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Introduction

The health of the child population is reflective of the overall health of a Nation, and has many implications for the Nation’s future as these children grow into adults. Physical, mental, and emotional health affect virtually every facet of life, such as learning, participation in leisure activities, and employment. Health habits established in childhood often continue throughout the lifespan, and many health problems in childhood, such as obesity and poor oral health, influence health into adulthood. Effective policies and programs are important to the establishment of healthy habits and the mitigation of risk factors for disease. However, the health and health care needs of children change over time, and current data on these issues is critically important as policy makers and program planners seek to maximize the health of children, now and into the future.

In 2010, nearly 25 percent of the U.S. population was under 18 years of age. The racial and ethnic composition of the child population is shifting, with a growing population of Hispanics and a decline in the representation of non-Hispanic Whites. In addition to race and ethnicity, the demographic composition of a population can also be characterized by factors such as nativity, poverty, and geographic location. In 2009, 21.9 percent of children in the United States had at least one foreign-born parent. Of all children, 18.9 percent were U.S.-born with a foreign-born parent or parents, and 3.0 percent were themselves foreign-born. In the same year, over 15 million children under 18 years of age lived in households with incomes below 100 percent of the U.S. Census Bureau’s poverty threshold ($21,954 for a family of four in 2009), representing 20.7 percent of all children in the United States. Differences in health risks have also been observed for children by geographic location. In 2007, about 82 percent of children lived in urban areas while 18 percent lived in either large or small/isolated rural areas. Children in rural areas — particularly those in small or isolated rural communities — were more likely to be overweight or obese than children living in urban areas.

Good health begins before birth. Timely prenatal care is an important preventive strategy that can help protect the health of both mother and child. In 2008, 71.0 percent of women began prenatal care during the first trimester (according to data from areas using the “revised” birth certificate. A small proportion of women (7.0 percent) did not receive prenatal care until the third trimester, or did not receive any at all.

Following birth, there are a variety of preventive or protective factors that can affect a child’s health. Vaccination is a preventive health measure that begins immediately after birth and protects into adulthood. Vaccines are available for a number of public health threats, including measles, mumps, rubella (German measles), polio, diphtheria, tetanus, pertussis (whooping cough), hepatitis B, and varicella (chicken pox). In 2009, 70.5 percent of children 19-35 months of age received this recommended series of vaccines. This estimate excludes receipt of the Haemophilus influenza type b vaccine (Hib) which has been presented in previous editions of Child Health USA.

Breastfeeding is also an important protective factor, and rates have increased steadily since the beginning of the last decade. In 2007, 75.5 percent of children through age 5 had been breastfed for some period of time. Although recommended by the American Academy of Pediatrics, only 12.4 percent of children were breastfed exclusively (without supplemental food or liquids) for the first 6 months of life. Exclusive breastfeeding through the first 6 months of life was more common among older mothers and mothers with more than a high school level education.

Family and neighborhood characteristics can also play a role in the health and well-being of children. In 2009, 71.4 percent of women with children under 18 years of age were in the labor force (either employed or looking for work). Mothers with children under 6 years of age were less likely to be in the labor force (64.2 percent). In 2007, 54.2 percent of children from birth through age 5 were in child care for 10 or more hours per week, but not all families were able to secure needed child care: nearly 20 percent of families who did not receive 10 or more hours of child care per week reported that they needed it. Family activities and parent-child relationships can affect health and well-being, and in 2007, nearly 70 percent of parents with children aged 6-17 years reported that they could share ideas or talk about things that really matter with their children. The proportion of parents reporting that they could share ideas and have meaningful conversations with their child was higher among those with children aged 6-11 years than those with children aged 12-17 years.

Physical activity is another factor that can affect health through the lifespan. Results from the Youth Risk Behavior Surveillance System show that 18.4 percent of high school students met currently recommended levels of physical activity in 2009 (one hour or more of physical activity every day, most of which should be moderate- to vigorous-intensity aerobic activity). Nearly one-quarter of students did not participate in 60 or more minutes of physical activity on any day in the preceding week. Participation in physical activity can be adversely impacted by in media use — or “screen time.” The American Academy of Pediatrics recommends that parents limit children’s daily use of media to 1-2 hours per day. Yet, in 2007, 12.8 percent of pre-school aged children and 10.8 percent of children aged 6-17 years engaged in 4 or more hours of media use on an average weekday, including watching TV or videos or playing video games.

Child Health USA also presents information on risk factors for adverse health outcomes. According to preliminary data, 8.2 percent of infants were born low birth weight (less than 2,500 grams or 5 pounds 8 ounces) in 2009, and 1.5 percent of infants were born very low birth weight (less than 1,500 grams, or 3 pounds 4 ounces). Children born underweight are more likely to suffer from long-term disability and have higher rates of mortality than children born of normal weight.

Violence and neglect are also risk factors for poor health, and in 2009, investigations determined that an estimated 702,000 children were victims of abuse or neglect, equaling a victimization rate of 9.3 per 1,000 children in the population. Victimization rates were highest among young children. Among older children, peer violence is also of concern. In 2009, 11.1 percent of high school students reported that they had been in a physical fight on school property in the prior 12 months and 9.8 percent reported that they had experienced dating violence — having been hit, slapped or physically hurt on purpose — at the hands of a boyfriend or girlfriend.

Information on the prevalence of various diseases and conditions in childhood is also important in the effort to improve health in the child population. For instance, obesity is a serious health concern for children — obese children are more likely to have risk factors for cardiovascular disease, such as high blood pressure, high cholesterol, and Type 2 diabetes. Obese children are also at increased risk of obesity in adulthood, which is associated with a host of serious health consequences. In 2007, 15.3 percent of children aged 10-17 years were overweight and 16.4 percent were obese, based on parent-reported height and weight.

HIV/AIDS and other sexually transmitted infections (STIs) are also of concern. In 2009, an estimated 166 children younger than 13 years of age and an estimated 8,294 people aged 13-24 years were diagnosed with HIV. Chlamydia continues to be the most common STI among adolescents and young adults. Based on the number of cases reported to the Centers for Disease Control and Prevention, there were 2,000 chlamydial infections per 100,000 adolescents and 2,165 infections per 100,000 young adults in 2009. Rates of gonorrhea were 405 and 479 per 100,000 adolescents and young adults, respectively.

In 2009, there were nearly 3.1 million hospital discharges among people aged 1-21 years. While injuries are the leading cause of death among this age group, they were not the most common cause of hospitalization. In 2009, diseases of the respiratory system were the most common cause of hospitalization among children aged 1-4 and 5-9 years, while mental disorders were the most common cause of hospitalization among children aged 10-14 years, and pregnancy and childbirth was the most common cause of hospitalization for adolescents aged 15-19 years and young adults aged 20-21 years.

Depression and suicide remain critical public health challenges for the adolescent population, in particular. In 2009, 2.0 million adolescents — or 8.1 percent of children aged 12-17 years — experienced at least one major depressive episode (MDE). Occurrence of MDE was significantly higher among females (11.7 percent). In the same year, data from the Youth Risk Behavior Surveillance System found that 13.8 percent of all high school students had considered attempting suicide in past 12 months while 6.3 percent reported at least one suicide attempt during the same period.

The health status and health services utilization indicators reported in Child Health USA can help policymakers and public health officials better understand current trends in pediatric health and wellness and determine what programs might be needed to further improve the public’s health. These indicators can also help identify positive health outcomes which may allow public health professionals to draw upon the experiences of programs that have achieved success. The health of our children and adolescents relies on effective public health efforts that include providing access to knowledge, skills, and tools; providing drug-free alternative activities; identifying risk factors and linking people to appropriate services; building community supports; and supporting approaches that promote policy change, as needed. Such preventive efforts and health promotion activities are vital to the continued improvement of the health and well-being of America’s children and families.

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