"Many things we need can wait. The child cannot. Now is the time his bones are being formed, his blood is being made, his mind is being developed. To him we cannot say tomorrow, his name is today."
- Gabriela Mistral, Chilean Poet, Nobel Laureate
The main aim of pediatrics is prevention. Prevention of diseases, of injury, of emotional problems, of developmental and intellectual delays. Our armamentarium include vaccines; screening instruments; and guidance on development, safety, and nutrition.
It's time to add one more item to our tool kit: screening our young patients for health and emotional problems related to poverty.
At St. Christopher's Hospital for Children in the heart of North Philadelphia, we see 15 to 20 newborns a day, brought in for their checkups. Many are at high risk of developmental delays, school failure, ADHD, heart disease and even premature death - all because they ed areas were born into the most concentrated poverty in Pennsylvania.
This is the lottery of birth for millions of similar children across the United States.
The most common - and serious - disease in American children is poverty. The daily grind of living without knowing whether there will be enough to eat, whether the lights will come on, whether the landlord will fix the roof or seek to evict for not paying the rent has direct, dire health consequences.
Areas of deep poverty, where more than 40 percent of the population lives on less than $24,000 a year for a family of four, have doubled to include 13.8 million people since 2000. That's the highest level ever recorded.
More than 135,000 Philadelphia children - 16 million children nationwide - live in such circumstances, and it literally is killing them. A child from the most violent part of the city, North Strawberry Mansion/Swampoodle, has an average life expectancy of 68, which is about two decades less than a child from Old City/Society Hill, according to a recent study from the Robert Wood Johnson Foundation.
In an unprecedented move, the American Academy of Pediatrics (AAP) and the Academic Pediatric Association (APA) simultaneously released policy statements this month describing the epidemic of childhood poverty, the deleterious effects of poverty on the developing child, and what should be done about it. The reports help bring this issue to the forefront.
So does the science.
Evolution has gifted us with the ability to become stronger, to think faster, to jump higher when faced with a stressful situation. The brain senses danger and the adrenal glands secrete cortisol that bathes our bloodstream and attaches itself to muscle cells, our heart, our brain. All that helps us react in a productive or even lifesaving way.
But what happens when that stress is prolonged, chronic, and toxic, exacerbated by poverty?
A study in JAMA Pediatrics showed that poverty was associated with smaller brain volumes in areas of the brain that are responsible for memory, for language, for self control, for executive functioning. Another 2015 study of more than 1,000 children and young adults revealed that in poor children, small differences in income were associated with relatively larger differences in brain surface area. Is it then a surprise that only 14 percent of fourth graders in Philadelphia's public schools are reading at grade level? That there are epidemics of sexually transmitted diseases and violence, both of which require self-control and executive functioning to prevent?
Cardiovascular disease continues to be the leading killer of adults in the United States, and recent evidence shows heart damage starts early for children raised in poverty.
Teenagers facing adversity such as poverty have more circulating Endothelin-1, which causes blood vessels to constrict, raising blood pressure and damaging the delicate vessels around the heart, the brain, the kidneys, a recent study in the journal Hypertension found.
Another study in JAMA Pediatrics in March, "Childhood Psychosocial Factors and Coronary Artery Calcification in Adulthood," demonstrated that the more adversity a child had, the more likely that child was to have coronary artery disease 28 years later, even adjusted for traditional CVD risk factors such as smoking, obesity, depression, and lack of social support.
Childhood poverty and stress even creep into our DNA, creating changes that get passed on to the next generation, affecting how babies respond to stress.
So what works to ameliorate the effects of child poverty? The Earned Income Tax Credit and Temporary Assistance for Needed Families can help lift children out of poverty. CHIP and the Affordable Care Act have decreased uninsurance rates among children to an all-time low of 6 percent. Investments in early childhood education like Pre-K for Pa. have been shown to have long-lasting health benefits, as do nutrition programs such as WIC, SNAP, and school meals.
Home visiting and parenting programs help children bond with the most important buffer against poverty, a stable, supportive adult in their lives. Increasing the minimum wage is also of vital importance.
Social Security and Medicare have cut poverty among seniors. We cannot wait to do the same for our children. We need to act today.
Daniel R. Taylor, D.O., is an associate professor at the Drexel University College of Medicine and director of community pediatrics and child advocacy at St. Christopher's Hospital for Children.