Between 2007 and 2022, a child in the U.S. was about 1.8 times more likely to die than peers abroad. U.S. children today weigh more, battle more illnesses and face higher odds of dying than youngsters just a generation ago, according to the most extensive review of pediatric well-being published in nearly two decades.

The study, released Monday in the Journal of the American Medical Association (JAMA), tracked 170 separate health indicators drawn from eight national data sets that stretched back to 2002.

“All of them point in the same direction: children’s health is getting worse,” lead author Christopher Forrest of the Children’s Hospital of Philadelphia said.

Researchers found that obesity among 2-19-year-olds climbed from 17 percent in the 2007-2008 survey cycle to about 21 percent in the 2021-2023 cycle.

Electronic medical records covering more than 1 million young patients showed that diagnoses of at least one chronic condition, such as anxiety, depression, or sleep apnea, rose from roughly 40 percent in 2011 to 46 percent in 2023. A separate parent survey recorded a 15-20 percent jump in the risk of any chronic illness since 2011.

Mortality statistics drew an even starker contrast with other wealthy nations. The JAMA editorial noted that this survival gap left the United States at the bottom of child health rankings among advanced economies, including Canada, Germany and Japan.

Between 2007 and 2022, a child in the United States was about 1.8 times more likely to die than peers abroad, the study reported. Premature birth and sudden unexpected infant death dominated the figures for babies, while firearm injuries and road crashes took the heaviest toll on children and teenagers.

Warning signs emerged in mental health as well. Rates of depressive symptoms, loneliness, difficulty sleeping and limits on physical activity all climbed during the study period. “Kids are the canaries in the coal mine; they absorb social stress earlier and more intensely than adults,” Forrest said.

In a linked editorial, pediatricians Frederick Rivara and Avital Nathanson argued that protecting children will require stronger injury prevention, maternal health and vaccination programs and a concerted attack on the social conditions that undermine young lives.

They cautioned that cutting public health budgets, delaying infrastructure fixes or fanning anti-vaccine sentiment would move the country “in the wrong direction.”

The authors did not blame a single cause for the downturn. Instead, they pointed to the combined impact of diets packed with ultra-processed food, patchy access to medical care, unsafe neighborhoods and widening economic inequality. Forrest urged “neighborhood-by-neighborhood action plans that treat children’s health as a community responsibility.”

Although the United States spends more per person on healthcare than any other nation, the study concluded that reversing the slide would demand investments far beyond clinics, into schools, housing, transport, and social services, before today’s warning signs become tomorrow’s adult crises.