Infant & Child Health
Young children make up the fastest growing population group in the District with over 45,000 children under five, and close to 30,000 of this population is between the age 0-3 . Improving the well-being of infants and children is an important public health priority in the District of Columbia and the nation. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system. Indicators such as the infant mortality rate, prenatal health outcomes, preterm birth rates, birth-weight, school engagement, and emotional and mental health development markers, are used to monitor infant and child population health.
The DC Healthy People 2020 goals for this topic include:
1. Women of child-bearing age, fathers, infants, and children have equitable access to high-quality and appropriate health care.
2. Health issues for mothers, infants, and children are rare and they thrive in their environments.
For infants in the first year of life, good health begins with a healthy full-term pregnancy, safe delivery, and a healthy and safe home environment. In the District, infant mortality has been declining since 2010 with a historic low of 6.8 infant deaths per 1000 live births in 2013. However, this improvement has not been consistent for all subgroups within the District. Infant mortality is higher among non-Hispanic Black infants (11.49 per 1000 live births) as compared to non-Hispanic white infants (2.55 per 1000 live births), those with high school education, Medicaid recipients, and residents of Wards 5, 7, and 8 in the years 2012-2016 .
Preterm birth refers to when a baby is born before 37 weeks of pregnancy have been completed . Preterm birth may result in health complications for infants such as developmental delays, breathing problems, and feeding difficulties. Nationally, preterm birth accounts for 17.4% of infant deaths . There was a decrease in the percentage of preterm live births in the District between 2006 to 2016 from 13.3% to 10.8% respectively, however, preterm births remained comparatively higher for non-Hispanic Black populations at 12.8% .
Parental education, income, employment, and family structure are closely linked with a child’s well-being and health outcomes. In 2016, 76% of all District children under the age of 6 had both parents in the labor force, more than any other state . Of the 31,500 children living in poverty in the District, over 11,000 are children five years of age or younger, which is about 25% of the total population of children five and under. In 2016, 72% of children living below the poverty line in the District are children of color . In 2017, District children ages 5-17 are more likely to live with a disability (7.8%) compared to the national average (6.6%) .
According to the Economic Policy Institute, DC is the most expensive place in the US for childcare. In the District, the average annual cost of childcare is $24,243, or $2,020 per month, making it more expensive than in-state tuition for four-year public college . Consistent with the determinants of health outcomes for adults, infant and child health are similarly influenced by the conditions in places they live, learn, and play. Socio-demographic and behavioral factors, such as education, family income, and breastfeeding, as well as the physical and mental health of parents and caregivers are also linked to the health of infants and children .
In 2017, the obesity rate for District children between the age of 10-17 was 35%. According to the CDC, 76.3 % of District children between the age of 19-35 months have received their combined vaccine series including 92.4 % that have received at least one dose of the MMR vaccine . Asthma-related ED visits, while elevated, have been declining for children under age 15.
Patterns of preventive care for children who are covered by Medicaid shed light on how insurance can support parents in taking children for well-child visits and also uncover areas for further investigation of the barriers faced by families not accessing preventive care.
Childhood Trauma & Abuse
The impact of childhood trauma and abuse on the physical and emotional development of children has been widely documented. Childhood trauma due to exposure to violence can lead to health consequences later in life . Adverse childhood experiences (ACEs) are traumatic events occurring before age 18. ACEs include all types of abuse and neglect as well as violence, parental mental illness, substance use, divorce, and incarceration, and domestic violence. A landmark study in the 1990’s found a significant relationship between the number of ACEs a person experienced and a variety of negative outcomes in adulthood, including poor physical and mental health, substance abuse, and risky behaviors . The more ACEs experienced, the greater the risk for these outcomes.
Children’s frequent exposure to gun violence, domestic violence, poverty, or an unstable living environment also negatively affect their performance in the classroom. In 2018, the DC Office of the State Superintendent of Education won a $10.6 million preschool development grant that will be used to strategically create a more efficient, responsive and coordinated mixed-delivery system for infants to 5-year-olds in the District. This early childcare will work to specifically meet the needs of vulnerable children and families including children experiencing homelessness, children with special needs, children in foster care, and children in families with very low incomes .
The presence of ACEs does not mean that a child will experience poor outcomes. However, children’s positive experiences or protective factors can help prevent children from experiencing adversity and can protect against many of the negative health and life outcomes even after adversity has occurred .
Adverse childhood experiences influence health by a variety of mechanisms across the lifespan. Not only can there be developmental impacts, but also future adoption of health risk behaviors and earlier-onset disease or disability .
In the District, reports of child abuse and neglect have increased over the past year, but the increase could also be associated with more cases being reported, and not necessarily more cases. After declining for several years, a larger percentage of children in foster care are placed in group homes or congregate care. While it’s important for foster children to be in family-based care settings, some children with different needs have better outcomes in congregate care settings . That being said, congregate care setting should be used judiciously, efficiently, and effectively .
Mental & Socioemotional Health
Healthy mental and emotional growth allows children to develop self-confidence, high self-esteem, and a healthy outlook on life in general. Early assessment of a child’s mental and emotional health creates early access to treatments and appropriate care for children. In the District, 23 percent of children between the ages of 2 to 17 are reported to have one or more emotional , behavioral, or developmental conditions such as autism, Attention Deficit and Hyperactivity Disorder (ADHD), depression, or anxiety .
The American Academy of Pediatrics recommends screening for developmental delays using age-appropriate questions conducted during well-child visits at 9, 18, and 24 or 30 months. In the District of Columbia, only 31 percent of parents have completed developmental screenings for the year 2016-2017 . Another indicator used to measure the emotional and mental health of children is “flourishing” that measures a child’s curiosity and discovery about learning, resilience, attachment with parent, and contentment with life. In the District, 70% of 6 months–5 years old met all flourishing items as compared to 64% children in the same age category nationally .
In 2009, the District began an ambitious expansion that offers two years of universal, full-day preschool across the city’s public schools, public charters, and some private preschool programs administered by community-based organizations. As of 2017, approximately 90% of the District of Columbia’s 4-year-olds and 70% of the city’s 3-year-olds were enrolled in publicly-funded preschool through the expansion . As of school year (SY) 2016-17, the majority of students enrolled in public school are African American (68%) followed by Hispanic/Latinx students (18%) and White students (10%).
The District tracks students at risk of academic failure, which is defined as students who are homeless, are in foster care, qualify for federal food stamp and welfare, or are older than the expected grade-level age. This identification is used to ensure schools receive additional local funds to better serve these students. In SY 2016-17, 47% of students in the District were identified to be at risk of academic failure, with the highest percentage of students living in Ward 7 (56% of students in this ward) and Ward 8 (66% of students in this ward) .
Assets & Resources
• Project Empowerment, collaboration with Department of Employment Services to implement healthy relationships and parenting skills curricula with men
• Help Me Grow, a centralized referral program that links prenatal women and children 0-5 and their families to services to support healthy development
• Early Childhood Innovation Network (ECIN), Place-based approaches to improve perinatal health: Smart from the Start Woodland Terrace Child & Family Development Program
• Home Visitation, (202) 442-5925
• Project Launch, linking actions for unmet needs in children’s health
• Early Childhood Comprehensive Systems, aims to address needs of all children 0-8 years in DC
Promising Practices & Policies:
• A-I Create a standard billing structure that will allow children to visit their doctor three times a year for asthma follow-up to prevent emergency department visits and hospitalizations.
• AH-I Offer comprehensive early childhood development programs for low income families.
• AH-II Implement the Whole School, Whole Community, Whole Child approach to achieve comprehensive, integrated, and collaborative school health services.
• MHMD-II Screen for and improve surveillance around childhood trauma.
• MICH-V Increase the proportion of children with special health care needs who have access to a medical home
• TU-IV Improve surveillance of children exposed to secondhand smoke.
Citations & Additional Data Resources
1. U.S. Census Bureau, 2013-2017 American Community Survey 5-Year Estimates
2. DC Department of Health. Perinatal Health and Infant Mortality Report. 2018.
3. CDC-Division of Reproductive Health. Preterm Birth. 2019
4. OSSE. Making Data Count: Thrive by Five DC. 2019
5. Economic Policy Institute. The Cost of Child Care in Washington DC. 2019
6. Healthy People 2020. Maternal, Infant, and Child Health. 2019
7. CDC MMWR. Vaccination Coverage Among Children Aged 19-35 Months–United States, 2015. 2016
8. DC Healthy People 2020. Maternal, Infant, and Child Health. 2016
9. U.S. Department of Health and Human Services. Adverse Childhood Experiences. 2019.
11. The Annie E. Casey Foundation. Kids Count Data Center. 2013
12. Data Resource Center for Child & Adolescent Health. National Survey of Children’s Health 2016-2017.
13. Center for American Progress. The Effects of Universal Preschool in Washington, D.C. 2018
14. DC Deputy Mayor of Education. Public Education Supply and Demand for the District of Columbia Citywide Fact Sheet, SY 2016-17. 2017
15. U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. A National Look at the Use of Congregate Care in Child Welfare. 2015.
16. CDC-Violence Prevention. Adverse Childhood Experiences. 2019