An unfinished recovery: Trends in US children's flourishing by socioeconomic status, 2018–2024

Objectives Flourishing among children is an emerging indicator of positive health and well-being yet no studies have examined trends and socioeconomic variations spanning pre-and post-pandemic time periods. Study design Repeated cross-sectional analysis of a nationally representative sample of children in the US. Methods Data from seven cycles of the National Survey of Children's Health (2018-2024) with information on the components of the child flourishing index including resiliency, positive emotions, curiosity and emotional connection. A total of 308,255 children ages 6 months to 17 years were included with sociodemographic data (age, sex, race/ethnicity, parental education level, and family income to poverty ratio). Logistic regression models were used to estimate the odds ratios (ORs) associated with flourishing across socioeconomic strata. ORs were estimated to compare flourishing prevalence between the post-pandemic period (2023-2024) with the pre-pandemic period (2018-2019) by age group and family income to poverty ratio (FPR). Results Flourishing among very young children ages 6 months to 5 years declined from 83.8% (95% CI, 82.0%-85.6%) during 2018 to 79.9% (95% CI, 78.4%-81.3%) in 2024 ( P -trend = 0.000). Among school-aged children (aged 6 to 17), flourishing fell from 66.5% (95% CI, 65.1%-67.8%) in 2018 to 60.6% (95% CI, 59.6%-61.9%) in 2024 ( P -trend = 0.000). Compared to the pre-pandemic period, the multivariable-adjusted ORs of flourishing were 0.72 (95% CI, 0.64-0.81) for young children and 0.75 (95% CI, 0.71-0.79) for school-aged children. Conclusion The prevalence of flourishing among US children decreased significantly between 2018 and 2024. There is little evidence of a post-pandemic recovery in the prevalence of child flourishing.