In just a matter of weeks, the COVID-19 pandemic has led to huge societal public health and economic challenges worldwide. The clinical effects of COVID-19 on young children are uncertain when compared with older age groups, with lower morbidity and mortality rates and no conclusive evidence supporting transmission during pregnancy, on the one hand, but some emerging evidence of rising rates of child hyperinflammatory shock, on the other. Research on the effects of prior pandemics and disasters clearly indicates that there will be both immediate and long-term adverse consequences for many children, with particular risks faced during early childhood, when brain architecture is still rapidly developing and highly sensitive to environmental adversity. Estimates predict a rise in maternal and child mortality in low- and middle-income countries as health services for non-COVID related issues become scarce. For example, a conservative scenario of 15% reduction in coverage of life-saving essential health interventions for 6 months in low- and middle-income countries is associated with a 9.8% increase in under-5 mortality and an 8.3% increase in maternal mortality. Before the pandemic, 43 % of all children under 5 years of age in the world were estimated to be at risk of not achieving their developmental potential. Unless there is a commitment to support coordinated, multisectoral approaches in which low-and middle-income countries governments receive international support to scale up essential interventions, a much higher percentage of children are at risk of devastating physical, socioemotional, and cognitive consequences over the entire course of their lives. We review the evidence base on short- and long-term risks for children during early childhood development (ECD, defining this from prenatal to 8 years of age). We also present evidence-based mitigating program and policy actions that may reduce these risks.
