By Janet Adamy

For decades, advances in healthcare and safety steadily drove down death rates among American children. In an alarming reversal, rates have now risen to the highest level in nearly 15 years, particularly driven by homicides, drug overdoses, car accidents and suicides.

The uptick among younger Americans accelerated in 2020. Though Covid-19 itself wasn’t a major cause of death for young people, researchers say social disruption caused by the pandemic exacerbated public-health problems, including worsening anxiety and depression. Greater access to firearms, dangerous driving and more lethal narcotics also helped push up death rates.

Between 2019 and 2020, the overall mortality rate for ages 1 to 19 rose by 10.7%, and increased by an additional 8.3% the following year, according to an analysis of federal death statistics led by Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University, published in March. That’s the highest increase for two consecutive years in the half-century that the government has publicly tracked such figures, according to Woolf’s analysis.

Other developed countries including the United Kingdom, Germany, Canada and Norway also saw a rise in some death counts among young people during that time, though the upticks were often concentrated in narrow age groups or one gender, according to global death counts provided by Christopher J.L. Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington.

The U.S. is the only place among peer nations where firearms are the No. 1 cause of death in young people.

Suicides among Americans age 10 to 19 began increasing in 2007, while homicide rates for that age group started climbing in 2013, according to the research by Woolf and co-authors Elizabeth Wolf of Virginia Commonwealth and Frederick Rivara of the University of Washington.

The increases in suicides and homicides among young people went largely unnoticed at first because overall child and adolescent mortality rates still declined most years.

Penicillin and other antibiotics drove down deaths from bacterial infections in the years following World War II, and vaccines controlled lethal viruses such as polio and influenza. Safer automobiles, seat belts and car seats made driving less deadly. Bicycle helmets, smoke detectors and swimming lessons reduced fatal accidents and drownings. Medical advancements that save premature babies and treat leukemia and other cancers helped more children survive once-lethal diagnoses.

“All of those gains are now being offset by essentially four causes of death,” Woolf said.

When the pandemic started, deaths of young people due to suicide and homicide climbed higher. Deaths caused by drug overdoses and transportation fatalities—mainly motor-vehicle accidents—rose significantly, too.

Covid, which surged to America’s No. 3 cause of death during the pandemic, accounted for just one-tenth of the rise in mortality among young people in 2020, and one-fifth of it in 2021, according to the research led by Woolf, which uses data from the Centers for Disease Control and Prevention.

Joshua Gillihan was 11 years old when the pandemic closed his suburban Houston middle school in March 2020. He’d grown up confident with lots of friends, and played baseball and rode his dirt bike in their upper-middle-class neighborhood in Cypress, Texas, said his mother, Kim Gillihan. The shutdowns turned a temporary break from organized sports into an indefinite hiatus. Kim Gillihan watched as Joshua’s typical adolescent hangups about having to wear glasses and his appearance gave way to more worrisome levels of anxiety.

“When the Covid hit, our child that was never depressed became depressed,” she said.

Kim Gillihan’s husband, Steve Gillihan, discovered marijuana in Joshua’s backpack. When they realized he was using the drug regularly, his mother grew alarmed and sought counseling for him and for the family to stop it. She agreed to put him on medication for his depression, hoping it would dissuade him from seeking illicit ways to ease his symptoms from that and ADHD. Kim Gillihan took Joshua’s computer and phone, instead lending him her phone to communicate with friends. She forbade sleepovers and closely monitored her son. She periodically tested him for THC, the main psychoactive substance in marijuana.

After a family trip to Disney World this past summer, Joshua, age 14, started high school and seemed excited about meeting new people, Kim Gillihan said. It was Friday night after the first week of his freshman year, and she brought home Sonic hamburgers that she and Joshua ate together at the kitchen island. He told his mother about a girl he wanted to ask to the homecoming dance, and Kim Gillihan began planning to get him a mum, a Texas tradition, that he could give to his date.

Joshua went to his room for the night while his mother packed for a business trip the next morning. She told her husband she thought their efforts to stop their son’s marijuana use were finally working. “I feel so good about everything,” she recalled telling Steve Gillihan. “I think we have turned the corner.”

The next morning, she went to say goodbye to Joshua before her planned trip and found his body cold and lifeless in his bed. An autopsy showed he died from fentanyl toxicity. Kim Gillihan said she believes her son took what he thought was oxycodone or Percocet but was instead pure fentanyl. She said she doesn’t know how he obtained it.

“We thought we were doing all the right things,” she said.

Older children and teenagers, ages 10 to 19, accounted for most of the increase in death rates for young people. Boys, whose mortality rates are roughly twice those of girls, saw their death rates worsen to a slightly greater degree during the pandemic, Woolf found. The overall findings held true when researchers excluded those ages 18 and 19, who were included in the broader research because such government data is grouped in five-year age bands.

Physicians and public-health researchers say that school closures, canceled sports and youth activities and limitations on in-person socializing all worsened a burgeoning mental-health epidemic among young people in the U.S. Social media, they say, has helped fuel it by replacing successful relationships with a craving for online social attention that leaves young people unfulfilled, and exposes them to sites that glamorize unhealthy behaviors such as eating disorders and cutting themselves.

Demand for psychiatric services, counseling and other behavioral health supports far outstripped supply, leaving young patients to turn to emergency departments that were strained by the crush of Covid.

“We are seeing younger and younger patients coming in with mental-health crises, and even those 8 to 10 years old coming in with suicidal ideation,” said Lois Lee, a pediatric emergency physician at Boston Children’s Hospital who chairs the American Academy of Pediatrics Council on Injury, Violence and Poison Prevention.

Lee saw an 8-year-old patient who tried to wrap something around his neck to take his life, she said. There is such a severe lack of inpatient mental-health services, she said, that young patients can wait in emergency departments for days or weeks until there’s room for them in a psychiatric facility.

To some extent, the rising mortality rates for young people mirror trends in the adult population. Death rates started climbing for middle-aged, white Americans starting in 1999, largely because of suicide, alcohol abuse, drug overdoses and chronic liver diseases, although rates for Black and Hispanic Americans fell over the same period.

In 2020, life expectancy fell 1.8 years, the largest decline since at least World War II, not just because of Covid but also because of increased mortality from unintentional injuries, including drug overdoses, as well as homicides.

Researchers point to the fact that gun ownership increased during the pandemic, and that high-profile acts of police violence, including the murder of George Floyd, heightened distrust of law enforcement. That prompted some people to resort to deadly forms of “street justice” instead of calling the police, said Daniel Webster, a public-health professor at Johns Hopkins University who researches gun violence and prevention.

A growing supply of so-called ghost guns—weapons manufactured with parts bought online or made on 3-D printers—made it easier for teenagers to get firearms that they couldn’t legally obtain due to age restrictions. “You have the most firearms under the least social supports, and that’s the brew, if you will, of what leads to very sudden and dramatic increases of lethal violence,” Webster said.

Black teenagers accounted for nearly two-thirds of homicide victims ages 10 to 19 early in the pandemic, according to the research led by Woolf, a portion that has grown from about half two decades ago. White teenagers have historically died at higher rates of drug overdoses, but rising rates of such deaths among Black and Hispanic teens closed that gap in 2020.

TiKiya Allen was an honor roll student and a cheerleader while growing up in Detroit, said her grandmother Bonnie Whittaker. She enrolled at nearby Oakland University after high school and was studying to be a nurse while working part time at a Taco Bell.

TiKiya, age 18, was on a bicycle while visiting a friend on Detroit’s northwest side when she was killed in a drive-by shooting in broad daylight in July 2021. The crime remains unsolved. Detroit police said it appeared TiKiya was an innocent bystander caught in the crossfire.

“Why shouldn’t a child be able to ride their bike down the sidewalk without the threat of losing their life?” Whittaker said.

The rise in transportation-related fatalities comes despite the fact that people drove less when the pandemic started. Researchers say that the absence of other cars on the road prompted some people to drive more recklessly, and that distractions from cellphones have made driving more deadly in recent years. Alcohol consumption increased during the pandemic, possibly pushing up deaths caused by drunken driving.

Many public-health experts say they don’t think the end of the pandemic will reverse the rise in death rates among young people. Rivara predicts these problems will continue due to persistent issues around mental health and the accessibility of guns.

Wolf said demand for child and adolescent psychiatric services still outstrips supply in her Richmond, Va., office. Patients are on monthslong waiting lists to see a psychiatrist that accepts insurance.

She spent two years practicing pediatric medicine in sub-Saharan Africa early in her career. “There we saw children die from malnutrition and infectious diseases,” she said. “Now that I’ve come back to the U.S., it is incredibly difficult to see children dying from man-made causes, like bullets and cars.”