In the Journals

Homelessness affects children’s health, even before they are born

Photo of Megan Sandel
Megan Sandel

Children who experienced prenatal and postnatal homelessness were at high risk for poor health outcomes, according to study results published in Pediatrics. Homelessness lasting longer than 6 months was also a negative determinant of health.

“We found that homelessness negatively impacted a child’s health even before birth, and children under the age of 1 who were homeless for more than 6 months experienced high risks of poor health outcomes and developmental delays.” Megan Sandel, MD, MPH, associate director of the GROW Clinic and a pediatrician at Boston Medical Center, told Infectious Diseases in Children. “This tells us that the earlier and longer in development a child experiences homelessness may have a larger cumulative toll of poor health.”

Sandel and colleagues interviewed 20,571 low-income caregivers of children aged younger than 4 years in urban pediatric clinics and EDs in Baltimore, Maryland; Boston; Little Rock, Arkansas; Minneapolis, Minnesota; and Philadelphia. Families with private health insurance were excluded from the study.

The researchers controlled for birth outcomes and other potential confounders in their analysis. They reported that children who were both prenatally and postnatally homeless were at the highest risk of postnatal hospitalizations (adjusted OR = 1.41; 95% CI, 1.18-1.69), fair or poor child health (aOR = 1.97; 95% CI, 1.58-2.47) and developmental delays (aOR = 1.48; 95% CI, 1.16-1.69) compared with children who were never homeless. However, children who were homeless prenatally or postnatally were not significantly at risk of being underweight (aOR = 0.95: 95% CI, 0.76-1.18) or overweight (aOR = 1.07; 95% 0.84-1.37).

Boy in poverty
Source: Shutterstock.com

Sandel and colleagues also reported that infants who experienced homelessness for more than 6 months were more likely to have a history of hospitalizations (aOR = 1.51; 95% CI, 1.03-2.22), be in fair or poor health (aOR = 3.13; 95% CI, 2.05-4.79), be at developmental risk (aOR = 1.81; 95% CI, 1.11-2.94), and have overweight status (aOR = 1.74; 95% CI, 1.12-2.70), compared with children who were never homeless. Toddlers who were homeless also were more likely to have a history of hospitalizations (aOR = 1.47; 95% CI, 1.15-1.87) and fair or poor health (aOR = 1.89; 95% CI, 1.38-2.58).

“This research provides even more evidence of how important it is to prevent homelessness among children,” Sandel said. “There is no safe amount of time for a child to be homeless, and as pediatricians we should be regularly screening families for housing instability, so interventions can reach those at risk of experiencing homelessness. With the data on the housing status of our patients, we can also be better advocates for resources to drive innovations in addressing housing instability.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.

Photo of Megan Sandel
Megan Sandel

Children who experienced prenatal and postnatal homelessness were at high risk for poor health outcomes, according to study results published in Pediatrics. Homelessness lasting longer than 6 months was also a negative determinant of health.

“We found that homelessness negatively impacted a child’s health even before birth, and children under the age of 1 who were homeless for more than 6 months experienced high risks of poor health outcomes and developmental delays.” Megan Sandel, MD, MPH, associate director of the GROW Clinic and a pediatrician at Boston Medical Center, told Infectious Diseases in Children. “This tells us that the earlier and longer in development a child experiences homelessness may have a larger cumulative toll of poor health.”

Sandel and colleagues interviewed 20,571 low-income caregivers of children aged younger than 4 years in urban pediatric clinics and EDs in Baltimore, Maryland; Boston; Little Rock, Arkansas; Minneapolis, Minnesota; and Philadelphia. Families with private health insurance were excluded from the study.

The researchers controlled for birth outcomes and other potential confounders in their analysis. They reported that children who were both prenatally and postnatally homeless were at the highest risk of postnatal hospitalizations (adjusted OR = 1.41; 95% CI, 1.18-1.69), fair or poor child health (aOR = 1.97; 95% CI, 1.58-2.47) and developmental delays (aOR = 1.48; 95% CI, 1.16-1.69) compared with children who were never homeless. However, children who were homeless prenatally or postnatally were not significantly at risk of being underweight (aOR = 0.95: 95% CI, 0.76-1.18) or overweight (aOR = 1.07; 95% 0.84-1.37).

Boy in poverty
Source: Shutterstock.com

Sandel and colleagues also reported that infants who experienced homelessness for more than 6 months were more likely to have a history of hospitalizations (aOR = 1.51; 95% CI, 1.03-2.22), be in fair or poor health (aOR = 3.13; 95% CI, 2.05-4.79), be at developmental risk (aOR = 1.81; 95% CI, 1.11-2.94), and have overweight status (aOR = 1.74; 95% CI, 1.12-2.70), compared with children who were never homeless. Toddlers who were homeless also were more likely to have a history of hospitalizations (aOR = 1.47; 95% CI, 1.15-1.87) and fair or poor health (aOR = 1.89; 95% CI, 1.38-2.58).

“This research provides even more evidence of how important it is to prevent homelessness among children,” Sandel said. “There is no safe amount of time for a child to be homeless, and as pediatricians we should be regularly screening families for housing instability, so interventions can reach those at risk of experiencing homelessness. With the data on the housing status of our patients, we can also be better advocates for resources to drive innovations in addressing housing instability.” – by Bruce Thiel

Disclosures: The authors report no relevant financial disclosures.