When Dr. Christopher Forrest began his career in pediatrics some 25 years ago, he says it was pretty uncommon to see children come in with chronic conditions. But that’s changed. Nowadays, he says anecdotally, more children come into the hospital and even primary care practices with chronic disease.

“They just seem to be sicker. And it turns out they are,” says Forrest, a professor of pediatrics at Children’s Hospital of Philadelphia.

In a new study in the journal JAMA, Forrest and his colleagues report that the health of America’s children has significantly worsened across several key indicators since 2007.

They found that a U.S. child was 15% to 20% more likely to have a chronic condition in 2023 than a child in 2011. In particular, the prevalence of depression, anxiety, sleep apnea and obesity all increased, as did rates of autism, behavioral problems, developmental delays and attention-deficit hyperactivity disorder.

Reports of problems such as poor sleep, limited physical activity, early-onset menstruation and loneliness also rose.

“I think the overall message is that children’s health in the United States has been declining for almost two decades,” Forrest says. He says the researchers consulted eight comprehensive data sets, including nationally representative surveys and millions of electronic pediatric health records.

The researchers also looked at mortality rates for American infants, young children and teenagers and compared them to their peers in other high-income countries over time. Forrest says that back in the 1960s, “the chance that a child was going to die in the United States was the same as European nations.” But that’s no longer the case, he says.

“What we found is that from 2010 to 2023, kids in the United States were 80% more likely to die” than their peers in these nations, he says.

Among infants, these disparities in mortality were driven largely by sudden unexpected infant death and prematurity. In older children and adolescents, the gap was fueled by gun violence, motor-vehicle crashes and substance abuse.

“In 2020, firearm mortality overtook motor vehicle crashes as the leading cause of death in U.S. youth,” the authors write.

Dr. Frederick Rivara is a professor of pediatrics at the University of Washington. He co-wrote an editorial that accompanies the new study in JAMA. He says health care coverage is one major reason why American kids seem to fare worse than their peers in other rich nations. He notes that unlike Canada or the United Kingdom, the U.S. does not offer universal health care coverage.

“And now that’s going to get worse with kids being removed from Medicaid,” Rivara says, because of huge cuts to the Medicaid program for low-income Americans that were included in the tax and spending bill President Trump signed into law last week.

According to the Pew Research Center, an estimated 41% of all U.S. children were enrolled in Medicaid as of January.

“While the administration’s Make America Healthy Again movement is drawing welcome attention to chronic diseases and important root causes such as ultra-processed foods, it is pursuing other policies that will work against the health interests of children,” Rivara and his co-authors wrote. That includes massive budget cuts at the Department of Health and Human Services, including to injury prevention programs and the elimination of the team that ran the Safe to Sleep campaign for babies, aimed at reducing incidents of sudden infant death syndrome, and initiatives that question the safety of childhood vaccines.

Edited by Jane Greenhalgh

Copyright 2025 NPR

Key takeaways U.S. children and teens were nearly twice as likely to die as their peers in 18 other high-income countries between 2007 and 2022, researchers found.

Among 3- to 17-year-olds, the prevalence of chronic conditions increased from 39.9% to 45.7% in pediatric health systems.

Childhood obesity increased from 17.0% to 20.9%.

The health of children in the United States has deteriorated significantly across nearly every major health indicator over the past 17 years, according to a study led by Dr. Christopher Forrest and a team of researchers at Children’s Hospital of Philadelphia (CHOP), along with Dr. Neal Halfon of UCLA.

The study, published in JAMA, draws on data from several national surveys, mortality statistics, and electronic health records from over 2 million children.

“This study confirms what many pediatricians, educators, and parents have been sensing for years; that our children are facing a growing health crisis,” said Halfon, distinguished professor of pediatrics and director of the UCLA Center for Healthier Children, Families & Communities. “The breadth and consistency of these declines across physical, mental, and developmental health indicators demand urgent national attention.”

The study analyzed 172 health indicators using data from five national surveys, U.S. and international mortality databases, and PEDSnet — a network of 10 pediatric health systems.

The study found that U.S. children and teens were nearly twice as likely to die as their peers in 18 other high-income countries between 2007 and 2022. Leading causes of death included firearm injuries, motor vehicle crashes and infant deaths due to prematurity and sudden unexpected infant death.

Chronic conditions also rose sharply: among 3 to 17-year-olds, the prevalence of chronic conditions increased from 39.9% to 45.7% in pediatric health systems and from 25.8% to 31.0% in the general population. Diagnoses of anxiety, depression and eating disorders more than tripled in some cases. Childhood obesity increased from 17.0% to 20.9% and early onset of menstruation rose by over 60%. More children reported trouble sleeping, physical symptoms like fatigue and pain and feelings of loneliness and sadness.

The authors emphasized that these findings should prompt a national reckoning with the systemic factors driving these trends. Future research will focus on identifying the root causes — including social, economic and environmental contributors — and informing policy and practice changes that can reverse the decline. The study underscores the urgent need for a coordinated, cross-sector response to rebuild the developmental ecosystem that is so crucial for supporting healthy child development.

Key Points A study published in JAMA has found that children’s health in the United States has declined since 2007.

Researchers and experts cite many reasons for this, including the rise of gun violence, food insecurity, and health care accessibility.

The report highlights a necessity for policies that can improve collective health.

A new study published in the journal JAMA finds that children’s health in the U.S. has worsened since 2007, with researchers reporting that a child in this country was 15% to 20% more likely to have a chronic condition in 2023 than a child in 2011.

In particular, they found that kids are more likely to die as infants due to prematurity, sudden infant death syndrome (SIDS), congenital anomalies, and respiratory infections compared to 17 years ago. At the same time, older children are more likely to die due to gun violence, motor vehicle accidents, and substance abuse. Likewise, the rates of depression, anxiety, obesity, and sleep apnea increased, as did rates of autism, developmental delays, and attention-deficit hyperactivity disorder (ADHD).

The study also found that kids in the U.S. were roughly 80% more likely to die than their peers in European countries. The two causes of death that are greatest for kids younger than 12 months are premature birth and SIDS. For kids older than 1 year, the greatest causes of death are gun violence and motor vehicle crashes.

“These findings are a call to action to address the underlying root causes and to renew the focus on promoting the health of the whole population,” says Alex Kemper, MD, MPH, division chief of Primary Care Pediatrics at Nationwide Children’s Hospital.

Why Is Collective Health Declining?

According to Dr. Kemper, children’s health should not be viewed in isolation since it reflects the overall health of our communities. For instance, the biggest cause of infant mortality in the United States is prematurity, so improving maternal health reduces the risk of prematurity, he says.

“For older children, the biggest cause of death is related to firearms, which we must address,” says Dr. Kemper. “Other factors that contribute to the decline in child health include access to high-quality nutritious foods and green space. Other studies have shown that children whose families have food insecurity are more likely to have obesity.”

Many complex social factors lead to health inequalities, he says. In addition to addressing these issues, Dr. Kemper says we also need to ensure that children and teens have access to medical care to prevent or treat health problems.

“There are additional threats on the horizon,” says Dr. Kemper. “We now have the [highest] number of cases of measles in this country in more than 25 years, despite easy access to a safe and highly effective vaccine. Vaccine skepticism is likely to have long-term negative consequences. Reducing access to medical care for families by cutting Medicaid will also make the trends worse.”

The Role of Gun Violence in This Data

School shootings are at an all-time high, according to a study published last year in Pediatrics. Plus, in the last 10 years, there have been more fatalities and injuries than in the previous 15 years.

“Gun violence is now the leading cause of death in U.S. children and adolescents,” says Heather Felton, MD, a pediatrician at Norton Children’s in Louisville, Kentucky. “These are preventable deaths, and this is a uniquely American crisis.”

Part of the issue could be easy access to firearms—especially at home—and a need for more policies around gun restrictions and ownership. “The increase in mortality due to gun violence is staggering,” says Jomarie Rivera, MD, a pediatrician with IWS Children’s Clinic in Oak Park, Illinois. “As a student, I learned that motor vehicle accidents were the number one cause of death, though by 2009, firearms became the leading cause and have continued to be the leading cause of mortality to this day.”

How Experts Suggest Collective Health Can Improve

According to Dr. Kemper, it has taken a long time for these problems to develop, and there will be no quick fix—especially on an individual level. To start, he says, addressing the underlying problems will require policy solutions.

“We should not just focus on keeping children and teens from developing health problems, but focus on what it will take to have them thrive and be successful adults,” he says. “This is complicated and hard work, but critical for our future.”

To improve these numbers across the board, Dr. Rivera says it has to be a concerted effort by our politicians, health care leaders, and communities to prioritize children’s health.

“There should be a focus on prevention, ensuring pregnant women have resources to get high-quality prenatal care to help with a healthy delivery, as well as giving parents access to high-quality health care providers for scheduled well-child visits and vaccinations,” says Dr. Rivera. “In recent years, there has also been a decline in the number of medical students choosing to enter pediatrics, and I don’t think the field’s reputation as being the lowest paid medical specialty helps.”

What Can Parents Do?

Families and caregivers should talk to their child’s health care provider about the things that can be done to help their kids thrive. “This ranges from safe sleep practices, the appropriate use of car seats and seatbelts, vaccination, safe gun storage, and healthy nutrition and exercise.”

However, he says parents and community members also need to talk to each other about the lessons from this study and other similar studies and come up with ways to implement evidence-based solutions that are beneficial for everyone.

In the meantime, here are some things Dr. Felton and Dr. Rivera say you can do to prioritize your child’s health today and help change the trajectory of this trend for your child.

Keep regular check-ups and well-child visits

Allow your pediatrician to monitor and screen for conditions and offer anticipatory guidance

Discuss what community services are available

Follow safe sleep guidelines

Prioritize healthy sleep, nutrition, and exercise

Limit social media and screen time

Monitor mental health and advocate for services

Secure firearms safely and talk to your kids about them—even if you don’t own one

Encourage more play, which can help with obesity and mental health

Get kids involved in an organized sport or activity

Contact lawmakers to advocate for better gun control laws

Advocate for more funding for early intervention and after-school programs

“There are often too few resources for children to access mental health services,” says Dr. Felton. “School and community support, firearm safety legislation, and programs to address inequity in things like healthy food, safe places to learn and play, education, and access to health care [could help address this issue].”

The foundation of a nation’s health and prosperity lies in the well-being of its children. However, a concerning trend has emerged in the US, where children’s health has declined over the past 17 years, with alarming increases in obesity, chronic diseases, and mental health issues like depression, threatening their future and the nation’s prosperity.

The study titled as, “Trends in US Children’s Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms” suggests that, “the health of US children has worsened across a wide range of health indicator domains over the past 17 years. The broad scope of this deterioration highlights the need to identify and address the root causes of this fundamental decline in the nation’s health.”

Much of what researchers found was already known, but the study paints a comprehensive picture by examining various aspects of children’s physical and mental health at the same time.

“The surprising part of the study wasn’t any with any single statistic; it was that there’s 170 indicators, eight data sources, all showing the same thing: a generalized decline in kids’ health,” said Dr. Christopher Forrest, one of the authors of the study published Monday in the Journal of the American Medical Association.

Health Secretary Robert F Kennedy Jr has brought children’s health to the forefront of the national policy conversation, unveiling in May a much-anticipated “Make America Healthy Again” report that described kids as undernourished and overmedicated, and raised concerns about their lack of physical activity. But the Trump administration’s actions – including cuts to federal health agencies, Medicaid and scientific research – are not likely to reverse the trend, according to outside experts who reviewed Monday’s study.

“The health of kids in America is not as good as it should be, not as good as the other countries, and the current policies of this administration are definitely going to make it worse,” said Dr. Frederick Rivara, a pediatrician and researcher at the Seattle Children’s Hospital and UW Medicine in Seattle. He co-authored an editorial accompanying the new study.

Forrest and his colleagues analyzed surveys, electronic health records from 10 pediatric health systems and international mortality statistics.

Among their findings:

Obesity rates for US children 2-19 years old rose from 17% in 2007-2008 to about 21% in 2021-2023. A US child in 2023 was 15% to 20% more likely than a U.S. child in 2011 to have a chronic condition such as anxiety, depression or sleep apnea, according to data reported by parents and doctors. Annual prevalence rates for 97 chronic conditions recorded by doctors rose from about 40% in 2011 to about 46% in 2023.

Early onset of menstruation, trouble sleeping, limitations in activity, physical symptoms, depressive symptoms and loneliness also increased among American kids during the study period.

American children were around 1.8 times more likely to die than kids in other high-income countries from 2007-2022. Being born premature and sudden unexpected death were much higher among U.S. infants, and firearm-related incidents and motor vehicle crashes were much more common among 1-19-year-old American kids than among those the same age in other countries examined.

MICHEL MARTIN, HOST:

It turns out that the kids are not all right. That is the conclusion of a study that indicates the health of America’s children has significantly worsened since 2007. As NPR’s Maria Godoy reports, that includes the number of kids and teens with chronic diseases.

MARIA GODOY, BYLINE: Dr. Christopher Forrest is a professor of pediatrics at Children’s Hospital of Philadelphia. He says 25 years ago, it was pretty uncommon to see kids come in with chronic conditions, but that’s changed.

CHRISTOPHER FORREST: We’ve been seeing, sort of anecdotally, more and more kids come into the hospital, come into specialty clinics and also populate our primary care practices with more chronic disease. They just seem to be sicker.

GODOY: It turns out they are. In a new study in the journal JAMA, Forrest and his colleagues report that a U.S. child was 15% to 20% more likely to have a chronic condition in 2023 than a child in 2011. In particular, the prevalence of depression, anxiety and obesity all increased. So did symptoms like poor sleep and loneliness.

FORREST: I think the overall sort of message is that children’s health in the United States has been declining for almost two decades.

GODOY: The researchers also looked at mortality rates for American infants, kids and teens and compared them to their peers in other high-income countries over time.

FORREST: In the 1960s, the chance that a child was going to die in the United States was the same as European nations.

GODOY: But he says that’s no longer the case.

FORREST: What we found is that from 2010 to 2023, kids in the United States were 80% more likely to die.

GODOY: Among infants, these disparities were driven largely by sudden unexpected infant death and prematurity. In older children and adolescents, the gap was fueled by firearm injuries, motor vehicle crashes and substance abuse.

Dr. Frederick Rivara is a professor of pediatrics at the University of Washington. He says health care coverage is one big reason why American kids seem to fare worse than their peers in other rich nations.

FREDERICK RIVARA: And now that’s going to get worse with kids being removed from Medicaid.

GODOY: That’s because of the huge cuts to the Medicaid program included in the tax and spending bill President Trump signed into law last week.

Maria Godoy, NPR News.

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