Organization for Economic Cooperation and Development Encourages U.S. To Spend More On Early Childhood

According to a recent report released by the Organization for Economic Cooperation and Development (OECD), a France-based supervisor of industrialized nations, the United States has some of the modern world’s worst rates of child impoverishment, teen pregnancy and infant mortality. These results are striking given that the U.S. spends more per child (approximately $140,000) on welfare and educational services than the OECD average of $125,000 (Keller & Kurowski, 2009).

Child poverty statistics in the U.S. are almost twice the OECD average, at 21.6 percent compared to 12.4 percent. The rate of adolescent births in our country is triple the OECD average, with only Mexico reporting a higher rate among the 30 member OECD countries.

Why did the United States fare so poorly in the child well-being survey, despite spending more money per child? The OECD report suggests that U.S. government funding for children is heavily skewed to older children and adolescents (ages 12-17). U.S. spending on education, health and social services for children under six years of age trails far behind other industrialized nations- we spend about $20,000 on early childhood compared to the OECD average of $30,000 (Keller & Kurowski, 2009).

In “Doing Better For Children”, the report released last Tuesday, the OECD encourages the United States to transfer more of its public funding to our youngest citizens in order to advance our health and educational attainment. “A better balance of spending between the ‘Dora the Explorer’ years of early childhood and the teenage ‘Facebook’ years would help improve the health, education and well-being of all children in the long term,” the OECD said. The group suggests that the U.S. could benefit from investing in early childhood programs that strengthen pre- and post- natal services, promote breastfeeding and educate parents about healthy diet and risk factors such as smoking.

There is an urgent need to address these risk factors associated with poor child welfare, as they are especially prevalent in our community. In Memphis, almost one in five births are to females less than 20 years of age (Annie E. Casey Foundation, 2005). Additionally, over 40% of Memphis children (under 18 years of age) live in impoverished households (Annie E. Casey Foundation, 2007) . Each year, more than half of the children born in Shelby County are born into families in poverty and lacking access to basic resources that young children need for optimal early childhood development [TUCI], 2009).

Research shows that spending on early childhood is one of the smartest investments a society can make. By focusing on our youngest children and families – particularly the cohort of young children most in need - and implementing successful interventions, we can make economic and social decisions now that will enhance the well-being of the next generation (TUCI, 2009). We encourage our local, state and federal officials to consider the suggestions offered by the OECD- invest wisely in our youngest citizens in order to reach the future we envision for our community and our nation.

For more information on the well-being of children in Memphis and Shelby County, visit The Urban Child Institute at http://www.theurbanchildinstitute.org/.

References

The Annie E. Casey Foundation, KIDS COUNT Data Center, www.kidscount.org.

Keller, G. & Kurowski, R. (2009, September 2). US fares poorly in child welfare survey. The Associated Press. http://www.google.com/hostednews/ap/article/ALeqM5g_CQ5dFodttwmt5mQB0fQiOrq_uwD9AEMF2O4

The Urban Child Institute. (2009). The State of Children in Memphis and Shelby County: Data Book. Memphis, TN: The Urban Child Institute.

Child Care Programs Assist Parents In Building “Social Capital”: Suggestions For Administrators and Faculty

Eighty percent of human brain development occurs during the first 36 months of life, and early surroundings can either encourage or impede effective cognitive growth. Sixty-five percent of mothers with very young children (under age 3) are employed; therefore, many infants and toddlers across the country and in Shelby County spend a substantial amount of time in the care of providers others than their parents (The Urban Child Institute [TUCI], 2009).

Quality child care benefits children and their families. First, parents are able to retain regular employment and provide for their children when affordable daycare is accessible. Second, enriching early care can advance children’s intellectual and social/emotional skills, ensuring that they reach the kindergarten classroom prepared and ready for academic success (TUCI, 2009).

Recent research from the University of Chicago suggests that early care programs have an often unnoticed capacity- linking parents with each other as unofficial consultants in parenting practices while also connecting them to organizations that can assist with the obstacles of child rearing. According to the study of 3,500 mothers in 20 U.S. cities, child care programs are regularly as beneficial for the parents as for the kids in terms of building companionable relationships and forming a support system. Early care programs become headquarters where parents can build “social capital”- the associations they require to assist with issues such as child behavior and locating quality medical care and schools. Child care programs that coordinated parent gatherings and had rigid drop-off and pick-up times where parents could connect had particularly effective parent support systems (Goldsmith, 2009).

“Parents come to school to find someone to care for their children, and they end up learning ways of taking care of each other…When you are a parent, particularly a first-time parent, the best resource you have is another parent” (Small, quoted in Goldsmith, 2009, p.1).

Early care administrators and teachers can easily encourage relationship building among enrolled families (Raising Children Network, 2009):
- Invite parents to a welcoming party at the beginning of the school year.
- Send home a weekly newsletter informing parents about classroom events and upcoming activities.
- Set up informal, monthly meetings between parents and teachers. Invite mothers and fathers to bring a packed lunch and join staff for a casual question and answer session.
- Formally recognize parent contributions (through a bulletin board or notes sent home).
- Establish positive communication with all families.

For more information on the well-being of children in Memphis and Shelby County, visit The Urban Child Institute at http://www.theurbanchildinstitute.org/.

References

Goldsmith, B. (August 30, 2009). Child care helps parents make invaluable friends too: study.
Reuters Life! http://www.reuters.com/article/lifestyleMolt/idUSTRE57U0E720090831

Involving parents in school and child care. 2006- 2009 Raising Children Network (Australia).
http://raisingchildren.net.au/working_with_parents/working_with_parents_landing.html

The Urban Child Institute. (2009). The State of Children in Memphis and Shelby County: DataBook. Memphis, TN: The Urban Child Institute.

Numbers Matter: How To Help Young Children Learn The Foundational Math Skills They Need For Kindergarten Success

This summer, the Committee on Early Childhood Mathematics of the National Research Council issued a report entitled "Mathematics Learning in Early Childhood: Paths Toward Excellence and Equity" (Cross et al., 2009). The report details the importance of incorporating early math skills in the pre-school curriculum and provides information for parents and teachers to use in making sure that children are mathematically ready for school. Most parents know that learning to count and recognize basic shapes are important skills that will help their preschooler get ready for kindergarten. However, the report recommends that parents and pre-school teachers help children master more than these basic skills . Specifically, young children need to learn, “concepts of number, space, passing of time, (and) volume” (Chute, August 30, 2009, 1). Understanding these mathematical concepts at an early age helps children connect mathematical ideas to the physical world. This knowledge – in turn – provides preschoolers with a solid foundation on which to build a more complex mathematical understanding later in life.

Helping young children get ready for math does not have to be difficult. In fact, many pre-math skills are best learned through play. As children explore the world around them, they naturally make observations about numbers, space, time, and shapes and sizes. These are all key pre-math concepts. Parents and caregivers can enrich this exploration by helping children understand and interpret what they are observing. The most important thing is that children need to understand math concepts through their experiences of the tangible world and not as abstractions. The evidence is clear: even very young children benefit from an early introduction to key math concepts.

Sources

Chute, Eleanor. (August 30, 2009). “Back to School/Do the Math: Latest 'new math' concept: Start early and make it fun,” Pittsburgh Post Gazette. Accessed August 31, 2009. http://www.post-gazette.com/pg/09242/994281-298.stm#ixzz0PnO4uPu4

Cross, Christopher T., Taniesha A. Woods, Heidi Schweingruber, Eds. (2009). Mathematics Learning in Early Childhood: Paths Toward Excellence and Equity. Washington D.C.: The National Academies Press. < http://www.nap.edu/catalog.php?record_id=12519 >

Duncan, Greg J. et al. (November 2007). School Readiness and Later Achievement. Developmental Psychology, 43, 6: 1428 – 1446. http://www.apa.org/journals/releases/dev4361428.pdf

Parlakian, Rebecca. (n.d.) Growing Up Healthy: What Local Governments Can Do to Support Young Children and Their Families. Washington D.C.: Zero to Three. Accessed August 31, 2009. < http://www.zerotothree.org/site/DocServer/GrowUpHealthy.pdf?docid="1722">

New Pediatric Sub-Specialty Board Approved for Certification of Pediatricians with Expertise in the Management of Victims of Child Maltreatment

It has been well demonstrated that maltreatment in the earliest years of life can lead to life- long behavioral and health problems (Sameroff, 1998). In November of 2009, approximately 200 doctors will sit for a board examination offered for the first time by the American Board of Pediatrics. The Board Exam will be for candidates in the field of child abuse pediatrics- a specialty involving not only caring for child maltreatment victims but also working with law enforcement and caseworkers and testifying in court cases. The acceptance of child abuse pediatrics as a medical concentration is expected to lead to an established system of accreditation for the estimated 25 child maltreatment fellowship programs in the U.S. for which there are presently no nationally agreed upon standards.

Administrators expect the changes to result in more specialists who can teach in medical universities, conduct research and serve as a resource for the general medical community. Additionally, practitioners also hope the increased acceptance of the concentration will generate higher reimbursements from insurance organizations and government health care programs- a benefit for hospitals that usually lose money on their child maltreatment teams because of the time devoted to these complicated cases (Hollingsworth, 2009).

The need for the maltreatment focus area is clear: research has regularly indicated that many medical professionals lack the knowledge to effectively handle these demanding cases. A recent study published in Pediatrics suggests that current standards of child maltreatment instruction are insufficient (Hollingsworth, 2009).

Even medical professionals who are not certified in child abuse pediatrics should focus on preventing child abuse and neglect: it is an integral component of accomplishing their responsibility of ensuring children’s health and welfare. Young children who are abused or chronically neglected have increased risks for social-emotional, behavioral and cognitive delays. Too often, by the time a child is determined to be a maltreatment victim, these problems have already begun to develop (Hawley, 2000). In 2008, children under six were the victims in nearly half of all investigations of abuse or neglect in Shelby County (TN DCS, 2008).

General principles that all who are involved in child care should become aware of include the following (Dubowitz, 2002):

1. Risk factors for abuse and neglect (such as parental substance abuse and maternal depression) need to be recognized and confronted. Caregivers at risk for abuse and/or neglect usually need mental health and social supports, and providers should expedite referrals.

2. Recognition and identification of a parent’s strengths and resources is vital to understanding the circumstances and preparing an appropriate response.

3. Child and family intentions/goals should be defined, clarified and integrated into the overall health care plan. For instance, a mother’s desire for her toddler to respect rather than fear her assists in the introduction of effective discipline approaches.

4. Acceptance of unconventional and informal assistance (i.e., friends, family, faith community) can be supported. For example, doctors can promote a grandmother’s engagement in child rearing by asking her to attend office visits.

For more information on the well-being of children in Memphis and Shelby County, visit The Urban Child Institute at http://www.theurbanchildinstitute.org.

References
Dubowitz, H. (2002, June). Preventing child neglect and physical abuse: A role for pediatricians.
Pediatrics In Review, 23(6), 191-196.

Hawley, T. (2000). Starting smart: How early experiences affect brain development. Zero To Three/The Ounce of Prevention Fund. Washington, DC.

Hollingsworth, H. (2009, August 18). New specialty spurs hope for helping abused kids. Associated Press: Yahoo News. Retrieved on August 24, 2009 from
http://news.yahoo.com/s/ap/20090818/ap_on_he_me/us_child_abuse_pediatrics.

Sameroff, A.J. (1998). Environmental risk factors in infancy. Pediatrics, 102, 1287-1292.

Tennessee Department of Children’s Services. CPS/Custody Data. Nashville, TN.

Exposure to Multiple Risk Factors in Early Childhood Impairs Children’s Brain Development

30 years ago, a group of researchers created a longitudinal study of children called the Rochester Longitudinal Study (RLS) to examine the influence of exposure to multiple known risk factors on children’s cognitive and social/emotional development. The study examined the social/emotional and cognitive development of children at birth, 4 months, 12 months, 30 months and again at 48 months of age. Interestingly, the researchers reexamined the children in the study when they were 13 and 18 years old.

In addition to tests of the children’s social/emotional and cognitive development, the researchers also gathered evidence on the children’s exposure to known risk factors that influence development, including socio-economic status, mother’s physical and mental health status, parent’s education, marital status, family size, stressful life events and occupations. They hypothesized that exposure to multiple risk factors would impair children’s social/emotional and cognitive development in their earliest years and as they grew up. Their formal list of risk factors included:

- Having a mother who sought treatment for mental illness on more than one occasion;

- Having a mother with a high level of anxiety;

- Having a small amount of spontaneous interaction between parent and child;

- Having parents in a semi or unskilled occupation;

- Having parents who lacked a high school education;

- Being a minority;

- Having a parent with rigid beliefs about child development;

- Having a single mother;

- Being exposed to a large number of stressful life events; and

- Being in a family with 4 or more children

Each child in the study was assigned a risk score based on the number of identified risk factors at birth. They also updated the child’s risk score at each visit. As they hypothesized, children with only one or no risk factors did not suffer social/emotional or cognitive delays over the course of their earliest years. Unfortunately, children exposed to two or more risk factors in early childhood did have diminished cognitive and social/emotional development. In fact, the more risk factors a child was exposed to in early life, the larger their developmental deficits. On average, exposure to each additional risk factor in early childhood lowered a child’s IQ at age 4 by 4 points. So a child in the study who was exposed to 5 risk factors during early childhood, on average, had an IQ that was 20 points lower than a child who was exposed to one or no risk factors (Sameroff, 1998).

Disturbingly, the researchers also found that a child’s exposure to risk factors was consistent over the course of their childhoods. Very few children in the study who were at risk, by exposure to multiple risk factors, lost their exposure as they grew up. Additionally, the prolonged exposure to risk factors continued to have a negative effect on cognitive and social/emotional development. At 4 years of age, 22% of the children exposed to 4 or more risk factors had an IQ below 85. By the time the children were re-tested at 13, 46% of them had an IQ below 85 (Sameroff, 1998).

We have no way of knowing if the results of the Rochester Longitudinal Study would hold true for children growing up in Memphis. However, we do know that many children growing up in Memphis are exposed to many of their identified risk factors on a daily basis. While poverty is often identified as a serious risk factor for cognitive and social/emotional delays, we often do not examine what it means to live in poverty.

Fundamentally, poverty is an umbrella term, describing the multiplicity of psychosocial
and bio-ecological risks children growing up in poverty are likely to encounter, such as
family turmoil or instability, less responsive parenting, less access to educational
stimulation at home or in school, increased exposure to dangerous neighborhoods, and
environmental pollution (Evans, 2004).

In other words, children growing up in poverty are regularly exposed to multiple risk factors which work together to undermine their foundational cognitive, social/emotional and physical development. Beyond being troubling, the RLS’s findings have important implications for the way that we seek to improve children’s developmental and long term outcomes. Most importantly, they imply that it is not enough to meet one identified need here and there. Our approach must be holistic and seek to provide protective factors which insulate children from the range of risk factors that interact to undermine their development.

Sources

Evans, G. (2004). The environment of childhood poverty. American Psychologist, 59, 77–92.

National Scientific Council on the Developing Child, Young Children Develop in an Environment of Relationships. (2004). Working Paper No. 1. Retrieved [August 21, 2009] from www.developingchild.net/pubs/wp/environment_of_relationships.pdf

Sameroff, Arnold J. (1998). Environmental Risk Factors in Infancy. Pediatrics, 102, 1287-1292. Accessed August 20, 2009 <http://www.pediatrics.org/cgi/content/full/102/5/SE1/1287>

Two U.S. Health Organizations Collaborate To Improve Breastfeeding Rates

Last week, administrators from the U.S. Office of Women’s Health and the Centers for Disease Control and Prevention met at the CDC Headquarters in Georgia to learn from breastfeeding specialists about improving child and maternal health through breastfeeding initiatives. By mid-2010, the agencies aim to disseminate a “Call To Action”- a government plan that promotes distinct procedures and operations to address what is being called an essential public health concern.

“Helping women breastfeed is a no-brainer in the health and well-being of mother and baby,” said Sheela R. Geraghty, medical director of the Center for Breastfeeding Medicine at Cincinnati Children’s Hospital Medical Center. “It’s a completely cost-effective mechanism to improve health in the U.S. And, it’s an economic benefit, with less formula costs, less bottles.” (Gardner, 2009, p.1)

Improving breastfeeding rates can be difficult. Many hospitals separate mothers and infants immediately after birth. Furthermore, the majority of women who are of childbearing age are employed at least part-time, and many employers require mothers to return to work as early as six to eight weeks after childbirth. Employed mothers can utilize breast pumps to extract and store breastmilk for their infants while they are at work; however, breast pumps are expensive and many people do not have a private place to pump while on the job. Across the country, mothers in lower socioeconomic categories do not breastfeed as often as mothers with greater access to financial resources (Gardner, 2009).

Providers and policymakers should work to overcome these obstacles: the benefits of breastfeeding are expansive and research-supported. Breast-fed babies have a lower risk for obesity, asthma, diabetes and sudden infant death syndrome (Gardner, 2009). Breastfeeding enhances the cognitive development of young children and their intellectual and scholastic ability in later life. Breastmilk contains high amounts of important fats, such as DHA and ARA. These are very important components of brain structures, and research has shown that breastfed infants have higher concentration of these essential fats in their brain and blood than do formula fed babies (BPNI, 2005).

Fast Facts:

1. In Tennessee, breastfeeding prevalence rates vary significantly by socioeconomic status.

Percentage of TN children (0-5) having ever been breastfeed by socioeconomic status (National Survey of Children’s Health, 2007) :

Children living below 100% of the federal poverty line: 49.4%
Children living at 100% to 199% of the federal poverty line: 57.9%
Children living at 200% to 399% of the federal poverty line: 71.4%
Children living at or above 400% of the federal poverty line: 78%

2. About half of residents in Memphis/Shelby County believe mothers should stop breastfeeding completely at some point when their baby is between 0 and 11 months of age (MidSouth Social Survery, 2008). Meanwhile, The American Academy of Pediatrics suggests that there is no upper limit for breastfeeding duration- Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child.

3. Tennessee code Ann. 50-1-305 (1999) requires employers to provide daily break time for a mother to express breast milk for her infant child, as well as make a reasonable effort to provide a private location, other than a toilet stall, in close proximity to the workplace for this activity. In 2008, only one in five Shelby County respondents were aware of this law’s existence.

Local Resources

La Leche League (LLL) is an international, nonprofit, nonsectarian organization dedicated to providing education, information, support and encouragement to women who want to breastfeed. All breastfeeding mothers and mothers-to-be interested in breastfeeding are welcome to contact LLL of Memphis for breastfeeding help or information. For more information, please visit http://www.llleus.org/web/MemphisTn.html.

Baptist Memorial Hospital for Women’s Breastfeeding Resource Center is staffed by certified lactation consultants who have more than 20 years of experience with mothers and newborns. Staff is available to assist new moms with their breastfeeding questions through one-on-one consultation sessions. For more information, call (901) 227-9620.

References

Child and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health, Data Resource Center for Child and Adolescent Health website. Retrieved [08/17/09] from
www.nschdata.org

Gardner, A. (August 13, 2009). It’s time for more moms to breastfeed, U.S. officials say. HealthDay Reporter.
http://news.yahoo.com/s/hsn/20090814/hl_hsn/itstimeformoremomstobreastfeedusofficialssay

Breastfeeding and brain development (Cognitive development): Information sheet- 9. (2005,
February). IBFAN Asia Pacific/Breastfeeding Promotion Network of India (BPNI).

Breastfeeding laws. (2009, May). National Conference of State Legislatures: Maternal and Child
Health Overview. U.S. Department of Health and Human Services. Washington, D.C.: Author.

Breastfeeding and the use of human milk. Pediatrics, 115(2), 496-506.

Providing Universal Healthcare Access for Children (0-18): Children’s Health Initiatives

Why is health care access important during the first 36 months of life? The American Academy of Pediatrics and the Centers for Disease Control state that children need to be immunized against 15 different diseases during this period. Additionally, 9 of these vaccines are administered in multiple doses during this time period (CDC, 2009). Pediatricians are also an important source of early detection for developmental delays including cognitive, social/emotional and physical delays. Early Intervention Services can effectively remediate many types of developmental delays and have a demonstrated cost benefit of $13 in public savings for every $1 invested (Glascoe & Shapiro, 2007).

There is also a demonstrated connection between having insurance and consistent health care access. Uninsured children do receive health care services, but often they do not receive all of the care that they need when it is needed. This can be very expensive for them and the healthcare system since paying for chronic pre-existing conditions is significantly more expensive than providing preventive care (Stoll and Thorpe, 2005).

So who currently pays for care for uninsured children? A 2005 Families USA report revealed that roughly 1/3^rd is paid by uninsured children’s families, 1/3^rd is paid for through a combination of existing government programs and the final third is passed on to privately insured individuals and families in the form of higher health insurance premiums. The report estimated that the average privately insured family in Tennessee will be paying just over $1,299 extra in health insurance premiums each year by 2010 to cover the cost of providing health care for uninsured individuals (Stoll and Thorpe, 2005).

Increasingly, children whose families earn too much to qualify for publicly funded health insurance programs (Medicaid and SCHIP) lack insurance. California responded to this reality by creating the Children’s Health Initiative (CHI). The first Children’s Health Initiative was created in 2001 in Santa Clara County. Currently there are Children’s Health Initiatives in 30 counties and during their 8 years of existence, they have helped provide health insurance to 88,000 uninsured children (California Children’s Health Initiatives, 2009).

Children’s Health Initiatives work by enrolling eligible children in Medi-Cal, California’s Medicaid program, and Healthy Families, their SCHIP program. Children who are ineligible for either program are enrolled in locally funded and non-profit programs. The Initiative is primarily funded through the Foundation community of California, including the David and Lucille Packard Foundation, the California Endowment and the Tides Center. The programs which provide health insurance for children who do not qualify for Medi-Cal or Healthy Families include:

- Healthy Kids, a locally operated insurance program that does not have income eligibility limits. Families pay low premiums and co-pays for health, dental and vision coverage.

- CalKids, a non-profit program for children ages 2 through 18 whose families earn below 250% FPL, regardless of immigration status;

- Kaiser Permanente Child Health Plan, a state level program that provides low cost care for all children who do not qualify for state plans, regardless of family income.

There are also two federal and state funded programs that provide care for children with identified disabilities or medically necessary care.

To date, the CHI has demonstrated improved access to dental and medical care services, reduced child hospitalizations and improved health care status for many children statewide who would have lacked coverage otherwise (Cousineau et al, 2007; Howell and Trenholm, 2007; Phipps et al, 2008).

Sources

California Children’s Health Initiative (2009). History. Altadena, CA: The Tides Center. Accessed August 14, 2009. < http://www.cchi4kids.org/history.php>

California Children’s Health Initiative (2009). Vision and Mission. Altadena, CA: The Tides Center. Accessed August 14, 2009. < http://www.cchi4kids.org/vision&mission.php>

California Children’s Health Initiative (2009). Partners. Altadena, CA: The Tides Center. Accessed August 14, 2009. <>

Centers for Disease Control and Prevention (2009). Recommend Immunization Schedule for Persons Aged 0 through 6 Years. Washington D.C.: Author. Accessed August 14, 2009. <>

Cousineau, Michael R., Gregory D. Stevens and Trevor A. Pickering (December 2007). Children’s Health Initiatives Have Helped Prevent Over 1,000 Unnecessary Child Hospitalizations Annually. University of Southern California: Center for Community Health Studies. Accessed August 14, 2009. <>

Glascoe, F.P. & Shapiro, H.L.(2007). Introduction to developmental and behavioral screening.
Developmental Behavioral Pediatrics Online, www.dbpeds.org

Howell, Embry and Christopher Trenholm (March 2007). Santa Clara County Children’s Health Initiative Improves Children’s Health. Los Altos, CA: David and Lucille Packard Foundation. Accessed August 14, 2009. <>

Phipps, Kathy, Joel Diringer, T. Em Arpawong, Chris Feifer, Michael R. Cousineau, and Gregory D. Stevens (July 2008). Dental Utilization in California’s Children’s Health Initiatives’ Healthy Kids Programs. University of Southern California: Center for Community Health Studies. Accessed August 14, 2009. <>

Stoll, Kathleen and Kenneth Thorpe (June 2005). Paying a Premium: The Added Cost of Care for the Uninsured. Washington, D.C.: Families USA. Accessed August 14, 2009. <>