Child Behavioral Health Research Articles

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The National Association for Children's Behavioral Health is holding its public policy conference July 11–12 in Washington, D.C. For more information, visit https://www.nacbh.org/public‐policy‐conference.

Andersen health care utilization model: A survey on factors affecting the utilization of dental health services among school children.

Children's quality of life, academic performance, and future achievement can all be negatively affected by poor dental health. The present study aimed to assess the need for dental health services and the factors influencing their utilization using the Andersen health care utilization model among school children. The current cross-sectional study was conducted among schoolchildren aged 13 to 15 in Bangalore, India (n = 1100). A questionnaire was developed using the concepts of the Andersen healthcare usage model. The parents of the children filled out the questionnaire. The factors were investigated using bivariate analysis and multivariate logistic regression analysis. About 78.1% of the children did not utilize dental health services. Regarding the reasons for not visiting a dentist, 65.8% said they did not have a dental problem, and 22.2% said they could not afford it. Bivariate analysis showed that age, gender, education level, occupation of the family's head of household, monthly family income, socioeconomic status, perceived oral health problems, accessibility of dental health facilities, and parental attitudes toward their children's oral health were significantly associated with using dental health services (p<0.05). Multiple regression analysis showed dental health service utilization was directly related to age (OR = 2.206), education, family size (OR = 1.33), and brushing frequency twice a day (OR = 1.575) with no significant relationship between distance to reach the dental facility, the number of dental visits, and socioeconomic status. Dental health service utilization was low in the past year. The age, number of family members, parent's education level, travel time to the dental facility, the child's oral health behaviors, and positive parental attitude all play a role in a children's utilization of dental health service.

Sleep health behaviors in pediatric patients with newly diagnosed cancer

ObjectiveDisrupted sleep and fatigue are common symptoms in children with cancer, but little is known about this population's sleep health behaviors and how they may impact nighttime sleep. We aimed to describe the sleep health behaviors of children with newly diagnosed cancer and to determine if they changed over the next 8 weeks. MethodsOur sample included 169 children with cancer (86 males) who were aged 2–18 years (mean [SD] = 8.14 [4.4] y), with parent proxy report for 140 children (71 male) aged 2–12 years (mean [SD] = 6.67 [3.2] y) and self-report for 78 children (39 male) aged 8–18 years (mean [SD] = 12.0 [2.9] y). Parents and patients completed sleep hygiene questionnaires within 30 days of oncology diagnosis (T1); follow-up questionnaires were collected 8 weeks later (T2). Descriptive analyses characterized the sample by sociodemographic characteristics, cancer diagnosis, treatments received, and prescribed medications. ResultsAge-related differences were found in sleep health behaviors, with adolescents reporting better overall sleep health behaviors than younger children at both time points. No differences in sleep health behaviors were found at T1 related to diagnosis, treatment, or medications. Some differences in sleep health behaviors were found at T2 related to gender, diagnosis, treatment, and medications. Sleep health behaviors and sleep problems remained relatively stable over 8 weeks. Fatigue was significantly associated with more pre-bedtime worries, insomnia, and lower rates of daytime sleepiness. ConclusionsThese findings offer novel descriptive characteristics of sleep health behaviors in a pediatric oncology sample and show relatively stable yet somewhat poor sleep health behaviors across 8 weeks. Better understanding of sleep health behaviors as modifiable factors will help inform targeted interventions.

The differential predictive utility of two caregiver-targeted self-efficacy measures to promote oral health of underserved children.

Oral health self-efficacy is a modifiable determinant of early childhood caries, which is one of the most prevalent childhood diseases. Yet, two common measures of self-efficacy (i.e., context-specific and behavior-specific) lack validation and clarity in the prediction of children's oral health behaviors. This study examined the psychometric properties of two caregiver oral health self-efficacy measures and investigated the predictive ability and age-varying effects of caregiver oral health self-efficacy on child oral health behaviors. In this secondary data analysis of caregiver-child dyads (n = 754, Mchild age = 2.4, 56.2% Black or African American, 68.3% below poverty level), caregivers reported their oral health self-efficacy and their child's tooth brushing frequency, diet, and sugar-sweetened beverage (SSB) consumption at baseline and 4, 12, and 24 months. Psychometrics were examined with confirmatory factor analyses (CFAs) and the predictive ability and age-varying effects of caregiver self-efficacy on child oral health behaviors were examined with time-varying effect models (TVEMs). The context- and behavior-specific oral health self-efficacy CFA models indicated mixed model fit. In the predictive TVEM models, greater behavior-specific, but not context-, oral health self-efficacy predicted greater child tooth brushing across all ages. Greater context-specific oral health self-efficacy predicted healthier child diet throughout childhood, but greater behavior-specific self-efficacy only predicted healthier child diet in older children. Greater behavior-specific self-efficacy predicted lower SSB consumption throughout childhood while greater context-specific self-efficacy only predicted lower SSB consumption in younger children. Both caregiver oral health self-efficacy measures were psychometrically comparable and differentially predicted oral health behaviors across varying childhood ages. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Generating Actionable Evidence for School-Based Mental Health Service Delivery: Public-Academic Partnership Based Evaluations.

Public-academic partnership-based program evaluations can generate actionable evidence for policymaking, program design and implementation in improving school-based mental health service delivery. The University of Pennsylvania Center for Mental Health and public behavioral health care agencies in Philadelphia in the United States have evaluated Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The variety of evaluations include (1) examining acute mental health service use of children receiving school-based mental health care and Medicaid expenditure, (2) examining children's externalizing and internalizing behaviors to measure school mental health providers' performance, and (3) examining effects of different types of school mental health programs on children's behavioral health functioning, school outcomes, and other out-of-school service use. This paper reports key findings of these evaluations, discusses how programs have been refined based on evaluation results, and shares lessons learned for successful public-academic partnership-based evaluations to promote use of actionable evidence.

Association of COVID-19 Government-Instituted Mask Mandates With Incidence of Mask Use Among Children in Alberta, Canada

To help prevent the spread of SARS-CoV-2, government-instituted nonpharmaceutical interventions (eg, social distancing, mask use, isolating), a provincewide government-instituted mask mandate occurred on December 8, 2020, in Alberta, Canada, although some local jurisdictions implemented an earlier mask mandate. There remains a limited understanding of the association between government-implemented public health measures and individual health behaviors of children. To examine the association between government mask mandates and mask use among children in Alberta, Canada. A cohort of children from Alberta, Canada, was recruited to examine longitudinal SARS-CoV-2 serologic factors. Parents were prospectively asked about their child's mask use in public places every 3 months (5-point Likert scale: never to always) from August 14, 2020, to June 24, 2022. A multivariable logistic generalized estimating equation was used to examine government mandatory masking mandates and child mask use. Child mask use was operationalized into a single composite dichotomous outcome by grouping parents who reported their child often or always wore a mask vs those who reported their child never, rarely, or occasionally wore a mask. The primary exposure variable was the government masking mandate (began on different dates in 2020). The secondary exposure variable was government private indoor and outdoor gathering restrictions. The primary outcome was parent report of child mask use. A total of 939 children participated (467 female [49.7%]; mean [SD] age, 10.61 [1.6] years). The odds of parents' report of child mask use (often or always) was 18.3 times higher (95% CI, 5.7-58.6; P < .001; risk ratio, 1.7; 95% CI, 1.5-1.8; P < .001) with the mask mandate on compared with the mask mandate off. There was no significant change in mask use over the course of the mask mandate due to time. In contrast, each day with the mask mandate off was associated with a 1.6% decrease in mask use (odds ratio, 0.98; 95% CI, 0.98-0.99; P < .001). The results of this study suggest that government-mandated mask use and providing the public with up-to-date health information (eg, case counts) is associated with increased parent-reported child mask use, while increasing time without a mask mandate is associated with decreased mask use.

A Qualitative Study of Military Connected parents’ Perceptions on Establishing and Maintaining Child Behavioral Health Services

Few studies have examined U.S. military parents’ perspectives in establishing, maintaining, and reestablishing child behavioral health services within the context of military life. This qualitative study focused on the experiences of military-connected parents raising children who were receiving non-psychiatric outpatient behavioral health services for a range of behavioral or emotional challenges. The purposes of the qualitative study were to understand parents’ perspectives on the unique challenges military families face while seeking treatment and to understand facilitators or barriers to treatment. Twenty-two parents across the branches of the U.S. military participated in semi-structured interviews. Data were analyzed using a grounded theory approach. Primary themes identified were difficulties reestablishing social and healthcare support networks when moving. When accessing behavioral health services, stigma, difficulty obtaining referrals, and family logistics were noted barriers. Facilitators included parental advocacy on behalf of their child and primary care providers providing quick referrals to specialized behavioral health services.

The 2022 ParticipACTION Report Card on Physical Activity for Children and Youth: Focus on the COVID-19 pandemic impact and equity-deserving groups.

The ParticipACTION Report Card on Physical Activity for Children and Youth is the most comprehensive national assessment of physical activity and related behaviors, characteristics, and opportunities for children and youth. The 2022 Report Card assigned grades based on data gathered during the COVID-19 pandemic to reflect this extraordinary time-period in Canada. Further, while not graded, efforts were made to summarize key findings for early years children and those identifying as: having a disability, Indigenous, 2SLGBTQ+, newcomers to Canada, racialized, or girls. The purpose of this paper is to summarize the 2022 ParticipACTION Report Card on Physical Activity for Children and Youth. The best available physical activity data captured during the whole COVID-19 pandemic was synthesized across 14 different indicators in four categories. The 2022 Report Card Research Committee assigned letter grades (i.e., A-F) based on expert consensus of the evidence. Grades were assigned for: Daily Behaviors (Overall Physical Activity: D; Active Play: D-; Active Transportation: C-; Organized Sport: C+; Physical Education: Incomplete [INC]; Sedentary Behaviors: F; Sleep: B; 24-Hour Movement Behaviors: F), Individual Characteristics (Physical Literacy: INC; Physical Fitness: INC), Spaces and Places (Household: C, School: B-, Community and Environment: B), and Strategies and Investments (Government: B-). Compared to the 2020 Report Card, the COVID-19 specific grades increased for Active Play and Active Transportation; and decreased for Overall Physical Activity, Sedentary Behaviors, Organized Sport, and Community and Environment. There were many data gaps for equity-deserving groups. During the COVID-19 pandemic, the grade for Overall Physical Activity decreased from a D+ (2020) to a D, coinciding with decreases in grades reflecting fewer opportunities for sport and community/facility-based activities as well as higher levels of sedentary behaviors. Fortunately, improvements in Active Transportation and Active Play during COVID-19 prevented a worse shift in children's health behaviors. Efforts are needed to improve physical activity for children and youth during and post-pandemic, with a greater emphasis on equity-deserving groups.

The National Association for Children's Behavioral Health is seeking proposals for its Emerging Best Practices Conference

The National Association for Children's Behavioral Health (NACBH) is seeking proposals for its Emerging Best Practices Conference, “Innovations on the Horizon: Exploring Programs, Technology and Services for the Future,” Nov. 28–30 in St. Pete Beach, Florida. The NACBH conference will provide a platform to explore new and innovative programs, technologies and services that can improve outcomes for children and families. The conference will explore the latest trends and emerging best practices in the field that enhance the delivery of care, address challenges facing the industry and promote equity and access to care for all children and families. For more information, visit https://nacbh.memberclicks.net/call‐for‐proposals‐‐2023ebpc.

Examining the Relationship Between Health Behaviors of Adults and Preschool Children.

Children aged two to five years old are influenced by the behaviors of their guardians and Early Care Education (ECE) teachers. This study aims to determine the relationship between adults' and children's health behaviors in home and ECE settings. This study is novel in examining this correlation between multiple environments. Surveys were conducted across 32 ECE centers. Guardians and teachers reported on their and their children's health behaviors within the home and ECE. Matched child-adult responses (n = 1,140) were analyzed from a representative sample of 32 ECE centers throughout Georgia. Frequency of consumption of fruits, vegetables, and water, as well as frequency of physical activity were measured. Spearman rho correlations were analyzed using SPSS software, with p < 0.05 indicating significance. Spearman rho correlations indicated significant positive correlations between guardian and child behavior (rho = 0.49 to 0.70, p < 0.001) for all data. Teacher and child correlations were inconsistently significant across categories (rho = -0.11 to 0.17, p < 0.001). The influence of guardian behavior modeling on child health outcomes is critical for improving ECE programming and child obesity outcomes. This research can be used to inform future health interventions for young children.

Advergames for children's health education and communication practices

PurposeAppropriate and deliberate use of drug prevention methods is the key to educating children about the dangers of addiction and the way of prevention. With the growing prevalence of digital games among youngsters, health education and communication among children can try adopting advergames on digital television instead of traditional media, which has also been supported by prior research. It is, therefore, this research attempts to apply digital games as a means of health promotion and carry drug prevention messages through digital gameplay. Based on behavioral models, this research investigated the communication design and effectiveness of advergames for children's health promotion.Design/methodology/approachTwo studies were conducted in this research. In Study 1, the research team investigated how public health message was assimilated into advergames, which affect the health behaviors of children, they are (1) Knowledge about Drug, (2) Attitude Toward Drug and (3) Perceived Severity toward Drug-abuse. In Study 2, this research investigated the effects of the advergames on children through a between-group experiment. A pre-test/post-test for the control group and experimental group with 180 primary school children in Hong Kong was conducted.FindingsThe finding showed the potential use of advergames in health communication among children. The result proved that the anti-drug advergame is a more successful intervention among the participating children in the experimental group than the control group. The result triggers further investigations in academic, professional and educational values for advergames design, health education and communication areas.Research limitations/implicationsBecause of the chosen small sampling locally in Hong Kong, the research results may lack generalizability for other countries or practices.Practical implicationsThe study evokes children's awareness of drug prevention, encourages their physical and emotional wellness, and finally advocates a healthy lifestyle for them, through the deployment of health game communication.Originality/valueDespite this research studied the use of advergames, instead of digital games in general, for health promotion and delivering drug prevention messages. The research design distinctively allowed the primary students to participate in the design of the advergames instead of being passive players and/or in the information delivery process. This approach is indeed a pioneer attempt in that limited practice has been found academically. The study expands academic and practical knowledge on health game communication.

Education Changes Child Health Behavior in China: A Mediating Role of Information Technology.

Objectives: In this study, we aimed to explore the impact of education in changing child health behavior in China and mediating role of information technology. Methods: The theoretical framework of this study incorporated variables including mental health literacy, health education, information technology, and health behavior. This is a quantitative study that has utilized secondary data for determining the results. Based on the cross-sectional data collection method, 778 responses were considered for structural equation modeling. Smart PLS 3 was used to validate the research hypotheses. Results: We found that health education and mental health literacy have a substantial impact on Chinese child health behavior. Furthermore, our data also revealed that the mediating role of information technology is useful for children's health behavior enhancement. Conclusions: The health behavior of children is influenced by education and information technology mediates the health education-health behavior relationship.

Health-Promoting Schools Project for Palestine Children's Oral Health

ObjectivesThe aim of this work was to assess the oral health outcome of a 2-year comprehensive school oral health programme based on school-health education combined with supervised toothbrushing using 1450-ppm fluoride toothpaste amongst schoolchildren in Palestine. MethodsA quasi-experimental study (2016–2018) recruited 3939 schoolchildren aged 5 to 6 years from 30 intervention schools (n = 2333) and 31 comparison schools (n = 1606). At baseline and postintervention, mothers and schoolteachers completed World Health Organization (WHO) self-administered questionnaires about oral health of children, oral health behaviour, and family factors. Of the initial participants 75.8 per cent took part in the follow up studies. In addition, 25 calibrated dentists examined dental caries of children according to WHO criteria. Trained teachers provided comprehensive oral health education to children in the classrooms and held regular oral health sessions for mothers. Children brushed their teeth with fluoride-containing toothpaste (1450 ppm fluoride). Student t-test and logistic regression were used in the statistical analysis of changes in dental health and related knowledge, behaviours, and attitudes (P < .05). ResultsIn both dentitions, dental caries experience declined over the project. The reduction in Decayed, Missing and Filled permanent Teeth and Decayed, Missing and Filled Surfaces in permanent teeth was 23.3% and 23.2% (P < .001), respectively. The drop in caries experience indices in the Gaza Strip was 8 to 4 times higher than in West Bank, and it reached 47.4% reduction. Mothers and teachers showed improvement in positive knowledge and attitudes towards dental care. Involvement of schoolteachers in oral health in schools and acceptance of dental health education materials significantly enhanced oral health behaviour of children. ConclusionsThe project recommends national implementation of an intervention for the improvement of oral health of schoolchildren and their parents in conflict zones. The project shows the importance of the WHO Health Promoting Schools concept and involving classroom-based health education carried out by schoolteachers. It is suggested to explore the health care system's capacity in hosting effective oral health programme and maintain its efficacy.

Social Connectedness and Smoking among Adolescents in Ireland: An Analysis of the Health Behaviour in Schoolchildren Study.

Continuing progress with preventing smoking initiation is a key to the tobacco endgame. Home- and school-based social networks shape the health behaviour of children and adolescents. This study described the relationship between social connectedness and smoking behaviour in school-aged children in Ireland. The 2014 Irish Health Behaviour in School-aged Children (HBSC) surveyed self-reported smoking status and measured perceptions of social connectedness and support with validated and reliable questions across a random stratified sample of 9623 schoolchildren (aged 10-19). Overall, 8% of school-aged children reported smoking, in the last 30 days 52% reported smoking daily, and prevalence increased with age (p < 0.001). Compared with schoolchildren who did not smoke, perceptions of social connectedness and perceptions of support at home, from peers, and at school were significantly poorer for schoolchildren who smoked across all measures examined (p < 0.001). The poorest rated measures were for school connectedness and teacher support for smokers. Policies and practices that build and support positive environments for schoolchildren must continue to be prioritised if progress on preventing smoking initiation is to be sustained.

Social determinants of the health behaviours of children and adolescents during the COVID-19 pandemic

Social determinants of the health behaviours of children and adolescents during the COVID-19 pandemic

Procedural anxiety among children and adolescents with cystic fibrosis and their parents.

Procedural anxiety involves acute distress around medical procedures and may lead to avoidance or resistance behaviors that interfere with effectivecystic fibrosis(CF) care and health outcomes. While individuals with CFcommonly endure uncomfortable and/or distressing medical procedures, procedural anxiety among children and adolescents with CF has received little research attention. This study investigated the prevalence and correlates of procedural anxiety among individuals with CF aged 6-18 and their parents. Eighty-nine parents of children with CF completed surveys examining child procedural anxiety, anxiety, and health behaviors (including treatment adherence); and parent vicarious procedural anxiety. Seventy-five percentof participants rated at least one CF-related procedure as "extremely" anxiety-inducing for their child. Parental vicarious procedural anxiety was reported in 80.9% of participants. Procedural anxiety significantly correlated with child anxiety, treatment-resistive behaviors, and parent-vicarious procedural anxiety. Procedural anxiety was associated with younger age and frequency of distressing procedures, but not with forced expiratory volume in 1 s, body mass index, hospitalizations, or exposure to general anesthesia. Procedural anxiety is common among children, adolescents, and caregivers, and is associated with child anxiety and treatment resistance, emphasizing the importance of screening and interventions for procedural anxiety as part of routine CF care from early childhood. Implications for screening and intervention are discussed.

Improving Health Behaviors and Weight Parameters With Motivational Interviewing and the TEEEN Program in an Ethnically and Socioeconomically Diverse Pediatric Population

ObjectiveObesity affects 14.7 million children and adolescents in the United States. Children's health behaviors are affected by parental health practices. Therefore, pediatric obesity interventions should include parents. The objective of this study was to assess the changes in self-reported health behaviors in a diverse population attending the TEEEN program, with motivational interviewing of child-parent dyads as a key component, for 1 year. MethodsHere we assessed the changes in Family and Nutrition and Physical Activity (FNPA) screening tool scores, a tool that assesses obesogenic behaviors, in the context of MI of child-parent dyads in a racially, ethnically, and socioeconomically diverse population who attended the TEEEN (Teens, Empowerment, Education, Exercise, Nutrition) program, a nonclinic and family-based behavior program in Massachusetts, for 1 year. ResultsParticipation in the TEEEN program, which includes MI of child-parent dyads, was associated with a significant increase in the overall FNPA score (median change= 4 points, P = .007). We observed that 76.5% of children experienced a decrease in BMI% and BMI z-score. The change in BMI% (median= −0.9, P = .006) and change in BMI z-score (median= −0.2, P = .008) were statistically significant. ConclusionParticipation in the TEEEN program seemed to be beneficial based on aspects of the FNPA screening tool and changes in weight parameters. The FNPA screening tool enhanced-motivational interviewing of child-parent dyads shows promise as an approach to address obesogenic behaviors. This study provides a detailed framework for medical providers to address pediatric obesity in a nonclinic setting with less time constraints.

"Give up your mic": Building capacity and sustainability within community-based participatory research initiatives.

Community-based participatory research (CBPR) partnerships strive to promote community capacity building and sustainability, yet initiatives often suffer when grants or relationships with academic partners end. To address these concerns, researchers hoping to develop truly sustainable CBPR partnerships should consider factors that promote the development of community capacity and, ultimately, independence. In this first-person account, using perspectives gathered from FAVOR, a Connecticut-based family-led advocacy organization and an academic researcher, we examine the practices and experiences of the members of a CBPR partnership focused on using community voice to inform changes in the state's children's behavioral health system of care. These practices ultimately led to FAVOR developing the necessary skills to assume full ownership of the community data-gathering initiative, ensuring that the initiative would be sustained. Through the perspectives of five FAVOR staff and an academic researcher, we describe the factors that contributed to the organization being able to develop the capacity to independently continue their community data-gathering initiative, including description of the training process and staff members' perspectives on training, autonomy, community value, and lessons learned. We use these stories and experiences to provide recommendations for other partnerships striving to promote capacity building and sustainability through community ownership of the research process.

Psychosocial associated factors of early childhood caries and oral health-related quality of life: Structural equation model approach

ObjectiveTo identify a structural model for the identification of psychosocial associated factors of early childhood caries (ECC) and oral health-related quality of life (OHRQoL) in preschool children and their families. MethodsA population-based cross-sectional study was conducted with 533 preschool children from 4 to 6 years-old public and private preschools, from Ribeirão das Neves, MG. Parents/caregivers self-completed the Brazilian versions of the Early Childhood Oral Health Impact Scale (B-ECOHIS) and Resilience Scale as well as a structured questionnaire addressing socioeconomic status and child's oral health behavior. Two dentists who had undergone training and calibration exercises for ICDAS‑epi and pufa index (Kappa≥0.95) performed the examinations for ECC. Stages of ECC were classified as free of visible carious lesion, initial caries, moderate caries, extensive caries without pulp consequences and extensive caries with pulp consequences. Data were analyzed using structural equation modeling, using Mplus version 8.6. ResultsLower socioeconomic status (b=-0.250; p<0.001) and higher frequency of free sugar consumption (b = 0.122; p = 0.033) were directly associated with a more severe stage of ECC. Lower parental resilience had an indirect impact on more severe stage of ECC which was mediated by the variable ‘frequency of free sugar consumption’ (b=-0.089; p = 0.048). ECC was associated with lower child's OHRQoL (b = 0.587; p<0.001) and lower family's OHRQoL (b = 0.506; p<0.001). ConclusionStructural modeling revealed that the severity of ECC negatively impacted the OHRQoL of preschoolers and their families. The main associated factors of the severity of ECC were lower socioeconomic status, higher frequency of free sugar consumption and lower parental resilience. Clinical SignificanceT The findings indicate that psychosocial and behavior variables can be associated with the severity of ECC, and ECC can be associated with negative impact on wellbeing and ability to perform daily activities of preschoolers and their families.

Impact of the COVID-19 lockdown on the oral health status of paediatric dental patients in Greece.

Limited evidence regarding the post-COVID-19 dental status of paediatric patients is available, with most studies assessing only children's oral health habits. To evaluate the effect of the COVID-19 lockdown on the oral health of paediatric dental patients in Greece. This was a retrospective cohort study that included a questionnaire on children's oral health behavior and a clinical examination assessing dental caries and dental treatment needs using the International Caries Detection and Assessment System criteria, dmft/DMFT, and Treatment Need Index. The Wilcoxon signed-rank test was used for a statistical comparison between questionnaire and clinical data before, during, and after the lockdown. A total of 102 children with a median age of 9 years were recruited from the current cohort of patients that had their last dental examination 6months prior to the lockdown. Results from the questionnaire showed decreased brushing frequency with increased eating frequency and sugar consumption during the lockdown period (p < .001). Moreover, 16.5% had to visit the dentist for urgent care during the lockdown, 13.6% experienced dental pain, and 51.5% did not experience any dental emergencies. Clinical examination, after the lockdown, recorded significantly increased mean dmft/DMFT scores by 0.63 units in the primary dentition (p=.01) and 0.52 units in the permanent teeth (p=.002). Significantly higher treatment needs, with more carious lesions requiring extensive treatment after the lockdown, were recorded (p < .001). The COVID-19 lockdown negatively affected children's oral health behavior: caries prevalence increased and more complex dental treatments were required.