# Age and geographic heterogeneity in COVID-19 outcomes among young children and parental practices in China

## TL;DR

This study explores how age and geography affect COVID-19 outcomes in young children in China and the role of parental care during a policy shift.

## Contribution

The study identifies age- and region-specific disparities in child outcomes and highlights the protective role of parental practices during a pandemic.

## Key findings

- Children aged 3–6 had milder outcomes compared to younger children.
- Urban-rural and North-South geographic disparities were significant in infection rates and medication use.
- Parental proactive caregiving practices were associated with better child outcomes.

## Abstract

This study examines age and geographic disparities in COVID-19 outcomes among Chinese children aged 0–6 years during China's rapid policy transition (December 2022–January 2023), and evaluates the protective role of parental caregiving practices.

A cross-sectional online survey leveraging a natural experiment during China's COVID-19 policy shift. Data were collected from 48,332 households through randomized national sampling, stratified by urban/rural and North/South residency. Chi-square tests (SPSS 22.0) and latent class analysis (Mplus 7.0) assessed disparities in infection status, symptom severity, healthcare access, and medication use, alongside parental response patterns.

Age-mediated disparities: Significant gradients in infection rates (χ2 = 30.060, p < 0.001), symptom severity (χ2 = 20.626, p < 0.001), and healthcare access (χ2 = 90.876, p < 0.001), with children aged 3–6 experiencing milder outcomes than infants (0–1 years) and toddlers (1–3 years). Geospatial inequities: Urban-rural gaps in infections (χ2 = 58.713, p < 0.001) and North-South disparities in medication use (χ2 = 71.160, p < 0.001), with urban northern children most vulnerable. Parental buffering effects: Parents have exhibited a notably proactive stance and practices in response to the COVID-19 pandemic.

COVID-19 infections in children vary by age and region, with parents playing a crucial role in home-based care. Policy responses should prioritize (1) parent-led protection programs and (2) targeted medical resource allocation to high-risk regions to ensure equitable pandemic recovery.