For pediatricians, a routine visit is a chance to chat with parents about their child's vaccinations, sleep patterns, nutrition and TV time. But new guidelines say that with nearly half of American children living in poverty or close to that line, pediatricians need to broach another health-related matter with mom or dad: Are you having trouble making ends meet?
"The early detection and management of poverty-related disorders is an important, emerging component of the pediatric scope of practice," says a policy statement issued this week by the American Academy of Pediatrics. "Pediatricians can apply interventions in practice to help address the toxic effects of poverty on children and families."
The academy's statement, undergirded by a lengthy technical report and published this week in the journal Pediatrics, leaves little doubt that living in poverty is a scourge with health effects across an individual's lifespan. In addition to raising the risk of pre-term birth and stunting cognitive development, poverty can impair immune function, contribute to psychiatric disorders and foster cardiovascular disease.
"Child poverty is associated with lifelong hardship," the academy's statement declares.
Dr. Benard Dreyer, president of the American Academy of Pediatrics and a pediatrician whose New York City patients are overwhelmingly from low-income families, called poverty "a chronic disease of children -- the most serious chronic disease they have." Pediatricians must use the significant trust they build with families to help in its treatment, he said.
But as with many other symptoms pediatricians investigate, parents will not necessarily volunteer their troubles getting enough food or keeping a roof over their children's heads. Even lack of healthcare insurance or childcare, or the need for psychological care or parenting help, may not feel to parents like a relevant concern to raise.
"We say you have to ask in order to help," said Dreyer, a physician at New York University Medical Center and Bellevue Hospital in New York.
In the United States, some 31.5 million children -- roughly 43% -- live under, at, or near the federal poverty line, defined as household income of less than $20,090 for a family of three or $15,930 for a family of two. Fully 6.8 million of those kids live in deep poverty, defined as subsisting on less than half that amount.
In a 2014 report, the Organization for Economic Cooperation and Development ranked the United States 35th among its 40 member nations for child well-being. Only Chile, Mexico, Romania, Turkey and Israel ranked lower. Given the recent recession's persistent impact on low-income families and the increasingly yawning gap between rich and poor, most American kids in low-income families have little hope of rising out of those circumstances, the American Academy of Pediatrics said.
Dreyer said the pediatricians' professional association is keenly aware of how many issues pediatricians also take on during an office visit with a patient and his or her family. But he said that physicians can keep at the ready a list of local, state and federal programs with local addresses and phone numbers, and encourage a parent to make contact with the office best suited to assist. Larger pediatric practices might designate a staff member who can help connect families to federal, state or local programs.
A pediatrician's encouragement to seek services in the interests of a child's health "has been shown in research to make a big difference," Dreyer said.
To that end, the American Academy of Pediatrics policy statement lists a wide range of programs aimed at alleviating poverty's effects and increasing access to money, social services and care. Among those programs are the earned income tax credit, Temporary Assistance for Needy Families (once known as welfare assistance), Medicaid and the Children's Health Insurance Program, the Women, Infants and Children (WIC) Program, food stamps, and a home-visiting program for parents of infants and young children established under the Affordable Care Act.
Dreyer said the academy has also sought to energize pediatricians to advocate for these programs, some of which he said have been effective in lifting families out of poverty. He said the pediatricians' group has been active at many levels in promoting an increase in the minimum wage, on the argument that such a hike would ease the burden of poverty on the children of those low-income workers.