The COVID-19 pandemic poses an acute threat to the well-being of children and families due to challenges related to social disruption such as financial insecurity, caregiving burden, and confinement-related stress (e.g., crowding, changes to structure, and routine). The consequences of these difficulties are likely to be longstanding, in part because of the ways in which contextual risk permeates the structures and processes of family systems. The current article draws from pertinent literature across topic areas of acute crises and long-term, cumulative risk to illustrate the multitude of ways in which the well-being of children and families may be at risk during COVID-19. The presented conceptual framework is based on systemic models of human development and family functioning and links social disruption due to COVID-19 to child adjustment through a cascading process involving caregiver well-being and family processes (i.e., organization, communication, and beliefs). An illustration of the centrality of family processes in buffering against risk in the context of COVID-19, as well as promoting resilience through shared family beliefs and close relationships, is provided. Finally, clinical and research implications are discussed. Public Significance StatementThe current paper reviews the literature on historical adversities that have threatened societies, such as natural and human-made disasters and recessions, in order to highlight the possible consequences of the current crisis on the well-being of families and children. Families are facing imminent threats to their relationships, rules, rituals, and routines due to COVID-19, which can have major implications for children's coping during this time. Some families will be more impacted than others, due to their prior circumstances, such as those with lower income, mental health and/or special needs, and/or experiences of racism or marginalization. It is important for families to preserve and nourish their relationships and shared beliefs as a way to provide security and hope for children during this time of stress and uncertainty.

y school entry, 1 in 4 children shows deficits and delays in developmental outcomes such as language, communication, motor skills, and/or socioemotional health. 1,2 Thus, many children are beginning school inadequately prepared for learning and academic success. Gaps in development tend to widen vs shrink over time without intervention, 3 creating a burden on education and health systems in the form of greater government and public expenditures for remediation and special education. 4,5 Consequently, there have been efforts to identify factors, including children's screen time, 6 that may create or exacerbate disparities in early child development. Digital media and screens are now ubiquitous in the lives of children. Approximately 98% of US children aged 0 to 8 years live in a home with an internet-connected device and, on average, spend over 2 hours a day on screens. 7 This amount exceeds the recommended pediatric guideline that children spend no more than 1 hour per day viewing high-quality programming. 8,9 Although some benefits of high-quality and interactive screen time have been identified, 10-13 excessive screen time has been associated with a number of deleterious physical, behavioral, and cognitive outcomes. 14-21 While it is possible that screen time interferes with opportunities for learning and growth, it is also possible that children with delays receive more screen time to help IMPORTANCE Excessive screen time is associated with delays in development; however, it is unclear if greater screen time predicts lower performance scores on developmental screening tests or if children with poor developmental performance receive added screen time as a way to modulate challenging behavior. OBJECTIVE To assess the directional association between screen time and child development in a population of mothers and children. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used a 3-wave, cross-lagged panel model in 2441 mothers and children in Calgary, Alberta, Canada, drawn from the All Our Families study. Data were available when children were aged 24, 36, and 60 months. Data were collected between

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IMPORTANCE Sexting is the exchange of sexual messages, photographs, or videos via technological devices and is common and increasing among youth. Although various studies have examined the association between sexting, sexual behaviors, and mental health, results are mixed. OBJECTIVE To provide a meta-analytic synthesis of studies examining the associations between sexting, sexual behavior, and mental health using sex, age, publication date, and study methodological quality as moderators. DATA SOURCES Electronic searches were conducted in April 2018 in MEDLINE, PsycINFO, Embase, and Web of Science, yielding 1672 nonduplicate records. STUDY SELECTION Studies were included if participants were younger than 18 years and an association between sexting and sexual behaviors or mental health risk factors was examined. DATA EXTRACTION AND SYNTHESIS All relevant data were extracted by 2 independent reviewers. Random-effects meta-analyses were used to derive odds ratios (ORs). MAIN OUTCOMES AND MEASURES Sexual behavior (sexual activity, multiple sexual partners, lack of contraception use) and mental health risk factors (anxiety/depression, delinquent behavior, and alcohol, drug use, and smoking). RESULTS Participants totaled 41 723 from 23 included studies. The mean (range) age was 14.9 (11.9-16.8) years, and 21 717 (52.1%) were female. Significant associations were observed between sexting and sexual activity (16 studies; OR, 3.66; 95% CI, 2.71-4.92), multiple sexual partners (5 studies; OR, 5.37; 95% CI, 2.72-12.67), lack of contraception use (6 studies; OR, 2.16; 95% CI, 1.08-4.32), delinquent behavior (3 studies; OR, 2.50; 95% CI, 1.29-4.86), anxiety/depression (7 studies; OR, 1.79; 95% CI, 1.41-2.28), alcohol use (8 studies; OR, 3.78; 95% CI, 3.11-4.59), drug use (5 studies; OR, 3.48; 95% CI, 2.24-5.40), and smoking behavior (4 studies; OR, 2.66; 95% CI, 1.88-3.76). Moderator analyses revealed that associations between sexting, sexual behavior, and mental health factors were stronger in younger compared to older adolescents. CONCLUSIONS AND RELEVANCE Results of this meta-analysis suggest that sexting is associated with sexual behavior and mental health difficulties, especially in younger adolescents. Longitudinal research is needed to assess directionality of effects and to analyze the mechanisms by which sexting and its correlates are related. Educational campaigns to raise awareness of digital health, safety, and security are needed to help youth navigate their personal, social, and sexual development in a technological world.

Background Experimental animal work shows that prenatal stress has a persisting effect on the Hypothalamic-Pituitary-Adrenal (HPA) axis of offspring. The implications of these findings for human health and development are not yet clear. Methods The data are based on the ALSPAC cohort, a prospective longitudinal study of a community sample that has followed mothers and children from pregnancy. When the children were aged 15 years, diurnal cortisol samples were collected at wake-up, 30 minutes post-awakening and at afternoon and evening times on up to three consecutive days on n=889 adolescents. Diurnal cortisol was predicted from prenatal anxiety and depression, obstetric, life-style, socio-demographic, and postnatal covariates. Results Multilevel model analysis indicated that maternal prenatal anxiety was associated with a modest alteration of diurnal cortisol, indexed by a reduced cortisol awakening response and flatter diurnal slope. The effects were independent of psychosocial and obstetric covariates and measures of maternal postnatal anxiety; effects were similar for prenatal maternal depression. There was no association between adolescent cortisol and paternal prenatal anxiety. Conclusions There are small but persisting associations between maternal prenatal mood and diurnal cortisol in the child that persist into adolescence and may constitute a programming effect.