Important dates for 2018-2019 School Year registration
The following events would be included during this year. As discussed below, the House bill would mandate that all states exclude child support payments from the payor household. Improper marketing and promotion of food products that compete with breastfeeding often negatively affect the choice and ability of a mother to breastfeed her infant optimally. States would likely need to pay for more credit checks to scrutinize and verify information that households provide. Infants aged 6—8 months who receive solid, semisolid or soft foods. Milk does a body good: Pediatrics Mar , peds.
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Video Abstracts -- brief videos summarizing key findings of new articles Looking for a change of scenery? Happy 70 th Birthday, Pediatrics! See top articles through the decades. Almost half of young children in the United States live in poverty or near poverty. The American Academy of Pediatrics is committed to reducing and ultimately eliminating child poverty in the United States.
Poverty and related social determinants of health can lead to adverse health outcomes in childhood and across the life course, negatively affecting physical health, socioemotional development, and educational achievement.
The American Academy of Pediatrics advocates for programs and policies that have been shown to improve the quality of life and health outcomes for children and families living in poverty.
With an awareness and understanding of the effects of poverty on children, pediatricians and other pediatric health practitioners in a family-centered medical home can assess the financial stability of families, link families to resources, and coordinate care with community partners.
Further research, advocacy, and continuing education will improve the ability of pediatricians to address the social determinants of health when caring for children who live in poverty. Accompanying this policy statement is a technical report that describes current knowledge on child poverty and the mechanisms by which poverty influences the health and well-being of children. Poverty is an important social determinant of health and contributes to child health disparities.
Children who experience poverty, particularly during early life or for an extended period, are at risk of a host of adverse health and developmental outcomes through their life course.
Child poverty is associated with lifelong hardship. Poor developmental and psychosocial outcomes are accompanied by a significant financial burden, not just for the children and families who experience them but also for the rest of society. Children who do not complete high school, for example, are more likely to become teenage parents, to be unemployed, and to be incarcerated, all of which exact heavy social and economic costs.
Child poverty is greater in the United States than in most countries with comparable resources. According to Census data, an estimated Demographics have a profound influence on the likelihood that a family or community will experience poverty or low income.
Children may be born into poverty, remain in a poor household throughout childhood, or, most commonly, rotate in and out of poverty over time. Equality of opportunity is central to the American dream and is reflected by social mobility or the potential of intergenerational economic betterment. However, social mobility is difficult to measure, because the usual method compares incomes of year-old persons against the incomes of their parents. Despite the difficulties, most researchers agree that social mobility in the United States has faltered as the wealth and opportunity gaps between rich and poor have widened in the past decade.
In comparison with European and other wealthy industrialized countries, social mobility in the United States ranks among the lowest. The result is a dramatic decline of the possibility of economic improvement for the poor. Wealthy children continue to be wealthy as adults and enjoy academic and employment advantages. The drag on social mobility resulting from income and opportunity inequality is even more striking for people of color.
Although legacy residential segregation and environmental racism persist as regions of deep poverty in mostly urban areas, 23 the epidemiology of poverty has shifted over the past decade, in part because of the housing crisis and the Great Recession. Since , suburbs have experienced larger and faster increases in poverty than either urban or rural areas. Because pediatricians work to prevent childhood diseases during health supervision visits and with anticipatory guidance, the early detection and management of poverty-related disorders is an important, emerging component of pediatric scope of practice.
With improved understanding of the root causes and distal effects of poverty, pediatricians can apply interventions in practice to help address the toxic effects of poverty on children and families. They also can advocate for programs and policies to ameliorate early childhood adverse events related to poverty.
Pediatricians have the opportunity to screen for risk factors for adversity, to identify family strengths that are protective against toxic stress, and to provide referrals to community organizations that support and assist families in economic stress.
This policy statement builds on previous policies related to child health equity, 26 housing insecurity, 27 and early childhood adversity. Programs that help poor families and children take many forms and often involve stakeholders from multiple communities, including governmental, private nonprofit, faith-based, business, and other philanthropic organizations.
The following paragraphs describe several antipoverty and safety net programs that are particularly important for child health and well-being. Individual program outcomes, including financial cost-benefit estimates, are documented where possible. However, the cumulative effect of safety net programs has been demonstrably positive. Longitudinal studies from to that used the Supplemental Poverty Measure SPM revealed that government programs have had a significant effect on family poverty.
The earned income tax credit EITC is a refundable federal tax credit that helps low-income families. The EITC helps reduce poverty by incentivizing employment and supplementing income for low-wage workers.
In , 25 states had established their own state-level credits to supplement the federal credit. An analysis of families who received the largest EITC under the s expansions of the credit showed lower rates of low birth weight children, fewer preterm births, and increased prenatal care among these families. The child tax credit provides tax refunds to low-income working families who pay payroll taxes but who might not owe federal income tax.
Although only partially refundable, this direct cash benefit in helped approximately 1. Temporary Assistance for Needy Families TANF is a block grant program by which the federal government provides money for states to fund work and family support programs with specific goals and time limits. The Personal Responsibility and Work Reconciliation Act of often referred to as welfare reform created TANF to replace Aid to Families with Dependent Children, thereby creating block grants for state administration, work requirements for eligibility, and lifetime limits on receipt of federal support.
Because of unchanging federal funding levels and limits of the amount of time individuals can access benefits, the number of families receiving TANF has decreased, despite the increased need since the Great Recession.
Income stagnation in recent decades and the erosion of purchasing power have contributed to the financial instability of working poor families. Financial stability means that basic needs, such as housing and transportation, are more dependable and family stress may be reduced. School readiness and academic performance of children are sensitive to family income. The association is strongest at the low end of the family income scale and becomes statistically nonsignificant for wealthy families.
Work requirements for cash and other benefits have been advanced, especially since welfare reform in the s, as a way to promote self-sufficiency and reduce welfare rolls. However, as a consequence of young mothers being required to work, infants may be placed in child care at a very early age, and mothers often require a patchwork of solutions, some of which may be substandard.
During the first 3 months of , the uninsured rate for poor children dropped further to 6. Early Head Start and Head Start are federally funded, community-based programs for low-income families with young children. Early Head Start serves pregnant women and families with infants and toddlers up to 3 years of age; Head Start serves families with preschool-aged children 3 to 5 years of age. These programs provide educational, nutritional, health, and social services.
In addition to child care and preschool services, Early Head Start and Head Start offer prenatal education, job-training and adult education, and assistance in accessing housing and insurance. Early childhood interventions have been found to have a high rate of return in both human and financial terms.
Early interventions in high-risk situations have the highest return, presumably through mitigating the effects of toxic stress by providing nurturance, stimulation, and nutrition. Child benefits include improved cognitive functioning, improved self-regulation, and advancement of development in all domains. The Supplemental Nutrition Program for Women, Infants, and Children WIC is a federal assistance program of the US Department of Agriculture that was first established in with the aim of improving the health of low-income women, infants, and children.
WIC is associated with improved outcomes in pregnancy and early childhood development. A series of reports from the US Department of Agriculture has shown that WIC participation for low-income women decreased the rates of prematurity and infant mortality and increased involvement in prenatal care.
Children participating in WIC have scored higher on assessments of mental development at 2 years of age than similar children who were not participating in the program. In addition, children whose mothers participated in WIC when they were in utero have also been shown to perform better on reading assessments than similar children of mothers who did not use the program. As with other federal programs, eligibility depends on income, age, family size, and citizenship.
More than 45 million Americans currently receive SNAP benefits each month, including approximately 20 million children. The National School Lunch Program is a federally funded program that provides low-cost and free breakfasts, lunches, and, on a limited basis, summer food to school-aged children.
The federal program supplies both public and private nonprofit schools with food and cash incentives. The meals are produced in accordance with the Dietary Guidelines for Americans. A recent analysis estimated that, using these guidelines, more than half of all US public school students are eligible to receive free or reduced-price meals. Nutrition support, such as WIC and SNAP, address undernutrition, but other forms of malnutrition, such as obesity, also may be responsive to supplemental programs.
For instance, a recent study in preschool-aged children found that those who participated in Head Start had a healthier BMI at school entry than did children who did not have the benefit of food provided by federal subsidy. It provides support for federal, state, and community governments to implement established and proven home visiting programs for at-risk children.
The stated goals of MIECHV are to improve maternal and newborn health; prevent child injuries, abuse, neglect, or maltreatment; reduce emergency department visits; improve school readiness and achievement; reduce crime or domestic violence; improve family economic self-sufficiency; and improve coordination and referrals for other community resources and supports.
MIECHV has identified 19 evidence-based interventions that target families with pregnant mothers and children younger than 5 years. First-time, low-income mothers are enrolled during the prenatal period and visited weekly by nurses trained in a validated curriculum beginning in the second trimester.
The benefit-cost ratio for high-risk mothers has been calculated at 5. Programs designed for the pediatric medical home provide opportunities for low-cost, population-based preventive intervention with low-income families.
An awareness of the protective factors that are present in children and families can help pediatricians to build on their strengths during health promotion conversations. In a medical home adapted to the needs of families in poverty, parents have the opportunities and resources to promote resilience in their young children, giving them the capacity to adapt to adversity and buffering the effects of stress. Healthy Steps for Young Children, a manual-based primary care strategy, and programs such as Incredible Years and Triple P, which integrate behavioral health into primary care, have been shown to promote responsive parenting and address common behavioral and developmental concerns.
Another program, the Video Interaction Project VIP , combines early literacy with guided parent-child interactions that support family relationships and social development of children. The AAP has promoted the National Center for Medical-Legal Partnerships model, which provides legal aid collocated with health services, especially to families in poverty.
A pilot study of medical-legal partnerships found that addressing the social determinants of health by providing legal services and helping families negotiate safety net organizations improves child health outcomes, reduces unnecessary urgent visits, and raises overall child well-being. Care coordination, a fundamental service of the medical home model, can link families with community resources and support interagency coordination to address basic concerns such as food and energy insecurity.
An example of a robust case management initiative is Health Leads, 77 an enhanced primary care strategy that uses college volunteers as advocates and advanced resource management techniques, which has improved coordination of care and utilization of collocated social services by low-income families with the intent of reducing the social barriers to good health.
To link families to services as early as possible, pediatricians can use screening tools that have high sensitivity and specificity. The WE CARE survey 78 is a brief set of questions that alerts the pediatrician to families experiencing stress related to poverty.
Effective early identification of families in need may facilitate prevention services, including nutritional supplements for young children, preventive health services, age-appropriate learning opportunities, and socioemotional support of parents. Program evaluation has supported this multifaceted approach in multiple countries and settings. Early childhood experiences that promote relational health lead to secure attachment, effective self-regulation and sleep, normal development of the neuroendocrine system, healthy stress-response systems, and positive changes in the architecture of the developing brain.
Two-generation strategies focus on helping low-income children and their parents simultaneously through high-quality interventions. Improved coordination of programs and services for low-income families is essential to a 2-generation strategy.
Recent research suggests that noncognitive skills, such as perseverance, empathy, and self-efficacy, remain malleable during adolescence 90 and build on the cognitive skills developed during early childhood. Interventions such as adolescent mentoring, residential training eg, Job Corps , and workplace-based apprenticeship programs can increase academic achievement, employment success, and other nonacademic accomplishments over the life span.
As the health care system increasingly focuses on efforts to improve quality and contain costs, there may be new opportunities to restructure the health care delivery system in ways that can improve care for children in low-income families.
Policy decisions in other countries, such as the United Kingdom, 91 also may inform these efforts. Incentivizing care coordination and team-based care may help more children access quality health care through patient- and family-centered medical homes FCMHs. Medical homes also can help families address unmet social and economic needs by using partners, such as community health workers, within the health care team.
State reforms and integrated health delivery systems in some regions are providing incentives for population health approaches, facilitating collaboration in healthy neighborhood initiatives. Although all children may benefit from greater collaboration between health care organizations and community resources, children and in poor and low-income families may experience even greater gains. Public policy efforts are needed to protect the health of children affected by poverty and to help families become economically secure.
The specific recommendations made in this and the following section are based on positive outcomes in peer-reviewed literature or preliminary studies that show sufficient promise that rigorous long-term evaluations are underway. Invest in young children. Funding quality early childhood programs can have a significant financial return on investment, but more importantly, making healthy development of young children a national priority while addressing social determinants of health helps families and communities build a foundation for lifelong health.
Protect and expand funding for essential benefits programs that assist low-income and poor children. Streamline enrollment and renewal processes for public benefit programs.
Support 2-generation strategies that focus on helping children and parents simultaneously. Promote the coordination and alignment of adult- and child-focused programs, policies, and systems. Support and expand strategies that promote employment and that increase parental income. Support policies that help parents increase family income, including higher minimum wages, education and job-training programs, and the EITC, child tax credit, and child and dependent care tax credit.
Support policy measures that improve community infrastructure, including affordable housing and public spaces. Ensure that all children have safe outdoor play areas as well as healthy, safe, and affordable housing. Improve access to quality health care and create incentives to improve population health with the goal of reducing health disparities. Strategies to improve quality and reduce costs should include care coordination and team-based care that help families address nonmedical health-related concerns, such as food, housing, and utilities.
Pediatricians and health care systems should be encouraged to partner with other stakeholders to advance community-level strategies that improve health and reduce disparities among populations of varying income levels. Enhance health care financing to support comprehensive care for at-risk families. All benefit plans should include coverage for enhanced services in the medical home for families in poverty.
Care coordination, team-delivered care, and coverage for mental health services provided by pediatricians are examples of these enhanced services. Make a national commitment to fully fund home visiting programs for all children living in low-income or poor households. Both Medicaid and education funding agencies should provide support in the medical home for parenting and literacy promotion. Improve national poverty definitions and measures.
The SPM is an improvement, but more research is necessary to quantify the extent of poverty in the United States and its effects on children and families so that effective responses can be developed and promoted. Support a comprehensive research agenda to improve the understanding of the effects of poverty on children and to identify and refine interventions that improve child health outcomes.
Research is needed to identify better ways to measure how poverty affects children, what works to help families in poverty, and how to translate the information gained into real solutions for the poor. The following recommendations address how individual pediatricians can support the health and well-being of children living in poverty. Adaptations of the medical home to acknowledge the complex challenges that confront poor families require surveillance on the part of the practitioner of both risk and protective factors that characterize each family.
Create a medical home that acknowledges and is sensitive to the needs of families living in poverty. Although every family wants to provide the best resources and care to their children, economic barriers can stand in the way. All members of the care team and practice should become familiar with some of the common challenges faced by poor families.
Recognizing problems such as transportation barriers, difficult work schedules, and competing financial issues can help practices effectively communicate and partner with families.
An enhanced medical home providing integrated care for families in poverty is informed by the understanding that emotional care of the family, including recognizing maternal depression, is within the scope of practice for community pediatricians and that the effects of toxic stress on children can be ameliorated by supportive, secure relational health during early childhood.
Screen for risk factors within social determinants of health during patient encounters. Practices can use a brief written screener or verbally ask family members questions about basic needs, such as food, housing, and heat. Screening for basic needs can help uncover not only obvious but also less apparent economic difficulties experienced by families. As patient-centered medical homes continue to develop, care coordinators will fulfill the role of community liaison for families in poverty, connecting them with needed resources.
These programs help parents develop the capacity and confidence to build resilience in their children and improve the ability of the family to cope with adversity. Bright Futures guidelines provide the most comprehensive recommendations for health supervision and are enhanced by strategies to advance behavioral health care into the pediatric medical home and to address the social determinants of health. Identify and build on family strengths and protective factors.
Although families in poverty face many challenges, each family has strengths, capabilities, and protective factors. Pediatricians can strive to identify and build on protective factors within families, such as cohesion, humor, support networks, skills, and spiritual and cultural beliefs. Collaborate with community organizations to help families address unmet basic needs and assist with family stressors. When unmet basic needs and poverty-associated risks are identified, pediatricians can refer families to appropriate community services and public programs.
Key partners may include local and state public health departments, legal services, social work organizations, food pantries, faith-based organizations, and community development organizations. Some communities also may have innovative financial literacy programs that are helpful.
Engage with early intervention programs and schools to promote learning and academic achievement. Education professionals are often very involved in efforts to help children from low-income backgrounds with academic achievement and also may participate in initiatives focused on basic needs, such as feeding programs, clothing drives, and health screenings. Pediatricians can actively participate with these efforts as well as early intervention programs, after-school programs, tutoring programs, and social services provided through the school district.
Pediatricians should be familiar with local MIECHV programs and how to connect their patients with home visiting programs on the state and local levels.
Opportunities for enhanced communication between the FCMH and home-visiting programs may be explored, including the possibility of collocation of visitors in the FCMH as an integrated service model. Support community programs that enhance the involvement of fathers in the lives of their children. Pediatricians can be an important support resource and advocate for community-based fatherhood initiatives. When possible, nonresidential fathers should be involved in all aspects of pediatric care.
Advance strategies to address family and child mental health and development. Pediatricians are strongly encouraged to include routine screening for maternal depression at every health supervision visit during the first year of life and to be able to provide an appropriate referral for treatment when depression is suspected.
Pediatricians can advocate for increased resources to address mental health and behavioral issues in poor communities, including separate payment for screening for parental depression and for care coordination activities. Advocate for public policies that support all children and help mitigate the effects of poverty on child health.
Pediatricians can serve as important advocates for policies that help children and families in poverty. Pediatricians can add a unique voice to poverty-related advocacy by reframing poverty as an evidence-based health concern with lifelong health, social, and economic consequences.
Poverty and other adverse social determinants have a detrimental effect on child health and are root causes of child health inequity in the United States. Knowledge is expanding rapidly, especially regarding the neurobiological effects of poverty and related environmental stressors on the developing human brain as well as the life course of chronic illness.
Understanding the causative relation between early childhood poverty and adult health status should inform and influence the decisions of policy makers, researchers, and community pediatricians. The evidence strongly suggests that the FCMH with its enhanced capabilities is an essential asset in efforts to ameliorate the adverse effects of poverty on children. The AAP considers child poverty in the United States unacceptable and detrimental to the health and well-being of children and is committed to its elimination.
The AAP calls for concerted action by its state chapters as well as governmental, private, nonprofit, faith-based, philanthropic, and other advocacy organizations to reduce child poverty by supporting and expanding existing programs that have been shown to work and to make efforts to develop, identify, and promote other potentially effective policies and programs.
Together, these 2 pieces of legislation have greatly reduced and nearly eliminated poverty in the elderly. Trained 5, health workers to ensure competency in the prevention of Zika virus infection, the provision of voluntary family planning, the management of child illness, and the improvement of WASH. USAID developed standard operating procedures and budget implications to facilitate this scale-up.
Finalized a new Community Health Strategy, which introduced community health agents who increase access to health care in remote and hard to reach communities. Integrated nutrition services into a planned vaccination campaign, which gave 8. Worked with Christian and Muslim religious leaders to advocate for the healthy timing and spacing of pregnancy, stigma reduction among people living with HIV, and the prevention of gender-based violence.
Helped administrative units to be declared open-defecation free, and trained 9, community and local government members to apply improved sanitation methods and sustain ODF status. Assisted four laboratories in achieving international accreditation to conduct quality assurance testing of medicines, which means many maternal and child health drugs no longer need to be sent abroad for testing.
Transitioned from substantial financial and technical support for the community-based health insurance to targeted technical assistance only, as the insurance program has been transitioned to the Rwanda Social Security Board RSSB for ongoing management. Conducted a mapping of the Senegalese private sector, which will provide the Ministry of Health and Social Action with an accurate and comprehensive database of 2, private facilities.
Designed an effective contraceptive distribution system that, for the first time, enables the routine delivery of contraceptives to health facilities outside of the capital, Juba. This effort will be funded jointly between the Government and other partners. The Acting on the Call report focuses on the journey to self-reliance for preventing child and maternal deaths. Photo by Saving Mothers Giving Life. Photo by Morgana Wingard.
Ethiopia Advocated for the creation and filling of more than 1, Human Resource Manager positions within host-government institutions to improve the timely recruitment, motivation, retention, and transfer of health workers. Ghana Supporting the Ghana Health Service to the transition from pen and paper to a digital health record system, which will enable GHS to better manage patient cases and promote efficiency in data management.
Haiti Trained 5, health workers to ensure competency in the prevention of Zika virus infection, the provision of voluntary family planning, the management of child illness, and the improvement of WASH. Liberia Finalized a new Community Health Strategy, which introduced community health agents who increase access to health care in remote and hard to reach communities. Mali Integrated nutrition services into a planned vaccination campaign, which gave 8.