortality in US Children and Adolescents,” JAMA, published online, March 13, 2023.

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©Dee Wilson

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