March 14, 2016
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AAP: Unacceptable child poverty in US requires screening, policy reform

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Poverty has a significant impact on the health and development of children in the United States — increasing the risks for toxic stress, infant mortality, developmental delays and other adverse events — and requires universal screening at all well-child visits, according to a recent recommendation released by the AAP.

“Pediatricians are dedicated to preventing illness in children and intervening early when there is a problem,” James H. Duffee, MD, MPH, of the AAP’s Council on Community Pediatrics, said in a press release. “Because poverty so strongly influences children’s health and development, pediatricians are asking about poverty-related stress so we can connect families to resources in their communities.”

The policy statement outlines ways that poverty adversely affects children’s physical health and emotional development. According to the authors, almost half of young children in the U.S. live in or near poverty. Low family income is associated with increased risks for infant mortality, decreased language development, asthma, obesity and other bodily injuries. Poverty also can lead to other lifelong health conditions, including cardiovascular issues, immune disorders and psychiatric problems. In addition, children’s school readiness and academic achievement can be drastically impeded due to low family income.

The authors recommend pediatricians conduct simple universal screening for potential poverty-related harms during all well visits by asking parents if they “have difficulty making ends meet at the end of the month.” The statement recommends further questioning to determine whether children are receiving basic needs, such as food, heating and housing.

Other key recommendations included:

  • identifying and building on protective factors within families via surveys;
  • using strategies and programs to integrate behavioral health into primary care;
  • promoting early literacy in the medical home; and
  • advocating for public policy reform that invests in the basic needs of young children.

In an accompanying technical report, John M. Pascoe, MD, MPH, professor of pediatrics at Wright State University and developmental pediatrics specialist at Dayton Children’s Hospital, and colleagues identified the specific mediators and adverse effects of child poverty. The researchers identified the present state of knowledge on poverty’s impact on child health by studying its physiological, sociological, psychological, economical and epidemiological aspects. Among other findings, the researchers determined that stress caused by poverty can be lessened through parent engagement and good relational health.

“We know that poverty-related conditions can take a significant and lasting toll,” Pascoe said in the press release. “But we also know there are effective interventions to help buffer these effects, like promoting strong family relationships, which cause positive changes in the body’s stress response system and the architecture of the developing brain.”

The AAP policy statement declared that child poverty in the U.S. is unacceptable. Recommendations to policymakers included expansion of state and federal antipoverty and safety net programs. The authors also advocated for improvements in early childhood education, affordable housing, home visiting programs and nutritional support programs.

Dreyer_Bernard

Benard P. Dreyer

“Poverty is everywhere. It affects children of all backgrounds and in all communities,” Benard P. Dreyer, MD, president of the AAP, said in the release. “Pediatricians want to improve the health and well-being of every child, and helping families deal with poverty-related issues is essential to achieving that goal. Fortunately, we have realistic solutions that we know will work. This is a problem that can be solved, and it’s well within our reach.” – by David Costill

Disclosure: The researchers report no relevant financial disclosures.