What is the most important problem facing American children today?

According to the Academic Pediatric Association and the American Academy of Pediatrics, it is the effects of poverty on the health and well being of young people. But, they concede, there is no sustained focus on childhood poverty, or a unified pediatric voice speaking on the problem, or a comprehensive approach to solving it.

To try to remedy that, the American Pediatric Association Task Force on Childhood Poverty is beginning a long-term effort to address the problem by looking for solutions that will be effective, sustained and “protected from retrenchment,” according to this brief about the work of the panel.

Children in America are the poorest members of society. One in five children live below the federal poverty line, and almost one in two are poor or near poor, with a disproportionate burden falling on the very young, racial and ethnic minorities, Native Americans and children from immigrant families. The task force plans to pay special attention to helping these groups of children.

The role of poverty on student achievement has been one of the flashpoints between supporters and critics of modern school reform. Supporters insist that citing poverty as a reason for lack of student achievement is “an excuse” made by people who want to support the status quo. Critics of reform say that the major reform efforts ignore the effects that living in poverty have on children and their ability to do schoolwork and perform on standardized tests.

The Pediatric Academic Societies just had a plenary session in Washington, D.C., titled “A National Agenda to End Childhood Poverty,” where calls were made for a comprehensive approach to attacking child poverty. It was noted that there are solutions, as evidenced by efforts in other developed countries, including Britain, which dramatically reduced childhood poverty with sustained national efforts.

Here’s some of the brief about the task force:

Children are the poorest members of our society, a society that knows how to use policies and programs to raise its citizens out of poverty. Thirty five percent of seniors lived below the FPL  [federal poverty line] in 1959, but due to programs like social security expansion and Medicare, only 9% of seniors are poor today. What the US does for seniors is clearly good; so why do we not also protect children from the life-altering effects of poverty?

 

The effects of poverty on children’s health and well-being are well documented. Poor children have increased infant mortality, higher rates of low birth weight and subsequent health and developmental problems, increased frequency and severity of chronic diseases such as asthma, greater food insecurity with poorer nutrition and growth, poorer access to quality health care, increased unintentional injury and mortality, poorer oral health, lower immunization rates, and increased rates of obesity and its complications.

 

There is also increasing evidence that poverty in childhood creates a significant health burden in adulthood that is independent of adult-level risk factors and is associated with low birth weight and increased exposure to toxic stress (causing structural alterations in the brain, long-term epigenetic changes, and increased inflammatory markers).

 

The consequences of poverty for child and adolescent well-being are perhaps even more critical than those for health. These are the consequences that may change their life trajectories, lead to unproductive adult lives, and trap them in intergenerational poverty. Children growing up in poverty have poorer educational outcomes with poor academic achievement and lower rates of high school graduation; they have less positive social and emotional development which, in turn, often leads to life “trajectory altering events” such as early unprotected sex with increased teen pregnancy, drug and alcohol abuse, and increased criminal behavior as adolescents and adults; and they are more likely to be poor adults with low productivity and low earnings.

 

At present, there is not a consistent and unified pediatric voice speaking out about childhood poverty, the most important problem facing children in the United States today. The Academic Pediatric Association (APA), the American Academy of Pediatrics (AAP) and the Pediatric Policy Council (PPC) all advocate for individual issues (such as Medicaid, Child Health Plus, and food supplementation) that are important programs related to childhood poverty. There is, however, no sustained focus on childhood poverty itself, which underlies many of the ills of children, and which needs to be addressed in a comprehensive manner.

The task force will focus on four strategic priorities:

* Raising families out of poverty
* Providing high-quality early childhood programs and high-quality affordable child care to poor families.
* Promoting a White House Conference on Children and Youth
* Working with Neighborhood Revitalization Initiatives

Part of the task force’s work regards education:

The Task Force has set up a subcommittee to develop educational products and activities regarding childhood poverty for medical students, residents, fellows, faculty, practitioners, and other child health providers. These efforts will promote:

1. Understanding the impact of poverty and other social determinants of health on well-being over the life course and across generations.

2. Development of the knowledge, skills, and attitudes necessary to implement the elements of the PCMHC.

3. Advocacy training toward poverty reduction in conjunction with the AAP Community Training and Advocacy Initiative (CPTI), and models of advocacy training from residency training programs across the US. We will work to build statewide and regional collaboratives uniting the pediatric voice across the nearly 200 pediatric training programs in the US. Collaboration with other organizations offering advocacy training may also be important, including efforts of the American Academy of Family Physicians, the American Medical Student Association, Physicians for a National Health Program, and others.

Problems Facing Physically & Mentally Disabled Children

by Kevin McLeod, Demand Media Google

Children with physical and mental disabilities experience personal limitations in the social, psychological and economic spheres, some of which can be alleviated with parental, community and governmental support. The critical task is developing and maintaining a focus on abilities rather than on disabilities, then honing those abilities to provide the greatest degree of personal autonomy. Depending on the severity of conditions, the range of autonomy can vary from functional independence to assisted living to institutional care.

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Social Issues

Most children are naturally social and keenly aware of ostracism. Disabled children stand out as different, and may become targets for ridicule, bullying and mockery. Sometimes, children live in situations where adults fail to encourage other children in the community to be supportive, nor do they prepare the disabled child for unpleasant encounters and cruelty from peers. They should learn that they do not deserve victimization -- they can reject it and should seek the help of an adult when such situations present themselves. Sports can provide an effective way to strengthen socialization. When paired with developmentally similar peers and supportive adult guidance, children learn about teamwork, cooperation and fair play.

Psychological Issues

Children are remarkably resilient, but the psychological effects of physical and mental disability can be lasting and subtle. Beyond the obvious effects of social turbulence, mental disability can lead to frequent confusion, frustration, anxiety and anger. Some children, disabled or not, have sunny temperaments and roll with the punches. More often, though, disabled children internalize negative messages received from peers and assume they are less significant and valued than others. In this area, it's especially important for family and friends to communicate positive, reinforcing messages that the child is valued, loved and wanted. While it is not possible to shield a child from all derogatory remarks, it is possible to refute them.

Economic Issues

In stable families with adequate incomes, children may be shielded from the immediate economic effects of a physical or psychological condition. More commonly, though, expensive care requirements mean that money diverted to care is no longer available for a home in a better neighborhood, car repairs, vacations and so on. In extreme situations, the costs of care can bankrupt a family, leaving it in poverty. Financial problems can have direct effects on the child, such as nutritional deficiencies, sporadic or nonexistent availability of essential medications and uncertain access to medical care due to transportation hurdles. Available help in this area varies with locale. Some states provide generous supplemental health benefits, while others are cutting and even eliminating health programs.

Access to Services

Service quality and availability can vary greatly in different locales. Funding levels, local attitudes, care-provider training and competence are all factors. For example, some states have schools developed specifically for deaf education and others do not. Physical access to community services may not be comprehensive. Medical facilities for specialized care may not exist, in-home care and respite assistance may be limited, or administration of medicines may be unreliable. Without access to adequate support services, problems can quickly multiply for the child and his family. When access to services is inadequate, parents must become advocates for their children, build coalitions with others who share their interests and advocate for change.

Safety and Security

According to the Vera Institute of Justice, disabled children are three times more likely to be sexually abused than their non-disabled peers. Among children with intellectual and mental health disabilities, the risk is 4.6 times greater. Abusers seek out children who can be easily manipulated and coerced or have limited physical ability to resist. Most abusers are not strangers, but someone the victim knows. Children with limited communication abilities may not be able to describe abuse or reliably identify abusers. The key to preventing abuse is educating and training the disabled child. This means discussing appropriate and inappropriate contact and emphasizing the importance of reporting inappropriate contact to a trusted adult. More prevention steps are available from the National Center for Missing and Exploited Children's publication, "Preventing the Sexual Exploitation of Children," or at missingkids.com.

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