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Pediatricians find link between cumulative hardships and health in low-income young children

Pediatric researchers from Boston Medical Center (BMC), in partnership with other Children's HealthWatch investigators in Minneapolis, Little Rock, Philadelphia, and Baltimore, have found that the cumulative effects of crowded and unstable housing and uncertain supplies of food and heat act together to decrease the chances of normal growth and development and good physical health among infants and toddlers. The findings, which appear in the April 12th online issue of the journal Pediatrics, bring attention to remediable conditions that influence the health, development and growth of America's youngest children.

Poverty influences a child's well-being through multiple environmental stressors, the report says, but research and interventions often fail to take into account the remediable "material hardships" that may have direct physiologic impacts on children.

These hardships include food insecurity (lack of access to enough healthful food for an active healthy life) housing insecurity (unstable or overcrowded housing) and energy insecurity (inability of families to afford consistent home heating or cooling).

In order to test the cumulative effect of these multiple hardships, Children's HealthWatch researchers evaluated more than 7,000 children between 4 and 36 months old who were waiting for care at one of five urban primary-care clinics or emergency departments. The researchers found that as scores on a cumulative index of the hardships increased in severity, the chances of young low- income children simultaneously experiencing normal growth, health, and development (which the investigators term "wellness") decreased, even after controlling for multiple background factors.

According to the researchers, cumulative hardships--a diet of inadequate quality or quantity, temperature stress from lack of heat or cooling, and frequent moves or increased exposure to infectious disease and noise in crowded households--exert direct negative physiologic consequences on children.

"The current findings raise serious concerns about the future well-being of America's young children, given rising poverty among families with young children and many households' inadequate wages and benefits to meet fluctuating food, housing, and energy costs," explained lead author Deborah Frank, MD, director of BMC's Grow Clinic and a professor of pediatrics at Boston University School of Medicine. "We know that deprivations in early life can become biologically embedded, forcing children onto negative trajectories that jeopardize their health, their school readiness, and their ability to earn a living as adults. We also know that the remedies for many of these hardships are within reach if our society chooses to prescribe them."

Major funding for this study was provided by the W.K. Kellogg Foundation, with additional support from the Annie E. Casey Foundation, the Anthony Spinazzola Foundation, Citizen's Energy, the Claneil Foundation, the Eos Foundation, the Paul and Phyllis Fireman Charitable Foundation, the Beatrice Fox Auerbach Foundation Fund at the Hartford Foundation for Public Giving as directed by Jean and Vance Schiro-Zavela, General Mills, the Gryphon Fund, the Joint Center for Political and Economic Studies, the Krupp Family Foundation, the Larson Family Foundation, the New Hampshire Charitable Foundation, Susan Davies and Richard Talkov, Susan Schiro, Peter Manus, and anonymous donors.

Children's HealthWatch, a multi-site pediatric research center based at Boston Medical Center monitors the impact of economic conditions and public policies on the health and well-being of very young children. For more information on Children's HealthWatch publications and presentations in national forums and Congressional hearings, go to

Boston Medical Center is a private, not-for-profit, 639-licensed-bed, academic medical center affiliated with Boston University School of Medicine. Committed to providing high-quality health care to all, the hospital offers a full spectrum of pediatric and adult care services including primary and family medicine and advanced specialty care with an emphasis on community-based care. Boston Medical Center offers specialized care for complex health problems and is a leading research institution. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet—15 community health centers focused on providing exceptional health care to residents of Boston.

Gina DiGravio | EurekAlert!
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