Early Childhood Health
Policy in Brief:
The prenatal and early childhood period are considered the most vulnerable chapter in a person’s life. Dora Anne Mills describes the ways in which poverty, health insurance, pregnancy, early growth and development, infectious and chronic disease, oral health, environmental health, injury, mental health and physical activity and nutrition affect children. Along the way she notes policy successes and highlights some of the challenges that remain as well as new challenges that are emerging.
In Maine there are approximately 71,000 children under the age of five; of these, about one in five live in families that are below the official poverty level. Poverty is linked to poor physical health, poor cognitive abilities, reduced emotional and behavioral outcomes, and high chances of teenage childbearing.
Impoverished children, even when other factors are adjusted for, are twice as likely of being in fair or poor health, are twice as likely to have low birth weight, are twice as likely of being hospitalized, are three times as likely to get lead poisoning, and are twice as likely of dying in the first year of life.
Maine has done an excellent job expanding health insurance for children, resulting in one of the highest rates of children’s health insurance in the United States. Despite this success, 7 percent of children under age five, and 10 percent of children under age 18 lack health insurance. Being uninsured makes children vulnerable to a myriad of health problems as a result of late detection of illness and a lack of routine periodic well child care checks.
Growth and Development:
About 150 in 400 infants in Maine do not pass a newborn hearing test, and about four of them are identified with severe hearing impairment every year. One in 20 preschoolers has vision problems. With early screening and interventions, these children can develop naturally.
Autism is emerging as one of the most common developmental disorders, occurring in about one in 150 children. A neurological disorder that affects the ability of a person to communicate and interact with others, autism is normally identifiable within the first three years of life. Autism can and should be screened for in all young children since early diagnosis and intervention have been shown to help children to develop.
One hundred years ago one in five babies born in Maine did not live to see their fifth birthday. Today, this number is about one in 800. The main reason for this enormous success is the decrease of infectious diseases affecting mothers and infants. This public health success is directly due to state and federal policy to achieve safe drinking water, sanitary conditions, and immunizations.
Maine has one of the highest rates of tooth loss in the country among adults. Given that the foundation for adult oral health starts in early childhood, one can consider this adult health indicator to also be a measurement of childhood poor oral health.
There are two major policy-related strategies that improve the oral health of young children. The first is obtaining regular preventive dental health care at an early age. The second is community water fluoridation.
Lead poisoning remains one of the major environmental hazards threatening young children in Maine. Children under six years of age are at the greatest risk for lead poisoning because lead has a bigger impact on developing nervous systems. Its effects can lead to lifelong physical and developmental disabilities.
Motor vehicle crashes are the single biggest cause of death in Mainers ages one through five. These deaths have decreased over the years, from a rate of six per 100,000 for Maine children less than five years old in the early 1980s to 1.4 in the last three years (2004-2007). This dramatic reduction in crash deaths is directly related to policies that ensure the safe transport of young children.
Among infants, the second leading cause of injury hospitalization is assault. In 2007, an astonishing 5,307 children in Maine ages birth to 17 were found to be victims of substantiated abuse or neglect. Forty percent of these, 2,150, were children under five years old. Policies related to the reporting of these crimes, enforcement of laws against perpetrators, treatment of victims, and prevention strategies can have a positive effect of these devastating statistics.
In the five-year period between 2002-2006, more than 16,000 children in Maine were treated in emergency departments due to falls, and an additional 200 were hospitalized. Policies related to safe playgrounds and other places where young children spend time, along with educational efforts about children’s developmental stages can help reduce these falls.
Physical Activity and Nutrition:
Nutrition and physical activity habit seen in early childhood set the stage for related successes and challenges throughout the lifetime, and therefore warrant special attention by policymakers.
Maine data show the results of physical and nutritional challenges. 36% of Maine kindergarteners are overweight or obese. Breastfeeding in infancy is one of the best nutritional strategies for the health of infants and young children, including helping to prevent obesity and to boost infant immune systems.
Infant Mortality Policy:
In response to the state’s rising infant mortality rates, about two years ago the Maine Infant Maternal Mortality Review Panel was formed to do in-depth reviews of infant deaths in order to identify common and preventable contributory factors. It is modeled after the long-standing Maine Child Review Death Panel. The results of this policy initiative can be accessed here.
Growth and Developments, Early Intervention Policy:
A gap that needs to be remedied is the lack of any policy or program supporting preschool vision and hearing screening. Screening and early intervention for autism is another process that needs improvement.
Infectious Diseases Policy:
Today, our public drinking water supplies are more than 100 years old and need repairs to maintain safe water for a growing population. Adequate funding from state, federal and local sources is needed for these repairs and upgrades.
The United States is one of the few developed countries without sufficient federal oversight to ensure adequate manufacturing and distribution of vaccinations. Vaccine availability is dependent on each state’s policy and funding abilities.
Chronic Diseases Policy:
Some chronic diseases have biological risk factors that are identifiable in early childhood (e.g. high cholesterol, hypertension, and obesity). However screening for these risk factors is not fully incorporated into the health care system.
Environmental Health Policy:
A number of environmental health experts believe the U.S. should adopt the precautionary principle as a policy approach to commercial chemicals, as is being done in some other countries including the European Union. This precautionary principle would assure that research is done up front so that the proposed use of chemicals will not result in significant harm or that potential harm is minimized.
The Final Word:
Some of the most remarkable progress in health over the past 100 years includes measures that affect early childhood. These successes were primarily the result of coordinated, focused, and evidence-based investment in maternal and child health, yet the entire population reaped the benefits. We know from these successes that it is possible for all children in Maine to begin with a health start.
Mills, Dora Anne. 2009. “Early Childhood Health.” Maine Policy Review 18(1): 46-59. (13-pages, 17-minute read)
From MPR’s Archive:
Acheson, Ann. 2009. “Family Economic Security.” Maine Policy Review 18(1): 34-45.
Logan, Beth A., Marie J. Hayes, Mark S. Brown, Paul Tisher, Jonathan A. Paul, and Ramesh Krishnan. 2009. “Maine’s High-Risk Infants and Maternal Health and Wellbeing: The Maine Infant Follow-Up Project.” Maine Policy Review 18(1): 60-67.
Trostel, Philip A. 2009. “The Dynamics of Investments in Young Children.” Maine Policy Review 18(1): 18-25.
Centers for Disease Control. National Survey of Children Health.
CDC’s National Asthma Control Program. Asthma in Maine.
Maine CDC. Division of Disease Prevention. Maternal, Fetal and Infant Mortality Review Panel.