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Table of contents
In A Nutshell
- U.S. children and teens were 78%–80% more likely to die than peers in 18 other wealthy nations from 2007–2022.
- The largest excess deaths were from premature birth, sudden infant death, firearms, motor vehicle crashes, and substance use.
- Nearly half of American kids now have a chronic health condition.
- Childhood obesity, anxiety, depression, and early puberty have all risen dramatically.
- The study calls for urgent action to tackle systemic causes behind the decline in child health.
PHILADELPHIA — For American parents, the numbers are staggering: children in the United States are dying at rates that dwarf those in other wealthy countries. A study led by researchers at the Children’s Hospital of Philadelphia (CHOP) reveals that from 2007 to 2022, American infants were 78% more likely to die before their first birthday compared to babies in 18 other high-income nations. Children and teens aged 1 to 19 faced an even grimmer reality: hey were 80% more likely to die than their peers in countries like Canada, Sweden, and Japan.
But mortality is just the beginning. Published in JAMA Network, the findings show that American childhood health has been steadily deteriorating across virtually every measure for the past 17 years. Nearly half of all children now have a chronic health condition. Childhood obesity affects one in five kids. Depression among high schoolers has skyrocketed from 26% to nearly 40%.
Lead researcher Dr. Christopher Forrest, a professor of pediatrics at CHOP, deliberately designed the study to capture the full scope of childhood health trends. What he didn’t expect was to see a worsening picture across the board.
“We knew that obesity and anxiety rates were going up. However, when we took a comprehensive look at children’s mortality patterns, chronic disease, obesity, sleep, puberty, pain and other physical symptoms, and loneliness they all trends in the wrong direction,” he tells StudyFinds. (Our full Q&A with Dr. Forrest is at the end of the article.)
“In addition, we are experiencing a crisis in child health. This is clear and really not debatable,” he adds. “The article we published with eight data sources and 170 health indicators provides the evidence that is just about as conclusive as science can ever get.”
U.S. Child Mortality Data Shows Troubling Trend
Forrest and his team analyzed eight different data sources covering more than 80 million children to create the most comprehensive look at American child health to date. They examined national mortality statistics, electronic health records from major children’s hospitals, and five nationally representative surveys. Whatever is harming American children operates across multiple health domains simultaneously, a pattern that demands urgent attention to root causes rather than band-aid solutions.
During the 16-year study period, America experienced 315,795 excess deaths compared to what would be expected based on rates in other wealthy nations. That’s equivalent to 54 excess child deaths every single day.
American babies face particularly steep odds. They’re more than twice as likely to die from premature birth and sudden unexpected infant death compared to babies in peer countries. Birth defects and respiratory infections also claim more American infants at higher rates.
For older children and teens, the statistics become even more alarming. American youth were 15 times more likely to die from firearms than children in other wealthy countries. It seems as if gun violence has become a uniquely American childhood hazard. Motor vehicle crashes, substance use, and homicide also killed American children at rates far exceeding international norms.
Children’s Mental Health Crisis Intensifies
Beyond mortality, chronic health conditions now affect nearly half of American children aged 3 to 17, jumping from 40% in 2011 to 46% by 2023. Mental health disorders drive much of this increase, with anxiety showing the largest surge across all conditions studied.
Major depression among children tripled over the study period. Autism spectrum disorders more than doubled. Sleep disorders and eating disorders each increased more than threefold. Among high school students, persistent feelings of sadness or hopelessness climbed from 26% in 2009 to nearly 40% by 2023.
Physical symptoms diagnosed by doctors also became increasingly common. By 2023, more than 40% of children aged 5 to 17 experienced at least one physical symptom like abdominal pain, fatigue, or headaches, up from 31% in 2010. Skin problems increased nearly fivefold, while pain complaints nearly quadrupled.
Basic developmental milestones reveal troubling shifts in how American children grow up. Early onset of menstruation before age 12 increased by 63% among girls. Childhood obesity rates climbed from 17% to 21% of children aged 2 to 19. Sleep problems among older teens rose by 80%.
Children with chronic conditions increasingly report limitations in their daily activities, with 72% of those limitations tied to developmental disorders.
As the researchers write in their paper: “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.”
What’s Fueling America’s Child Health Decline?
While the study documents extensive health decline, it doesn’t pinpoint specific causes. Many concerning trends began decades ago and have persisted across different time periods, pointing to multiple contributing factors.
The rise in firearm deaths — which became the leading cause of death among American children and youth in 2020 — reflects policy failures around gun safety. Higher rates of premature birth and infant mortality may stem from inadequate prenatal care or maternal health issues. The surge in mental health conditions could relate to social media use, academic pressure, social isolation, or other modern stressors.
Environmental factors, economic inequality, and changes in diet, physical activity, and sleep patterns likely all contribute. Some increases in chronic conditions might also reflect better recognition and diagnosis of conditions like autism and anxiety disorders, rather than true prevalence increases.
However, the consistency of negative trends across multiple health domains and data sources shows that much of the deterioration represents genuine declines in child health and well-being.
American children are not thriving compared to their international counterparts, and the gaps are widening rather than narrowing over time. With nearly half of children now managing chronic health conditions and mortality rates diverging sharply from international peers, childhood health has become a national crisis demanding immediate action. Whether America will address this emergency remains an open question—one that will determine the future health and prosperity of an entire generation.
StudyFinds Q&A With Dr. Christopher Forrest
We asked Dr. Forrest for his personal feelings on the findings after completing the eye-opening study.
What was the single most surprising statistic for you when you analyzed this data?
CF: The widespread decline. We knew that obesity and anxiety rates were going up. However, when we took a comprehensive look at children’s mortality patterns, chronic disease, obesity, sleep, puberty, pain and other physical symptoms, and loneliness they all trends in the wrong direction.
In addition, we are experiencing a crisis in child health. This is clear and really not debatable. The article we published with 8 data sources and 170 health indicators provides the evidence that is just about as conclusive as science can ever get. The decline in health has been occurring over decades and is broad-based affecting virtually all aspects of health. Because children are rapidly developing and depend on adults and institutions (like schools) for the health, wellbeing, and resilience, they are the “canaries in the coal mine,” the first indicators that we have a more generalized deterioration in the ecosystem that all of us live within.
How do these U.S. trends compare historically? Were things ever better?
CF: We know that from 1960 to the mid 1970s childhood mortality rates in the US were about the same as high-income European nations. However, by the mid 70s kids in the US started dying at higher rates. These trends have been widening since then. In 1960 1 in 50 children according to national data had a limitation that kept them from playing, going to school, or just getting along in life. Today that number is 1 in 11. Obesity rates have gone from 5% in the 60s to 20% today. So the declines are long-term and across many domains of health.
What specific policies could help reverse this disturbing trajectory?
CF: There are no simple solutions, no simple fixes, no protective shields that we can erect. Instead, we need a full-scale transformation of the developmental ecosystem that children are growing up in. I can’t say that there is a single policy.
A developmental ecosystem refers to the web of human relationships, environments, and social systems that children rely on as they develop—families, schools, communities, nature, digital spaces, and cultural. It surrounds and supports kids. For many children, and especially those in low-income and marginalized communities, this developmental ecosystem has never been robust. But now, its infrastructure is aging, support is fraying, and its essential role in children’s lives ignored. Families are stressed and facing challenges everywhere they turn.
This editorial that accompanied the article went into specific policies in more detail.
Why do you think the U.S. has so many more excess child deaths than peer nations?
CF: This is incredibly disturbing. The key differences vary by age. For infants, there are more preterm births, which speaks to maternal health, more sudden infant death syndrome which speaks to sleep patterns and the need to keep babies on their backs, and more birth defects which may be due to a toxic chemical environment. For older youth, it is related to the safety of our kids – more gun violence, more homicides, more car crashes, and more overdoses.
What message do you hope parents take away from this research?
CF: So, what are families to do? That is the gist of your question. My single recommendation is to “engage.” Now is not the time to retreat into our homes to “protect” our kids. In fact, that kind of attitude has not been helpful to children over the past few decades, and may be a contributor to the nexus of influences that have created this crisis.
Engage with your extended family to wrap around you children a group of people who provide support, care, and love, and provide the same to you as parents. Creating a loving, nurturing, caring, and responsive home environment is critical for children’s healthy development. And, we cannot as parents do that alone. We need a relational web of support and care. Make family a priority, more important than a higher paying job.
Engage with your neighbors to create the types of local developmental ecosystems where kids can play outdoors with each other, creating their own games, exploring the physical and social world together as kids. Remember that when children learn through their own exploration, they learn better and retain their learnings longer than when they are shown how to do something by an adult. Unsupervised outdoor play is a huge missing ingredient in our children’s lives. But we need families to engage with each other to create the environments where this can happen. And, engage with your community to identify your local challenges to improving children’s health and work together to change them.
Engage with your children. Be present, responsive but not overbearing. Be aware of how you define “success” to your child. How many children are experiencing anxiety and overwhelming stress because of the expectations that we place on them to get straight As or get into a top college. What about defining success as being a great friend, someone with empathy, compassion, caring, and creativity, and an individual who contributes to the community?
There is no single solution to the crisis we are seeing in child health. We need the collective intelligence and wisdom of parents to collaborate on developing the solutions that will start to shift the places where children live, grow, and learn from environments that are unhealthful to ones that are health promoting.
Paper Summary
Methodology
Researchers analyzed data from mortality statistics comparing the US with 18 other high-income nations, electronic health records from 10 pediatric health systems (PEDSnet), and five nationally representative surveys. The study tracked children’s health from 2007 to 2023, including children from birth to age 19. Sample sizes ranged from about 1,600 to nearly 96,000 depending on the data source, with PEDSnet serving over 1 million children annually.
Results
American infants were 78% more likely to die than infants in other wealthy countries, while children aged 1-19 were 80% more likely to die, translating to 315,795 excess deaths over 16 years. Chronic conditions affected 46% of children by 2023, up from 40% in 2011. Mental health conditions showed the largest increases. Physical symptoms increased from 31% to 41% of children. Childhood obesity rose from 17% to 21%. Early menstruation increased by 63%, sleep problems by 80%, and feelings of sadness among high schoolers climbed from 26% to 40%.
Limitations
The study didn’t analyze results by race, ethnicity, or socioeconomic status. PEDSnet data came from 10 health systems rather than being nationally representative. Some increases in chronic conditions might reflect better diagnosis rather than true prevalence increases. The study documented health trends but didn’t investigate underlying causes.
Funding and Disclosures
The study was supported by institutional funds from the Applied Clinical Research Center at Children’s Hospital of Philadelphia. Dr. Forrest disclosed receiving royalties for co-developing the Johns Hopkins Adjusted Clinical Groups System used in the study.
Publication Information
“Trends in US Children’s Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms” was published online July 7, 2025, in JAMA Network. The research was conducted by Christopher B. Forrest, Lauren J. Koenigsberg, Francis Eddy Harvey, and Mitchell G. Maltenfort from Children’s Hospital of Philadelphia, along with Neal Halfon from UCLA.