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Objective To evaluate the impact of the COVID-19 pandemic experience on language development among children, we compared language development at 18 months of age, before and during the pandemic in Japan, where strict control measures continued over a long period. Methods This was a repeated cross-sectional study and we included children who attended the 18-month health check-up provided by the Okayama City Public Health Center between January 2017 and December 2022 (n=33 484). We compared indicators of language development before (from January 2017 to February 2020) and during (from March 2020 to December 2022) the pandemic. Our primary outcome was the proportion of children who required follow-up for language development by the Public Health Center. The secondary outcome was the proportion of children who could not say three or more meaningful words. We estimated risk ratios (RRs) and their 95% CIs, adjusted for potential confounders. Results The prevalence of the primary outcome

University hospitalUnited statesYoko okaHiroaki matsuokaSaori irieTakako besshoAnalisa avilaChiyori satouAiko teraokaEriko sasakiMayumi sanehiraNational centerOkayama city public health centerMinistry of healthChild healthPublic health center