Leading pediatrics association urges doctors to screen for poverty

Poverty and poor health often go hand-in-hand. However, the effects of poverty may be especially profound for children, who are moving through critical developmental and educational phases in their young lives. Knowing that this social determinant of health can lead to a lifelong struggle with poor health and disease, the American Academy of Pediatrics is now calling on pediatricians to screen their young patients for poverty.

Connecting low-income patients with social services and assistance is not necessarily new for many health care providers, but the fact that the nation’s leading professional association of pediatricians has adopted official policy on poverty screening is something to note (and celebrate). In a policy statement and related technical report published this month in the journal Pediatrics, the academy said a single question asked during a well-child check-up — “Do you have difficulty making ends meet at the end of the month?” — could help identify families who are struggling and need help.

According to the U.S. Census, in 2014, one in five U.S. children were living in poverty. That’s more than 15 million children. However, when you add in all the U.S. households designated as poor, near poor or low-income, the number of American children living in poverty goes up to 43 percent. To be more to the point: nearly half of children living in the wealthiest nation in the world are either living in poverty or near poverty. The academy’s new policy statement reads:

Poverty has a profound effect on specific circumstances, such as birth weight, infant mortality, language development, chronic illness, environmental exposure, nutrition, and injury. Child poverty also influences genomic function and brain development by exposure to toxic stress, a condition characterized by “excessive or prolonged activation of the physiologic stress response systems in the absence of the buffering protection afforded by stable, responsive relationships.” Children living in poverty are at increased risk of difficulties with self-regulation and executive function, such as inattention, impulsivity, defiance, and poor peer relationships. …

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.

Among its recommendations, the academy is encouraging pediatricians to create medical homes that are sensitive to the needs of poor families; screen for basic needs associated with poverty, such as food security, housing and heat; partner with community organizations to help alleviate the impacts of poverty; engage with early intervention programs and schools; and advocate for public policies that address poverty. In its conclusion, the academy states: “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.”

“Fifty years ago, the U.S. came together and nearly eliminated poverty in the elderly,” said academy president Benard Dreyer in a news release. “It’s time to do the same for children.”

Read AAP’s full policy statement and recommendations in Pediatrics.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.