10 facts about child well-being and health in America

“Unhealthy children grow up to be unhealthy adults, poor health and low income go hand in hand, and both poverty and poor health make large demands on public coffers,” according to the latest The Future of Children volume, a biannual series of papers co-published by Brookings and Princeton University. In the latest edition, “Policies to Promote Child Health,” experts review “how effectively U.S. policies promote child health.” Below are ten facts about child health gleaned from various articles in the volume, the complete version of which is available here.

1. In 2013, nearly 680,000 children were reported by states to be victims of abuse or neglect.

“Congress has the opportunity,” write Ron Haskins, Janet Currie, and Lawrence Berger in the volume’s accompanying policy brief, “to change the funding formula under Title IV of the Social Security Act so that states have the flexibility to put money where it will be most effective at keeping at-risk children safe, ensuring that they have a permanent home, and promoting their wellbeing.”

2. 1,520 children died from maltreatment in 2013.

Eighty percent are at the hands of their own parents. “Ironically,” write Haskins, Currie, and Berger, “parents are one of the biggest threats to many children’s health and development.”

3. Federal funding for back-end services after children have been removed from their homes is more than 10x funding for front-end services designed to prevent or treat such problems.

Two grant programs in Title IV-B of the Social Security Act gives states fixed funding of around $650 million each year for “front end” services to prevent or treat problems; Title IV-E programs give states open-ended funding totaling about $6.9 billion in 2014 for “back-end” programs after children have been removed from homes. “Under this financing structure, in which funds available for foster care on the back end exceed those for front-end services by a huge amount,” write Haskins, Currie, and Berger, “states seem to have financial incentives to remove children from their homes, especially if they cannot afford to provide treatment and services. This is unfortunate, because research shows that in borderline cases, children removed from their families do worse compared to children who remain with their families.”

4. The foster care caseload is at 5.4 children per 1,000, having fallen steadily since 1999.

The absolute number of children in foster care in 2013 stood at 402,000. The rate had risen from 4.2 in 1982 to 8.0 per 1,000 children in 1999. “The decline in the  number of children in foster care, as welcome as it is,” write Haskins, Currie, and Berger, “has caused many observers to think anew about reforming the IV-E foster care program to give states more funds for prevention and treatment on the front end.”

5. In 2012, the U.S. infant mortality rate was 6 deaths per 1,000 live births. In 1910, that figure was 127.6 per 1,000 live births.

For children under 5 years old, in 1910 mortality was 403.6 deaths per 100,000 children, and by 2012 it was 7.1. “One hundred years ago,” according to Sarah Rosenbaum and Robert Blub, “diarrheal diseases and pneumonia were major killers of infants and young children, as they still are in many low- and middle-income countries, along with prematurity. Today, congenital anomalies, sudden infant death, and prematurity are the leading causes of infant mortality. Given the reductions in infectious disease, injury and homicide have joined congenital abnormalities as the top three causes of mortality among children under age five.”

6. An estimated 13 percent of all U.S. children and 21 percent of black children will experience confirmed maltreatment at some point between birth and adulthood.

Lawrence Berger and Sarah Font observe that “only a small portion of those children and their families received any compensatory services. About 62 percent of the reports received by [Child Protective Services agencies] are screened in, meaning they receive an investigation or assessment, but the remaining 38 percent receive no formal response, and the families involved are often unaware that a report had been made.”

7. The U.S. infant mortality rate was 32nd among 34 OECD countries in 2010; the U.S. preterm birth date (less than 37 weeks gestation) was 130th of 184 countries.

“One important reason,” writes Maya Rossin-Slater, “is the United States’ higher cross-group inequality relative to similarly wealthy countries. For instance … relative to other races and ethnicities, non-Hispanic white mothers exhibit the lowest rates of low birth weight (defined as less than 2,500 grams) and preterm birth: 7.1 and 10.5 percent, respectively. In contrast, among non-Hispanic African-American mothers, 13.3 percent of children are born with low birth weight and 16.8 percent are born preterm (90 and 70 percent higher than non-Hispanic whites, respectively).”

8. An estimated 6.8 percent of children aged 3-17 are reported to “currently” have attention deficit/hyperactivity disorder.

Of minors between 12 and 17, the estimated prevalence of alcohol use disorder is 4.2 percent. “Child mental health is a serious public health and social problem,” argues Alison Cuellar in her piece on child mental health problems, “yet our interventions are notable for their lack of cohesiveness. … Funding streams follow idiosyncratic rules that make services more difficult to coordinate and deliver. When services are provided, they often focus on one dimension of a child’s mental health, such as symptoms, without sufficient attention to long-term outcomes such as educational success and employment. Divided system responsibilities for children also make it difficult to deliver prevention programs. All this can come at a heavy cost both for children and for society.

9. In 2011, 5.9 percent of families with children lived in homes deemed severely or moderately inadequate. This was down from 9.1 percent in 1975.

Eleven percent of poor families with children lived in housing deemed inadequate, down from 24 percent in 1975. Ingrid Gould Ellen and Sherry Glied note that “the data suggest that the size and quality of homes in which children live have improved over time. Children in the United States are living in larger and less crowded homes with fewer physical deficiencies.”

10. The National School Lunch Program served more than 31 million students in 2012, including 17 million who received free lunches.

“The research I’ve reviewed,” writes Craig Gundersen in his paper, “demonstrates that SNAP and school meal programs reduce the probability of food insecurity among low-income children in the United States.”

Download all the papers in this edition of The Future of Children journal