A study published in the Journal of the American Medical Association reveals a severe and widespread deterioration in the health of American children over the past 17 years, worthy of a national reckoning with the social, economic, and environmental root causes of this decline.
The research, led by a team from the Children’s Hospital of Philadelphia and UCLA, documents alarming increases in chronic illness, obesity, mental health conditions, and preventable deaths. They call for a coordinated response to rebuild what they term the “developmental ecosystem” essential for child health.
U.S. children are nearly twice as likely to die before age 20 compared to peers in 18 other high-income nations, with firearm injuries and motor vehicle crashes as leading causes.
Chronic conditions such as anxiety, depression, and obesity have risen sharply—with obesity rates climbing from 17% to nearly 21%. Early onset of puberty in girls increased by over 60%.
“This study confirms what many pediatricians, educators, and parents have been sensing for years; that our children are facing a growing health crisis,” said senior author Dr. Neal Halfon of UCLA. “The breadth and consistency of these declines demand urgent national attention.”
Dr. Ann Kellams, a pediatrician at UVA Health Children’s with 30 years of experience, was not surprised by the findings. She noted the shift in pediatric care from treating infections to addressing complex behavioral, mental health, and nutritional issues.
“The landscape of primary care pediatrics has gone from one of quick visits and infectious disease types of problems to behavior, mental health, poor nutrition, school problems, obesity – things that aren’t solved in a quick visit,” said Kellams, who was one of the first people in North America to become board-certified in breastfeeding and lactation medicine.
She said breastfeeding is key to setting children on a path to good health.
Kellams said breast milk is an active, living substance that adapts to each mother-baby pair, depending on their shared environment.
“It is protective against the viruses and bacteria that are in your environment right now,” she said. “It sets you up for healthy metabolism. Babies take in the exact right amount of food when they’re breastfeeding, as opposed to really overfeeding, which is a problem that starts in childhood and can lead to all kinds of issues in adulthood.”
Breast milk also protects against sudden infant death syndrome and can help lower the risk of childhood diabetes, she said.
“This study confirms what many pediatricians, educators, and parents have been sensing for years: that our children are facing a growing health crisis,” said Dr. Neal 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.