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By Taylor Knopf

When Katie Ferguson dropped her 2-year-old off for his first week of preschool this fall, he cried a lot.

At one point, the school called and asked Ferguson to come pick him up after 90 minutes of “excessive crying.” It was making other kids in the class upset, she said. 

This only added to the mother’s concerns about her youngest son, Cliff, who was born about six months before the COVID-19 virus came to North Carolina and upended everything. Ferguson said Cliff’s vocabulary is “massively delayed,” and the waitlists to get him evaluated for speech therapy are long. Cliff is also very anxious around anyone outside of his immediate family.

Ferguson and her husband took the public health safety recommendations very seriously. He worked from home and she helped her oldest attend first grade online. The family had their groceries delivered. And they only saw relatives a handful of times and socialized with neighbors from their driveway in Winston-Salem. 

Because of the pandemic, Ferguson didn’t take Cliff to music classes and library story time or leave him with babysitters or grandparents, as she had with her older children when they were babies. His whole world has been inside the home over the past 18 months. Ferguson said Cliff got “put on the backburner” as she juggled teaching math to her oldest while keeping her middle child occupied.

“Trying to balance all of that was insane,” she said.

Two-year-old Cliff on his first day of preschool this fall. Photo courtesy of Katie Ferguson

When Ferguson and her husband got vaccinated against COVID-19 — and before the Delta variant became more prevalent — she said she felt comfortable going inside grocery stores again. She strapped Cliff into a wearable baby carrier because she thought that would keep him safer and less exposed to germs while inside the store.

“If someone would walk past us, he would grip into and squeeze my arms. And people can’t help but talk to a baby, and he would say, ‘no, no, no, no’ and start crying,” she said. 

“And I’m thinking, ‘Oh my gosh, I’ve scarred him for life. By not taking him anywhere, we’ve kept him safe from a virus but now we’ve made him petrified of adults.’”

While many parents might be feeling this way, “the good news is that babies and toddlers are very resilient and very adaptive,” said Cathi Propper, advanced research scientist at the UNC Frank Porter Graham Child Development Institute.

“There are things that may be more delayed right now for those kids but they’ll catch up,” she added. “I don’t think it will be a long lasting effect, but it will be tough. And it’s tough enough for parents already.”

Studying the pandemic’s impact on babies

Because child development studies take months and years to collect data, researchers are just starting to see trends of how the pandemic and its related stressors  — such as food insecurity, stress, isolation, illness and loss — have affected babies born over the last couple of years. 

“There will be studies, such as mine, that I think soon will have some data to talk about,” Propper said.

She and her research team were well-positioned to collect data on the pandemic’s impact on infants and small children due to their ongoing research project that began in 2018 and examines the “association between poverty and executive functions in early childhood.” 

Half of the 230 children and their families participating in Propper’s study were enrolled before COVID. The other half were born after the pandemic began. 

While the study is ongoing and the results are not yet published, Propper has already noticed some initial pandemic-related trends. Part of the study includes measuring cortisol levels, a stress hormone, in pregnant women and the babies’ birth weight.

Preliminary observations show higher cortisol levels in samples taken from pregnant women during the pandemic. Additionally, the babies in the study born during the pandemic had lower birth weights than those born before it began.

The data Propper is collecting will soon shed even more light on the development and well-being of babies during the pandemic. For example, her study includes the babies wearing a device for 16 hours that records all of the language around them. She will be able to compare the amount of language exposure pre- and post-COVID. 

The first years of life are really important for brain development as connections form across different regions of the brain, and children learn a lot through language and social interaction, Propper explained. As long as children are exposed to some amount of that, Propper said she believes the children will be OK. 

Her research team is using MRI scans of the children’s brains at different points through the length of the study. She will be comparing those scans to see if children who experience more language, stimulating activities and parent interaction develop any differently than those who received less attention. 

The study subjects also wear wristbands for weeks at a time to monitor their sleep patterns. Biosamples, such as blood draws and urine testing, are being used to gauge the children’s nutrition intake. 

A diverse sample of families from every income level are included in the study to determine how poverty affects different areas of early childhood development. Some early evidence from a study in the UK suggests that children from lower socioeconomic households suffered more setbacks in cognitive, language and social development when child care centers were closed during the COVID-19 lockdowns.

Supporting the parents 

For many parents, the pandemic has been stressful due to unemployment, financial issues, child care facility closures, remote schooling, isolation, illness and loss. 

“What we know is that babies don’t grow alone. They’re really impacted by their caregivers, and what’s happening in their family context and social context. And I think a lot of times folks forget that,” said Rowena Mudiappa, a social worker at Duke Children’s Primary Care Roxboro Road Clinic in Durham.

“We know that when a family’s stress has increased it impacts the baby directly,” she added.

Mudiappa provides additional support to children from birth to age 3, working alongside pediatricians to tend to the social, emotional and more practical needs of some babies and their caregivers. Through the Healthy Steps program, she works with doctors who have a limited amount of time to spend with each patient. She often helps families with risk factors such as parents who have a history of mental illness, trauma, substance use and interpersonal violence.

During the pandemic, Mudiappa said her observations have been similar to those reported by families in the RAPID-EC survey, which tracks early childhood and family well-being during COVID. The survey of more than 10,000 families with young children throughout the U.S. asked questions about child and parent well-being, experiences of material hardship, access to and use of child care, and use of preventive health care.

In the early months of 2020, families had a lot of material needs, Mudiappa said, such as diapers, food and rent money.

“You could hear the stress in the parents’ voices,” she recalled, as she checked in virtually with families. She and others within the clinic noticed an increase of postpartum depression in mothers. 

“A lot of people are feeling isolated and needing extra support,” Mudiappa said. “This was a really difficult time to have a baby, and then to not have the support of what they usually have: grandmas or aunties and uncles or day care. Literally they didn’t have access to any of that anymore. And it continues to be difficult for a lot of families.”

Mudiappa’s clinic proactively reached out to every parent with a newborn to check in. She said it was different, but helpful, for parents to get a call directly from a provider to check in on them and ask how they were doing.

“That was a really exciting thing that we did that we’ll continue to do. I think we’ll adapt that to our practice,” she said.

During the pandemic, Mudiappa noted that a lot of families struggled with finding a manageable routine while at home with children of different ages, especially while some parents attempted to work from home.

Propper added that if a baby’s caregiver has been really stressed over this time, it could change their parenting behaviors. 

“The literature has shown that more sensitive parenting is really one of the most important things for infant and toddler development. And so if you’ve got parents who are under a lot of stress, they may be less sensitive or responsive to their babies,” said the UNC researcher. “On top of that, they might even be more negative. Sadly there have been increases in child abuse, but also just the day to day frustrations and negativity can be high.”

Because many parents were not comfortable letting grandparents, babysitters or nannies into the home during the pandemic, they were not able to take the same breaks to get away for a couple hours and mentally reset. 

The pandemic was particularly hard on families of children with special needs as many of their in-person services and supports moved online, Mudiappa said. Many of these children had trouble adjusting to and engaging with online support. She said for some families the shift to online was “just too overwhelming.” ABA therapy for kids with autism was delayed or interrupted, and Mudiappa found that one of her biggest challenges was to keep people connected to the support they needed and figuring out “what’s actually feasible for a family?”

Additionally, she said the long waiting lists continue for services such as speech and occupational therapy.

Some silver linings

One of the more “beautiful” highlights of the pandemic for Mudiappa was watching as communities and organizations come together to help parents during this exceptionally difficult time. She said her clinic partnered with other local organizations to get correct information out to families about COVID-19 and lists of local resources for the many challenges people were working through. 

Cliff’s mother said the two-year-old is surprisingly good about wearing his mask during the pandemic. Photo courtesy of Katie Ferguson

Mudiappa gave an example of a single mom of four kids who she helped find child care during the pandemic so that she could continue working to provide for her family. She helped this mother find a camp for her kids to attend that accepted a wide age range of children. Additionally, Mudiappa said the single mom was also worried about the possibility of contracting COVID and concerned about who would take care of her kids. Mudiappa talked her through setting up emergency contacts and what that plan would look like.

Ferguson, the concerned mother of a toddler, also noted some positive things that came from the pandemic lockdown. Her family had just moved to Winston-Salem from Charlotte, and she said they really bonded with their new neighbors as everyone was home more.

She was also able to get her youngest on a sleep schedule for the first time and continue nursing him for 18 months. Prior to COVID, Ferguson said she was always driving her older children to and from school, and Cliff was napping in carpool lanes. 

Meanwhile, Cliff has started to use more words in recent weeks after Ferguson found a retired speech pathologist who agreed to work with the 2-year-old. 

“I’m happy to be getting him services now,” she said. “He’s already so much more verbal, and we as parents feel more equipped to help him communicate.”

NC Health News reporter Taylor Knopf and her 2-year-old son, Theo. Photo credit: Taylor Knopf

Reporter’s notebook: Like Ferguson, I have also been navigating the pandemic with a baby at my side. My son, Theo, was seven months old when COVID-19 hit.

I was terrified to send him to child care for several months and attempted to report and write stories during nap times and late into the evening. To say it was exhausting and stressful doesn’t even begin to describe the experience. However, there were positives to being home with him.

I was extremely motivated to get Theo on a sleep schedule, and now he’s an amazing sleeper and bedtimes are easy. Because my husband was also working remotely, he got to witness his son’s first steps and first words. 

As a first-time mom, the idea for this story came to me as I kept up with regular baby developmental updates. For example, when Theo was 9 months old, the child development updates that I subscribe to shared tips for how to deal with separation anxiety that would likely develop at this age. To cope with these feelings, many children gravitate toward a “lovey” or comfort item, the update said.

Neither of these things happened, which was probably due to the fact that there was a “stay at home” order in North Carolina and Theo and I were always together. A year later, I got vaccinated against COVID-19, and Theo and I started traveling again. I put him in YMCA child care and started using the nursery at church. Almost immediately, he showed signs of separation anxiety and became attached to two stuffed animal bunnies.

Little experiences like this made me curious about how the pandemic has affected early childhood development for children who do not know a world without COVID.

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Taylor Knopf

Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...