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Overview of the Status of Child Health in the United States
The health of the nation’s children is reflective of the nation’s overall health, and has many implications for the future as these children grow into adults. Physical, mental, and emotional health affect many important aspects of life, including learning, participation in leisure activities, and employment. The health habits and health problems of childhood often continue throughout adult life. Effective policies and programs are important to the establishment of healthy habits and the mitigation of risk factors for disease.
In 2010, nearly 25 percent of the U.S. population was under 18 years of age. The racial and ethnic composition of the child population is shifting, with a growing population of Hispanics and a decline in the representation of non-Hispanic Whites. In 2009, 21.9 percent of children in the United States had at least one foreign-born parent, and 3.0 percent were foreign-born. In the same year, over 15 million children under 18 years of age lived in households with incomes below 100 percent of the U.S. Census Bureau’s poverty threshold ($21,954 for a family of four in 2009), representing 20.7 percent of all children in the United States. In 2007, about 82 percent of children lived in urban areas and the 18 percent living in rural areas were more likely to be overweight or obese than children living in urban areas.
Timely prenatal care is an important preventive strategy that can help protect the health of both mother and child. In 2008, 71.0 percent of women began prenatal care during the first trimester but 7.0 percent of women did not receive prenatal care until the third trimester, or not at all.
Vaccination for measles, mumps, rubella (German measles), polio, diphtheria, tetanus, pertussis (whooping cough), hepatitis B, and varicella (chicken pox) is a critical preventive health measure that begins immediately after birth and protects into adulthood. In 2009, 70.5 percent of children 19-35 months of age received this recommended series of vaccines—this estimate excludes receipt of the Haemophilus influenza type b vaccine (Hib).
Breastfeeding is also an important protective factor for infant health, and rates have increased steadily since the beginning of the last decade. In 2007, 75.5 percent of children through age 5 had been breastfed for some period of time. Although recommended by the American Academy of Pediatrics, only 12.4 percent of children were breastfed exclusively (without supplemental food or liquids) for the first 6 months of life.
In 2009, 71.4 percent of women with children under 18 years of age and 64.2 percent of mothers with children under age 6 years were in the labor force (either employed or looking for work). In 2007, 54.2 percent of children from birth through age 5 were in child care for 10 or more hours per week, but not all families were able to secure needed child care: nearly 20 percent of families who did not receive 10 or more hours of child care per week reported that they needed it.
Physical activity is another factor that can affect health. Only 18.4 percent of high school students undertook the recommended level of physical activity of one hour or more of physical activity every day, most of which should be moderate- to vigorous-intensity aerobic activity. Nearly one-quarter of students did not participate in 60 or more minutes of physical activity on any day in the preceding week.
Participation in physical activity can be adversely impacted by in media use—or “screen time.” The American Academy of Pediatrics recommends that parents limit children’s daily use of media to 1-2 hours per day. Yet, in 2007, 12.8 percent of pre-school aged children and 10.8 percent of children aged 6-17 years engaged in 4 or more hours of media use on an average weekday, including watching TV or videos or playing video games.
Child Health USA (see link below) also presents information on risk factors for adverse health outcomes. According to preliminary data, 8.2 percent of infants were born low birth weight (less than 2,500 grams or 5 pounds, 8 ounces) in 2009, and 1.5 percent of infants were born very low birth weight (less than 1,500 grams, or 3 pounds, 4 ounces). Children born underweight are more likely to suffer from long-term disability and have higher rates of mortality than children born of normal weight.
Violence and neglect are also risk factors for poor health, and in 2009, an estimated 702,000 children were victims of abuse or neglect, a victimization rate of 9.3 per 1,000 children in the population. Victimization rates were highest among young children. Among older children, peer violence is also frequent with 11.1 percent of high school students reporting that they had been in a physical fight on school property in the prior 12 months and 9.8 percent reporting that they had experienced dating violence—having been hit, slapped or physically hurt on purpose—at the hands of a boyfriend or girlfriend.
Information on the prevalence of various diseases and conditions in childhood is also important in the effort to improve health in the child population. For instance, obesity is a serious health concern for children—obese children are more likely to have risk factors for cardiovascular disease, such as high blood pressure, high cholesterol, and Type 2 diabetes. Obese children are also at increased risk of obesity in adulthood, which is associated with a host of serious health consequences. In 2007, 15.3 percent of children aged 10-17 years were overweight and 16.4 percent were obese, based on parent-reported height and weight.
HIV/AIDS and other sexually transmitted infections (STIs) are also a serious problem. In 2009, an estimated 166 children younger than 13 years of age and an estimated 8,294 people aged 13-24 years were diagnosed with HIV. Chlamydia is the most common STI among adolescents and young adults. Based on the number of cases reported to the Centers for Disease Control and Prevention, there were about 2 chlamydial infections per 100 adolescents and young adults in 2009. Rates of gonorrhea were 405 and 479 per 100,000 adolescents and young adults, respectively.
In 2009, there were nearly 3.1 million hospital discharges among people aged 1-21 years. While injuries are the leading cause of death among this age group, they were not the most common cause of hospitalization. In 2009, diseases of the respiratory system were the most common cause of hospitalization among children aged 1-4 and 5-9 years, while mental disorders were the most common cause of hospitalization among children aged 10-14 years, and pregnancy and childbirth was the most common cause of hospitalization for adolescents aged 15-19 years and young adults aged 20-21 years.
Depression and suicide remain critical public health challenges for the adolescent population, in particular. In 2009, 2.0 million adolescents— or 8.1 percent of children aged 12-17 years—experienced at least one major depressive episode (MDE). Occurrence of MDE was significantly higher among females (11.7 percent). In the same year, data from the Youth Risk Behavior Surveillance System found that 13.8 percent of all high school students had considered attempting suicide in past 12 months while 6.3 percent reported at least one suicide attempt during the same period.
The health status and health services utilization indicators reported in Child Health USA are a rich source of data that can help policymakers and public health officials better understand current trends in pediatric health and wellness and determine what programs might be needed to further improve the public’s health. These indicators can also help identify positive health outcomes, which may allow health professionals and the public to draw upon the experiences of programs that have achieved success. Better preventive efforts and health promotion activities are vital to the continued improvement of the health and well being of America’s children and families.
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