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Behavioural and Emotional Symptoms Did not Increase During the COVID-19 Pandemic in Swedish Preschool Children

Anders Hjern1,2, Malin Bergström1,2, Anncharlotte Lindfors2

  • 1Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.

Acta Paediatrica (Oslo, Norway : 1992)
|December 12, 2025
PubMed

Insights

Swedish preschools remained open during COVID-19, finding no increase in behavioral or emotional problems. Children in home care showed a temporary rise in issues, highlighting the benefit of continued preschool attendance.

Area of Science:

  • Child psychology
  • Epidemiology
  • Public health policy

Background:

  • The COVID-19 pandemic prompted widespread closures of educational facilities globally.
  • Sweden maintained preschool operations, offering a unique context to study the pandemic's impact on early childhood behavior.
  • Understanding the effects of pandemic policies on child development is crucial for future public health strategies.

Purpose of the Study:

  • To assess if behavioral and emotional problems in 3-year-olds changed during the COVID-19 pandemic in Sweden.
  • To compare children attending preschool with those in home care regarding behavioral and emotional outcomes.

Main Methods:

  • A cross-sectional study analyzed data from 71,917 children in Stockholm using the Strength and Difficulties Questionnaire (SDQ).
  • Data spanned 2018-2023, encompassing pre-pandemic, during-pandemic, and post-pandemic periods.
  • Multivariate linear regression and difference-in-differences analysis compared changes in SDQ scores between preschool attendees and home-care children.

Main Results:

  • Children attending preschool showed stable mean and high scores on SDQ measures throughout the study period.
  • Children in home care experienced a 6.0% increase in mean total SDQ scores during the pandemic, with emotional symptoms rising by 14%.
  • Behavioral and emotional symptoms in home-care children returned to pre-pandemic levels after restrictions were lifted.

Conclusions:

  • Keeping preschools open during the COVID-19 pandemic in Sweden was associated with stable behavioral and emotional well-being in young children.
  • Preschool attendance appeared to mitigate the negative behavioral and emotional impacts observed in children cared for at home.
  • Swedish public health policy regarding preschools demonstrated a beneficial effect on preschool children's mental health during the pandemic.
Abstract

Keywords:
inequitymental healthpreventionpre‐school childrensingle parentyoung parents

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