Reimagining Children's Rights in the US.

Importance: The US faces a pivotal moment of opportunity and risk regarding issues affecting children (aged 0-17 years). Although the US remains the only United Nations member state to not have ratified the Convention on the Rights of the Child (CRC), a child rights framework is essential for child health professionals seeking to advance many issues affecting children in the US. The Reimagining Children's Rights project (2020-2021) conducted an in-depth environmental scan of relevant literature and policy analysis using the Three Horizons design process to assess strategies that could advance the rights and well-being of children in the US.

The Gross Developmental Potential (GDP2): a new approach for measuring human potential and wellbeing.

Many factors influence the health and well-being of children and the adults they will become. Yet there are significant gaps in how trajectories of healthy development are measured, how the potential for leading a healthy life is evaluated, and how that information can guide upstream policies and investments. The Gross Developmental Potential (GDP2) is proposed as a new capabilities-based framework for assessing threats to thriving and understanding progress in achieving lifelong health and wellbeing.

Inequality and child health: dynamic population health interventions.

Purpose Of Review: Established social gradients across a wide range of child health issues including obesity, anxiety, infectious diseases, injuries, prematurity and low birth weight suggest that much illness is avoidable and there is an imperative to intervene in this whole of society issue. This review examines recent advances in understanding of the pathways to health and health inequalities and their application to interventions to improve health equity.

Recent Findings: Children's health develops over the life course in ways that are profoundly influenced by their entire developmental ecosystem including individual, family, community and system-level factors.

Using a Life Course Health Development Framework to Redesign Medicaid.

Since the Affordable Care Act, Medicaid programs serve millions more enrollees across the life course, yet beneficiaries continue to experience high rates of preventable morbidity and mortality rooted in earlier life experiences. By incorporating evidence from life course science into Medicaid, using the Life Course Health Development (LCHD) framework, states can more effectively achieve lifelong health improvement. We describe 5 elements of an LCHD-informed strategy states can use to align Medicaid redesign initiatives toward a common goal of improving life course health outcomes: targeting prevention to sensitive periods; prioritizing intervention on social exposures; maximizing longitudinal continuity in coverage and service delivery; building technological systems with capability to measure performance and outcomes over time; and selecting financial models that support LCHD-informed care.

COVID-19 and Children's Well-Being: A Rapid Research Agenda.

Purpose: Understanding the full impact of COVID-19 on U.S. children, families, and communities is critical to (a) document the scope of the problem, (b) identify solutions to mitigate harm, and (c) build more resilient response systems.

Measuring Equity From The Start: Disparities In The Health Development Of US Kindergartners.

Racialized disparities in health and well-being begin early in life and influence lifelong health outcomes. Using the Early Development Instrument-a population-level early childhood health measure-this article examines potential health inequities with regard to neighborhood income and race/ethnicity in a convenience sample of 183,717 kindergartners in ninety-eight US school districts from 2010 to 2017. Our findings demonstrate a distinct income-related outcome gradient.

Exploration of spatial patterns of congenital anomalies in Los Angeles County using the vital statistics birth master file.

Research has shown linkages between environmental exposures and population health metrics such as low birth weight and incidence of congenital anomalies. While the exact causal relationship between specific environmental teratogens and suspected corresponding congenital anomalies has largely not been established, spatial analysis of anomaly incidence can identify potential locations of increased risk. This study uses the Vital Statistics Birth Master File to map and analyze the rates of congenital anomalies of births from non-smoking mothers 15-35 years old within Los Angeles County.

How Well is the Medical Home Working for Latino and Black Children?

Objective To examine the benefits of having a medical home among Latino and Black school-aged children, both with and without special health care needs (CSHCN). Methods Data from the 2011-2012 National Survey of Children's Health (NSCH) were analyzed to examine the associations of preventive dental and medical care, unmet dental or medical care, or missed school days with having a medical home among Latino and Black children compared to White children. Multivariate logistic regression with survey weights was used to adjust for child, parent, home, and geographic characteristics and an interaction term to estimate differences in outcomes among Black or Latino children receiving care in a medical home compared to White children with a medical home.

Predictors of Poor School Readiness in Children Without Developmental Delay at Age 2.

Background And Objectives: Current recommendations emphasize developmental screening and surveillance to identify developmental delays (DDs) for referral to early intervention (EI) services. Many young children without DDs, however, are at high risk for poor developmental and behavioral outcomes by school entry but are ineligible for EI. We developed models for 2-year-olds without DD that predict, at kindergarten entry, poor academic performance and high problem behaviors.

Aging and Hearing Health: The Life-course Approach.

Sensory abilities decline with age. More than 5% of the world's population, approximately 360 million people, have disabling hearing loss. In adults, disabling hearing loss is defined by thresholds greater than 40 dBHL in the better hearing ear.

Racial and Ethnic Disparities in Early Childhood Obesity: Growth Trajectories in Body Mass Index.

Objective: The aims of this study are to describe growth trajectories in the body mass index (BMI) among the major racial and ethnic groups of US children and to identify predictors of children's BMI trajectories.

Methods: The Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) was used to identify predictors of BMI growth trajectories, including child characteristics, maternal attributes, home practices related to diet and social behaviors, and family sociodemographic factors. Growth models, spanning 48 to 72 months of age, were estimated with hierarchical linear modeling via STATA/Xtmixed methods.

Creating an MCH Pipeline for Disadvantaged Undergraduate Students.

Purpose: To address minority health disparities in maternal and child health (MCH), increasing the diversity of the MCH workforce is an important strategy.

Description: Guided by the MCH Leadership Competencies, we developed an undergraduate pipeline program for disadvantaged students. Our target population is minority undergraduates who are interested in entering health professions but have academic challenges.

Cognitive ability at kindergarten entry and socioeconomic status.

Objective: To examine how gradients in socioeconomic status (SES) impact US children's reading and math ability at kindergarten entry and determine the contributions of family background, health, home learning, parenting, and early education factors to those gradients.

Methods: Analysis of 6600 children with cognitive assessments at kindergarten entry from the US Early Childhood Longitudinal Birth Cohort Study. A composite SES measure based on parent's occupation, education, and income was divided into quintiles.

The changing nature of children's health development: new challenges require major policy solutions.

The epidemiology and social context of American childhood are rapidly changing. Adverse social, economic, and child-rearing conditions are loading children down with preventable illness, physical and behavioral disability, and dysfunction. This new epidemiology of childhood is swamping the capacity of the nation's health care system, schools, juvenile justice facilities, and child protective services to respond to the needs of those they serve.

Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience.

The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less is known about the population-based epidemiology of adverse childhood experiences among US children. Using the 2011-12 National Survey of Children's Health, we assessed the prevalence of adverse childhood experiences and associations between them and factors affecting children's development and lifelong health.

Applying a 3.0 transformation framework to guide large-scale health system reform.

Implementation of the Affordable Care Act is unleashing historic new efforts aimed at reforming the US health system. Many important incremental improvements are under way, yet there is a growing recognition that more transformative changes are necessary if the health care system is to do a better job of optimizing population health. While the concept of the Triple Aim-dedicated to improving the experience of care, the health of populations, and lowering per capita costs of care-has been used to help health care providers and health care systems focus their efforts on costs, quality, and outcomes, it does not provide a roadmap for a new system.

Children's health care and the Patient Protection and Affordable Care Act: what's at stake?

and Affordable Care Act (hereafter referred to as the ACA) of 2010 does not explicitly target the health care needs of children, its significant reforms and cascading effects throughout our complex health system are likely to directly and indirectly affect children’s health care. The ACA increases insurance coverage for children and their families by covering comprehensive preventive services with no cost sharing, eliminating exclusions for preexisting conditions, prohibiting lifetime dollar limits, extending dependent health benefits to 26 years of age, and expanding coverage to many previously uninsured parents. Despite these advances, some provisions of the ACA have the potential to compromise children’s health care in unanticipated ways.

Hearing difficulties in children with special health care needs.

Objective: To determine characteristics of children with special health care needs (CSHCN) with hearing difficulties including patterns of hearing aid use, comorbidity, and social and communication function.

Methods: Bivariate and multivariable analysis of cross-sectional data on 40,723 children aged from birth to 17 years from the 2005-2006 National Survey of Children with Special Health Care Needs, including 1,982 (5%) with parent-reported hearing difficulties.

Results: Among CSHCN, 383 (1%) used hearing aids, representing 20% of those with reported hearing difficulties.

Lifecourse health development: past, present and future.

During the latter half of the twentieth century, an explosion of research elucidated a growing number of causes of disease and contributors to health. Biopsychosocial models that accounted for the wide range of factors influencing health began to replace outmoded and overly simplified biomedical models of disease causation. More recently, models of lifecourse health development (LCHD) have synthesized research from biological, behavioral and social science disciplines, defined health development as a dynamic process that begins before conception and continues throughout the lifespan, and paved the way for the creation of novel strategies aimed at optimization of individual and population health trajectories.

A lifecourse approach to health development: implications for the maternal and child health research agenda.

Lifecourse-informed models of health fundamentally challenge simple biomedical models, introducing new ways of thinking about how diseases develop. This paper considers the broad implications of lifecourse theory for the maternal and child health (MCH) research agenda. The Lifecourse Health Development model provides an organizing framework for a synthesis of the existing literature on lifecourse health and identification of gaps in knowledge.