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Cosmos Study

Childhood Speech Development Delays Increasing Since the Start of the Pandemic

July 18, 2023
Dual-Team Study
Team A:Kersten Bartelt, RNMatthew Gracianette, MDJoe Deckert, PhD
Team B:Blaine Franklin, PT, DPTDave Little, MD, MSEric Barkley

Key Findings

  • Children who have turned two years old since the start of the pandemic are more likely to have a speech delay diagnosis compared to those who turned two in earlier years. 
  • Speech delay diagnoses have increased from an average of 9.0% of children in 2018 to 11.8% in the last quarter of 2021 and 16.9% in the first quarter of 2023. 
  • We did not observe an increased rate of motor, scholastic, or cognitive delay diagnoses related to the pandemic. 

The COVID-19 pandemic has had widespread effects on various aspects of life, including the social and speech development of young children.1,2 We studied whether there has been an increase in childhood speech, motor, and cognitive development delays since the pandemic began. We first evaluated the rate of speech delay diagnosis by age two in 1,667,926 children.  

We found that children who turned two years old between September 2020 and March 2023 were more likely to experience speech delays than those that turned two in earlier years. Compared to children who turned two years old in 2018, children who turned two in the last quarter of 2021 were 31.5% more likely to have a speech delay diagnosis, and those who turned two in first quarter of 2023 were 87.8% more likely. The increase in speech delays was observed in both urban and rural areas. The difference in speech delay diagnoses remained even after controlling for sex, premature birth status, and years of patient care documentation. 

Figure 1
Speech Delay Diagnosis Rate by Age Two
Speech Delay Diagnosis Rate by Age Two
Figure 1. Rate of speech delay diagnoses by quarter the patient turned two years of age compared to the average rate of diagnoses in patients who turned two in 2018.

We also evaluated the diagnosis rates for motor delay by age two, cognitive delay by age four, and scholastic delay by age eight. We selected these ages for the analysis based on the likelihood that assessments for these conditions would have been conducted according to the American Academy of Pediatrics’ Bright Futures recommendations.3 We did not find a significant change in the rates of these diagnoses after the start of the pandemic. However, because scholastic and cognitive delays are typically diagnosed in school-age children, additional impact related to the pandemic may remain to be seen among younger children. 

These data come from Cosmos, a HIPAA-defined Limited Data Set of more than 193 million patients from 208 Epic organizations including 1,187 hospitals and more than 25,400 clinics, serving patients in all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. 

  1. Sparks SD. Babies are saying less since the pandemic: Why that’s concerning. Education week. https://www.edweek.org/teaching-learning/babies-are-saying-less-since-the-pandemic-why-thats-concerning/2022/04. Published April 7, 2022. Accessed May 2, 2023. 
  2. Jones K. The initial impacts of COVID-19 on children and youth (birth to 24 years): Literature review in brief.  The Assistant Secretary for Planning and Evaluation. https://aspe.hhs.gov/sites/default/files/documents/188979bb1b0d0bf669db0188cc4c94b0/impact-of-covid-19-on-children-and-youth.pdf Accessed May 2, 2023.
  3. Bright Futures/American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care. https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf. Accessed on July 7, 2023.