Pediatricians on the Frontlines of Poverty

March 10, 2016early childhood, home visiting, toxic_stress

When taking your child to the doctor for a well-child visit, the appointment normally includes a physical exam, checking your child’s growth and development, vaccinations, and asking your doctor any questions you may have. Now, the American Academy of Pediatricians (AAP) is recommending that doctors add another component to these visits: screening for poverty.

In 2014, 21.1 percent of children in the U.S. (under 18 years old) lived in poverty.[1] This number was even higher for young children under the age of five (23.8%).[2] Furthermore, 42.9 percent of all U.S. children were living “in households designated as poor, near poor, or low-income” (i.e., households with incomes up to 200% of the Federal Poverty Line).[3]

These families often struggle to make ends meet and may be just one crisis away from falling into poverty. An expansive body of research has identified the potential detrimental effects of poverty on children. As the new AAP policy statement highlights, poverty, especially early in life or as experienced for an extended period of time, is associated with increased risks of adverse health, developmental, and social and behavioral outcomes over the course of a child’s life.[3]

“The impact that poverty has on physiology in childhood is pervasive,” says Dr. Racine, chair of the AAP Poverty and Child Health Leadership Work Group

As a part of their effort to reduce poverty and its negative effects on child health, the AAP has made new recommendations for pediatricians that feature opportunities for policy advocacy and community practice, including (but not limited to):

  • Advocating for continued investment in evidence-based programs that assist both children and their families, including quality early childhood programs like home visiting, two-generation strategies, child and maternal health programs, and programs that address needs in community infrastructure, among others;
  • Creating a “medical home” in which medical team members understand the challenges faced by poor families and are “sensitive to the needs of families living in poverty;”
  • Screening for “risk factors within social determinants of health during patient encounters” by asking patients and family members if they have unmet basic needs;
  • Collaborating with and linking families to early interventions and community partners who can help address families’ needs; and
  • Identifying “family strengths and protective factors,” such as “cohesion, humor, support networks, skills, and spiritual and cultural beliefs,” to empower families to use these strengths to address problems. [3]

Given the share of children living in or near poverty, the AAP’s recommendations have the potential to help curb the negative effects of poverty in many children’s lives. A Washington Post article from earlier this week noted that a recent randomized controlled trial “showed that when clinicians screen for social determinants like unmet basic needs, their patients received more community resources than controls.”[4]

In publishing these recommendations, the AAP has taken an important step in recognizing the negative impacts of poverty on our society, and the important link a pediatrician is for a family to other resources and supports in their community.

Related Resources: CFRP Toxic Stress 101 Storify,  CFRP Toxic Stress infographic, Home Visiting in Texas 

 

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Sources:

  1. DeNavas-Walt, C. & Proctor, B. D. (2015). Income and poverty in the United States: 2014. U.S. Census Bureau. Retrieved from http://www.census.gov/hhes/www/poverty/data/incpovhlth/2014/index.html
  2. U.S. Census Bureau (2015). POV01. Age and sex of all people, family members and unrelated individuals iterated by income-to-poverty ratio and race. Retrieved from http://www.census.gov/hhes/www/cpstables/032015/pov/pov01_000.htm
  3. AAP Council on Community Pediatrics (2016). Poverty and child health in the United States. Pediatrics, 137(4), 1-14.
  4. Blakemore, E. (2016, March 9). Doctors should screen for poverty during child-wellness visits, American Academy of Pediatrics recommends. The Washington Post. Retrieved from https://www.washingtonpost.com/news/to-your-health/wp/2016/03/09/doctors-should-screen-for-poverty-during-child-wellness-visits-american-academy-of-pediatrics-recommends/