Complex health, economic, and psychosocial challenges greatly influence the well-being and health outcomes of children. National reports from the Centers for Disease Control andPrevention (CDC) (e.g., http://www.cdc.gov/nchs/data/hus/ hus11.pdf#102 ) provide information about many of these issues.Some of the key issues include the following: • Health insurance coverage. In 2010 over eight million children in the United States had no health insurance coverage. In addition, 10 to 20 million were underinsured. Many children, despite public sector insurance, do not receive recommended immunizations. Although Medicaid and the State Children’s Health Insurance Program covered more than 42 million children in 2010 who otherwise would not have health care access, over a million U.S. children are unable to get needed medical care because their families cannot afford it.
Prenatal and perinatal care. Ten to 25% of women do not receive prenatal care during the first trimester. In addition, a significant percentage of women continue to smoke, use illicit drugs, and consume alcohol during pregnancy.
Preterm births. The incidence of preterm births (<37 weeks) peaked in 2006 and has been slowly declining (11.99% in 2010). However, the 2010 rates of low birth weight infants (≤2500 g [8.15% of all births]) and very low birth weight infants (≤1500 g [1.45% of all births]) are essentially unchanged since 2006.
Birth rate in adolescents. The national birth rate among adolescents has been steadily dropping since 1990, reaching its lowest rate (34.2 per 1000) for 15to 19-yearold adolescents in 2010.
Adolescent abortions. In 2009 nearly 800,000 abortions were reported to the CDC, a continued decline over the last decade. Adolescents from 15 to 19 years of age accounted for 15.5% of abortions. Approximately 60% of sexually active adolescents report using effective contraception.
Infant mortality. Although infant mortality rates have declined since 1960, the disparity among the ethnic groups persists. In 2011 the overall infant mortality rate was 6.05 per 1000 live births with a rate per 1000 live births of 5.05 for non-Hispanic whites, 5.27 for Hispanic infants, and 11.42 for black infants. In 2008 the United States ranked thirty-first in infant mortality. Marked variations in infant mortality exist by state with highest mortality rates in the South and Midwest.
Initiation and maintenance of breastfeeding. Seventy-seven percent of women initiate breastfeeding following the birth of their infants. Breastfeeding rates vary by ethnicity (higher rates in non-Hispanic whites and Hispanic mothers) and education (highest in women with a bachelor’s degree or higher). Only 47% of women continue breastfeeding for 6 months, with about 25% continuing at 12 months.
Cause of death in U.S. children. The overall causes of death in all children (1 to 24 years of age) in the United States in 2010, in order of frequency, were accidents (unintentional injuries), assaults (homicide), suicide, malignant neoplasms, and congenital malformations (Table 1-1). There was a slight improvement in the rate of death from all causes.
Hospital admissions for children and adolescents. In 2010 2.4% of children were admitted to a hospital at least once. Respiratory illnesses (asthma, pneumonia, and bronchitis/bronchiolitis) and injury are the causes of over 28% of hospitalization in children under 18 years of age. Mental illness is the most common cause of admissions for children 13 to 17 years of age.