Tweens Archives - Page 24 of 34 - Two Peds in a Pod®

Are my teen’s vaccines up to date? Maybe not—HPV, pertussis, meningococcal meningitis and flu

Today we bring you more advice from the Atlantic Regional Osteopathic Convention 2012 Adolescent session, where Dr. Amanda Manning updated us about adolescent vaccines. As always, be sure to review with your child’s doctor any contraindications as well as reasons to vaccinate early with all of these immunizations.

Tdap : This vaccine, which prevents pertussus (whooping cough), tetanus and diphtheria, is given to 11- 12 year olds. But since the pertussis component of the Tdap vaccine was not recommended until six years ago, your teen may have received the formulation without pertussis protection (dT). If so, he should now get a dose which contains pertussis. Recent evidence shows teens and adults lose their immunity to whooping cough and can spread disease to vulnerable infants and young children.

The meningitis vaccine, or “quadrivalent meningoccal conjugate vaccine”: Pediatricians routinely give this vaccine to tweens. New recommendations add a booster dose at age sixteen years. If the first dose was not given until age sixteen, a booster dose is not needed. Read our earlier post for more information about this vaccine and the disease it prevents.

HPV vaccine: This vaccine protects against Human Papillomavirus (HPV), which causes cancer of the cervix, vagina, penis, and throat. HPV also causes genital warts. Most people who are infected pick up the virus unknowingly during their first two years of sexual activity. In fact, eighty percent of women by age 50 are infected with some form of HPV. Luckily, the majority of infected women do not develop illness. The Pap tests that women receive at their yearly gynecology visits screen for cervical cancer caused by this virus. Here are common questions parents ask about the HPV vaccine:

Is this vaccine safe for my kids?- it’s too new

No more need to “watch and wait” for more safety data before giving it to your teen. Health care workers have given over 40 million doses of HPV vaccine worldwide so far with no serious adverse events. The vaccine has a good track record of safety, despite what some internet sources as well as politicians would have you believe. The side effects of local soreness and mild fever are the same as those seen in all other vaccines.

Should both girls and boys be vaccinated?

Yes, but only the brand Gardasil is approved for use in males.

Isn’t giving the vaccine at 11 or 12 years old “too young”? My kid is not sexually active.

Younger teens make better antibodies from this vaccine than older teens. The vaccine is most effective before the onset of sexual activity, before kids could be exposed to the virus.

If my teen forgets a dose, does she need to restart the series?

Three doses complete this vaccine series. Fortunately, if you forget to bring in your teen for the follow up dose, your teen’s doctor can simply continue the series wherever your teen left off and the vaccine will still be effective.

Can my young adult aged children also get the vaccine ?

Yes, but for Gardasil only up through 26 years and for Cervarix through age 25. Cervarix is not approved for males. Last year, the FDA did not find there was enough of a decrease in disease to widen the age range for Gardasil after age 26.

FLU: The guidelines for the flu vaccine are the easiest to remember of all the vaccines. Give a dose of flu vaccine to every teen every year, before the start of flu season. In fact, EVERYONE should get flu vaccine every year, including adults. The mist-in-the-nose form is safe for anyone without asthma or other chronic health conditions, and now, safety data shows most everyone can receive the injectable form, even kids with egg allergy. Please see our earlier post for more information about the flu virus, the flu vaccine, and how to tell if your child has the flu.

Amanda Manning, DO, FAAP, FACOP, is the site supervisor of the pediatric group at Geisinger Medical Group in Bloomsburg, Pennsylvania. She is a graduate of Duke University and The University of Medicine and Dentistry of the New Jersey School of Osteopathic Medicine, and completed her pediatric residency at the Geisenger Medical Center. Dr. Manning has been practicing general pediatrics for fifteen years.

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

Chewing the fat: new cholesterol screening guidelines for all kids

cholesterol cartoon I have a confession to make. Two of my kids still have not had their blood cholesterol checked. You see, according to the National Heart, Lung and Blood Institute (NHLBI), kids with risk factors for heart disease (in my children’s case, a grandfather who had an early heart attack) should have their cholesterol level checked. But I’ll be getting my kids to the lab soon. New research shows that although heart attacks and strokes are rarely seen until adulthood, atherosclerosis (cholesterol plugs) in blood vessels, which is a precursor for heart disease, can be seen as early as during fetal growth. The concern is so great for heart health that guidelines were recently revised: EVERYONE, regardless of risk factors, should be screened twice during childhood.

For those WITHOUT risk factors, your child’s doctor can order NON-fasting total and high-density lipoprotein-HDL (aka “total cholesterol” and “good cholesterol”) levels for initial screening. Routine screening should occur sometime between 9-11 years and again between 17-21 years.

For kids WITH heart disease risk factors like mine, the American Academy of Pediatrics recommends a nine to twelve hour fasting “lipid panel.” Lipid panels usually measure low density lipoprotein (LDL) “bad cholesterol” and triglycerides in addition to total and HDL cholesterol. For kids with risk factors, screening should occur when the risks are discovered.

Pediatricians start asking for a family history of risk factors by three years old. Risk factors include: a parent, grandparent, aunt/uncle, or sibling with a heart attack or evidence of heart blood vessel damage less than 55 years in males or less than 65 years in females, or a parent with high cholesterol or triglycerides. Other risk factors for your child include having medical conditions such as diabetes, high blood pressure, obesity (Body Mass Index/BMI ≥95th percentile) and smoking cigarettes. Ask your child’s doctor for a full list of qualifying conditions.

The easiest way to time a “fasting” blood draw is to give your child dinner at his regular time, send him off to bed, and go to the lab first thing in the morning. Bring a snack with you so you can feed your child immediately after his blood is taken.

Because drinking water will not affect the lab results, have your child drink plenty of water before-hand and throw a sweater on him. The extra fluid will plump up the veins and the warmth from the sweater will dilate blood vessels, making it easier for the lab technician to draw blood.

Worried about calming down your kids’ nerves before a blood draw? Use techniques discussed in How to take the sting out of injectible vaccines.

For the full NHLBI report check out http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm . For guideline analysis look at this link from the American Academy of Pediatrics.

Naline Lai, MD with Julie Kardos, MD

The Jersey Shore: pediatric style

We’re back from a Jersey Shore medical conference where we moderated the adolescent session of the Atlantic Regional Osteopathic Convention. In the next few weeks, we’ll be posting you advice gleaned from talks on teen depression, vaccine updates, fatigue in adolescents and worrisome teen drug use trends.

Today we start with advice based on Dr. Melisa Lai Becker’s talk, Trendy Tox Teen Behaviors:

How do I know if my kid is high? Your tween or teen wanders in late on a Saturday night and acts like he is in slow motion. “I’m just tired,” he claims. Is he high, you wonder? To answer the question, have him look you straight in the eye as you talk to him. Even if he is lying, the truth will be in his eyes. More specifically, it’s in the size of his pupils (the black part of his eyes). Too big (nearly covers the colored part of his eyes) or too little (like pinpoints) is a sign he is currently high.

Alcohol: Parents, beware. The type of alcohol in your beer, ethanol, is the same type of alcohol in your morning mouth wash and perhaps in your medicine cabinet. The difference is that mouthwash contains more alcohol than beer. Beer typically contains up to 5 percent ethanol, wine up to 14 percent ethanol, and liquors usually up to 40 percent ethanol. Compare this to Original Listerine with 27 percent ethanol and Nyquil Nighttime Cold/Cough with 25 percent ethanol (and you wonder why it helps you fall asleep?!).

How can you tell if your kid is drunk? Again, look at his eyes- if he is drunk you may see pupils dancing in small circles. The dancing eyes give the sensation of “dizziness” to drunk individuals.

Pharming: We teach our children that medicine is not candy, and yet Pharming—consuming prescription substances to get a high—is a big problem among teens. Since 2003, according to the Centers for Disease Control, more overdose deaths have involved painkillers like Vicodin and Percocet than heroin and cocaine combined. Among teens, medications prescribed for Attention Deficit Hyperactivity Disorder are the most popular pharmed drugs. Don’t unwittingly contribute to a pharming party where kids raid medicine cabinets, deposit pills into big bowls and randomly ingest them. This upcoming week, April 28, is National Prescription Drug Take-Back Day . Make it a spring cleaning priority.

The most important phone number parents (and doctors) can know:

poison control: 1-800-222-1222

Melisa Lai Becker, MD, is chief of Emergency Medicine at the Cambridge Health Alliance at Whidden Memorial Hospital campus in Everett, Massachusetts. She also serves as Director of Medical Toxicology of the Cambridge Health Alliance and as a Harvard Medical School instructor.

Naline Lai, MD and Julie Kardos, MD
©2012 Two Peds in a Pod®

How can I motivate my child in school? — Creating the resilient learner

“What will happen if your grade drops from an “A” to a “C”?” I sometimes ask during a check-up.

Many kids shrug and say, “Try harder next time, I suppose.” Others look shocked and anxious about the possibility and are speechless.

Still others will point at their parents and say,”THEY would kill me.”

Observe a toddler learning a new skill. You will see him repeatedly try to fit a ball into a hole until he is either successful or wanders way. He is not anxious or afraid of failure. He is not “stressed” about trying to learn. Although all children start this way, too often toddlers become big kids who end up in my office discouraged and worried about school performance. Today’s guests Principal Mr. Leonard Schwartz and Vice Principal Michael Testani, based on the work of Dr. Carol Dweck, discuss ways parents can influence their children so that they embrace learning.

– Drs. Lai and Kardos

Researchers under the leadership of Dr. Carol Dweck conducted a survey of parents of school aged children. The majority of parents thought it was necessary to praise their children’s intelligence in order to give them confidence in their abilities and motivate them to succeed. Instead, this approach can lead to fixed mindsets in children. Kids with fixed mindsets believe “my abilities are what they are.”

Instead, the most motivated and resilient students demonstrate a growth mindset. They are the ones who believe their abilities can be developed through their effort and learning. These students are resilient and persevere when tasks become challenging.

A study of students’ brain waves revealed students with a fixed mindset were interested in whether they got an answer right or wrong, but when they were wrong, they paid little attention to the correct answer. Students who were praised for their intelligence later lied about their scores. They felt the errors were so humiliating that they could not own up to them. The students failed to persevere, believing they were no longer “smart,” and therefore unable to meet academic challenges.

Students with a fixed mindset typically think it is best if they:

Don’t make mistakes – “I’m too smart to make mistakes.”
Don’t need to work hard –”I’m smart and learning comes naturally to me.”
Don’t try to repair mistakes- “I was wrong, and that is the end of it.”

Students with a growth mindset generally:

Take on challenges
Work hard
Confront their deficiencies and correct them

How should parents talk to their children in order to develop a growth mindset?

Wow, you got 10 out of 10 right! What strategy did you use to get a perfect score?
What can you learn from this mistake that will help you do better next time?
I am proud of how hard you worked on this project and look at how your hard work paid off!
The strategies you used last time didn’t work. Let’s take a look at them so I can help you figure out better strategies to use next time.
You’re becoming such a good learner!
Smart is not something you are; it’s something you become. Let’s figure out how you can become smart at this assignment.

What is your child’s mindset? Ask yourself, what is your own mindset? Have a conversation with your child as you discuss your child’s report card. Use any upcoming parent teacher conference to examine outlooks, attitudes, and strategies that are or are not supporting your child’s academic progress.

Where applicable, praise your child’s positive skills and attributes. Celebrate instances you observed that contributed to positive indicators.

When necessary, examine areas of poor performance and strategize with your child about how he or she can turn a weakness into a strength. Again, you may revisit situations you observed this past grading period in which your child took shortcuts, provided incomplete work products, or did not do his or her personal best.

Make your expectations very clear in terms of why you value attributes or traits of resiliency, and how they can and will develop into habits that will serve your child well.

Grades are a distant second to the level of effort a child invests in personal learning in any setting.

Leonard H. Schwartz, Principal, Mill Creek Elementary School

Michael R. Testani, Assistant Principal, Mill Creek Elementary School

Mr. Schwartz and Mr. Testani are part of the Central Bucks School System in Pennsylvania. After fourty-three years as an educator in two school districts and five schools, Mr. Schwartz retires this year. This post was published in it’s full original form in the publication Principal’s Prose of Mill Creek Elementary School.

Some like it hot: Hot Tub Folliculitis

hot tub rash From the start, a family I know was suspicious of the hot tub sanitation at the resort where they recently stayed. As time went by, even though the water looked clear, the hot tub seemed less chlorinated, and the water more tepid. They dubbed the tub “the scuz tub.” After their return, one of the kids broke out in the rash of hot tub folliculitis pictured to the left. You could say, they figured out just what the “scuz wuz”.

Hot tub folliculitis is a skin rash caused by a bacteria called pseudomonas aeruginosa. The rash appears a day or two after soaking in a hot tub. A light pink bump appears around hair follicles (hence the name). As you can see in this photo, the rash is typically worse on areas of skin where bacteria was trapped under a swimming suit. The rash can cover all body surfaces, including the face, if your child dunked his head under water.

The rash can be slightly itchy but is not usually painful. No other symptoms develop such as fever or sore throat. The rash is not contagious, but often other people who swam in the same hot tub also break out.

Treatment is to wait it out. Typically by one to two weeks, provided your child does not go back into the hot tub, the rash resolves on its own. If your child feels very itchy, you can treat her with oral diphenhydramine (brand name Benedryl). Rarely, just like mosquito bites, the rash can become infected with other bacteria if your child scratches too much.

Pseudomonas thrives in warm wet places. In fact, it’s the same bacteria that causes “swimmer’s ear.” Tight control of chlorine and acid content of the hot tub water limit the growth of the bacteria. Unfortunately, you can not tell the pseudomonas content of water just by eyeing it.

May you bring back a better souvenir than this family did on your next vacation.

Julie Kardos, MD and Naline Lai, MD

Cinnamon Challenge = Potential Choking Calamity

Do not take the cinnamon challenge Beware. There’s another choking “game” out there. This time, kids try to swallow a teaspoon (or more) of cinnamon without water as quickly as possible without coughing or vomiting. The cinnamon usually forms a thick slurry in the back of the throat and causes gagging and coughing. Hence, the “cinnamon challenge.”

We first saw warning reports of the cinnamon challenge via recent emails circulated by principals in local school districts, but yesterday Dr. Lai heard about it directly from a kid and his mother in her office. Luckily, the teen and his friends who played it the other day were fine. However, everyone did cough after taking in the cinnamon and one kid in his group threw-up.

“Do you know why people cough?” I asked him.

“Why?” he said.

“It’s a sign your body is trying to protect your airway,” I said.

The trend is spurred on by kids trying to copy YouTube videos and Daniel Tosh on the television show Tosh.0

Current statistics for emergency room visits or deaths related to this particular “game” are hard to come by. But we do know in 2000, according to the Centers for Disesase Control, 160 children aged 14 years and under died from airway obstruction associated with inhaled or ingested foreign bodies. Food was associated with about 40% of those deaths. Especially for those who already have sensitive airways such as those with asthma, any substance which tickles the back of the throat can produce spasm in the lungs. Also, the substance itself can get into the lungs.

Tosh starts off the video above by saying, “The internet is full of challenges.” Well, we’re on the internet too, Tosh, and we challenge you to model the healthy behaviors – not the dangerous ones.

Naline Lai, MD and Julie Kardos, MD

How to treat bloody noses- nothing to sneeze at

Our fantastic Two Peds in a Pod photographer Lexi Logan recently put in a request for a post on bloody noses. I cringed, thinking any photo would not be pretty. “No problem,” she replied,” I’m thinking just a tissue and a top-of-nose shot… pinch angle.”

I was aghast. “Looks like you fell for the number one myth associated with bloody noses,” I said.”That’s the wrong spot to pinch.”

“See,” she told me,”that’s why I need the post.”

So, how does one squelch the fountain of red which spews from a bloody nose? Apply pressure to the SIDE of the nostrils—not up near the bridge of the nose. More blood vessels lay near the bottom of the septum, the divider which separates the nostrils, than near the top. Pinch the nose firmly. Since kids never seem to apply enough pressure on their own, go ahead and pinch for them. You’ll find it easier to pinch both nostrils simultaneously even if the blood is dripping from only one side.

Now hold. Hold. Hold. Hold in the middle of the night until you nearly fall back to sleep. Hold until the pot of spaghetti boils over. Hold for at least ten minutes before peeking in order to allow the blood to clot. If the nose is still oozing, pinch for another ten minutes. Have your kid sit up straight or lean slightly forward. Otherwise, blood will drip down the back of her throat and cause nausea and vomiting.

Do not be surprised after an episode if the next couple of nights bring more bloody noses. At night during sleep kids tend to rub their noses. Any scab that formed from a recent nose bleed gets sloughed off.

To prevent reoccurrence, protect those fragile blood vessels by keeping the inside walls of the nose moist. Once or twice a day, spritz saline into the nose, then apply a thin layer of petroleum jelly. Try running a cool mist humidifier in your child’s bedroom.

Prevent nasal irritation by decreasing environmental irritations such as cigarette smoke or dust. Teach your child to dab at his nose or blow gently when he has a cold. Ironically, some steroid nasal sprays, which treat runny noses caused by allergies, can irritate nasal passages.

Your kid is having too many bloody noses when you start to carry around tissues or your child sleeps with a box of tissues next to his pillow “just in case.” Go to your child’s doctor if this occurs. Also, go if there are signs of a clotting problem such as easy bruising, bleeding gums, or heavy periods. Likewise, if bloody noses take more than twenty minutes to clot, or if the nose bleed requires an emergency room visit or packing in the nose, make an appointment. Other reasons for more evaluation include if your family has a history of clotting disorders, your child gets speckled flat rashes that look like broken blood vessels (petechiae) which do not blanch (lose color for a second when you press on it) or if a nosebleed is caused by trauma.

Your child’s doctor may recommend sealing vessels with cauterization or investigating for possible blood clotting problems. Depending on your child’s age, she may also recommend a short course of oxymetazoline (eg Afrin). Be sure to use oxymetaxzoline according to directions- overuse can cause rebound symptoms.

Ultimately, you may find that your kid’s bloody noses are just the result of the perfect storm: dry air and a kid who picks his nose. In the meantime save that thirty percent-off Kohl’s coupon. You might be buying a lot of pillow cases.

Naline Lai, MD and Julie Kardos, MD
©2012 Two Peds in a Pod®

Podcast: The barky cough of croup

You wake up in the middle of the night to the sound of a seal barking inside your house. More specifically, from inside the crib or toddler bed. Unless you actually have a pet seal, that bark is the sound of your child with croup.

What is happening and what to do? Press play here to listen to our latest podcast:

Julie Kardos, MD and Naline Lai, MD

About gender identity: when your boy says he is a girl or your girl says she is a boy

The news is filled with stories about boys wearing pink nail polish, a baby whose gender will be kept a secret by his/her parents, and Chaz Bono’s new book and identity as a man. What’s the deal with gender, and why have the media waves exploded in the past few years? Is gender variance becoming more common, or just more recognized? And what should you do if your son wants to wear pink or your daughter cuts her hair short?

First, some definitions.

–Gender is one’s internal sense of self as male, female, or neither, while sex is assigned at birth based on external appearance. As one astute child told me, “sex is what’s between your legs, while gender is what’s between your ears.”

–Gender expression is how one chooses to portray his or her sex or gender—for example a male child (sex assigned at birth) who feels he is a girl (gender) might still wear boys’ clothing and hairstyles to fit in with peers (gender expression). Or, a female child (sex) feels she is a girl (gender) but prefers to wear boys’ clothing (gender expression) and chooses a gender-neutral name. Her gender expression is masculine.

–Gender variant, gender diverse, and gender nonconforming refer to a child who expresses gender identity or expression that is different than what one expects based on sex. These terms refer to a wide range of children—from the little boy who likes to play with Polly Pocket dolls to the male child who insists he is a girl and wears dresses to school. Some gender variant children will be transgender, which refers to a child who persistently feels the sex assigned at birth is incorrect.

When gender variant children reach puberty, they may become aware of their sexual orientation, or who they are sexually attracted to. They may find that they are attracted to the “opposite gender” and have a straight (heterosexual) orientation, or they may be attracted to the same or any gender, and identify as gay, lesbian, or bisexual. Of course, these labels become especially confusing when discussing gender variant teenagers. For example, is a female-bodied teen who identifies as a man (transgender) and attracted to women heterosexual or homosexual? For this reason, many young people choose to identify as queer, an umbrella term with a positive connotation that conveys many ways of loving people with different bodies and gender expressions.

How common is gender variance?

International epidemiologic studies estimate the prevalence of transgender adults to be anywhere from 1 in 1,000 to 1 in 30,000. That’s a huge range. When you include children who are gender variant but not transgender, the numbers are much higher. For example, Gender Spectrum, an organization that I work with in California, conducts trainings at schools that have identified a gender variant child who is facing bullying or discrimination. To date, they have been invited to nearly every elementary and middle school in their geographic area. Most schools in this area have approximately 100-500 students, so my best estimate of gender variance in my geographic area is 1 in 500.

How do you know if a child is gender variant?

The child tells you. Many of the gender variant children I know recall telling their parents at an early age that they felt different. For example, some transgender boys (i.e. born in a female body, identify as male) I know corrected the adults who tried to call them girls as children, insisting they were boys. One parent recalls her transgender son telling adults “I am a boy now, but when I grow up I will be a mommy.”

Most kids exhibit some sort of gender exploration in their early childhood, and this is a normal part of development. However, a child who is shows gender variance generally makes claims that are early and persistent, and then develops distress when corrected by adults. The “test” becomes when a child is given the freedom to express his/her internal sense of gender. In gender variant children, this distress will be alleviated.

What do you do if this describes your child?

The emerging consensus among experts is to let your child guide you, and to aid your child in his or her gender exploration by working with local resources to create a supporting and accepting environment. In the past, some experts recommended a sort of reparative therapy, for instance removing all “girlish” toys from a boy-bodied child’s home and insisting that he wear only “masculine” clothing. While this may have worked for a short time, the child’s distress often emerged later on, often in puberty, with depression and suicide. In fact, a survey of transgender adults showed that one-third of them had attempted suicide in their life, some as young as age seven or eight. These are good reasons to pay attention to your young child. Research shows that children raised in supportive families have more positive outcomes.

Parents raising gender variant children worry about their safety and acceptance in their schools, neighborhoods, and extended families—and for good reason. Gender variant children are bullied and face discrimination, abuse, and violence at rates much higher than their peers. Often, parents do not agree with each other—as one parent may allow more gender exploration than the other. The child’s gender presentation may not be accepted in churches or within the family’s religious belief. It is imperative that families obtain professional help, especially when there is disagreement between parents on how to support the child. In addition, there are many parents groups and conferences where families can meet each other for mutual support.

If you are concerned about a child in your own life, there are wonderful organizations that can help you.

Resources:

Resources: Gender Spectrum www.genderspectrum.org

Family Acceptance Project http://familyproject.sfsu.edu/

Trans Youth Family Allies http://www.imatyfa.org/

My favorite blogs, articles, and videos about raising Gender Variant Children

Sarah Hoffman’s Parent Blog http://www.sarahhoffmanwriter.com/

A Boy’s Life from the Atlantic http://www.theatlantic.com/magazine/archive/2008/11/a-boy-apos-s-life/7059/

Two Families Grapple with Son’s Gender Identity from NPR http://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences

Transgender Kids recent CNN segment http://www.cnn.com/2011/09/27/health/transgender-kids/index.html

Ilana Sherer, MD

Returning guest blogger Dr. Ilana Sherer is the Director of General Pediatrics of the Child and Adolescent Gender Center at UCSF. She is a recipient of the Chancellors Award for LGBT leadership at UCSF and also of the American Academy of Pediatrics Dyson Child Advocacy Award.

The Hidden Homeless: Children and Families

As a call to service in honor of Martin Luther King Day, we bring you an eye opening child advocacy post from guest blogger Dr. Heidi Román, who works with underserved children and their families in California .

Early in my pediatric residency training I entered the exam room to see a one-year old patient. Her mom blurted out excitedly, “We finally have a place to live.” It turned out that they had been living in motels or with relatives for most of the child’s life. I paused for a moment as I realized that it had never really registered. She had been seen in our clinic for multiple visits, but no one had noticed the changing addresses. No one had asked the questions in a way that allowed her to tell us. They were homeless. This was my wake up call. Since then, I have met many families affected by homelessness. Many hard working families are pushed into poverty and homelessness by loss of a paycheck, foreclosure, or divorce. They are reluctant to talk about it. Children and families are the “hidden” homeless.

While the mainstream media consistently covers the recession, quoting jobs numbers and the like, there is a disturbing new set of data out that doesn’t seem to be getting much press. Last month the The National Center on Family Homelessness released their report on child homelessness entitled “America’s Youngest Outcasts 2010“, and the news is not good. During the time period of the recession (2007-2010) there was a 38% spike in the number of homeless children. Currently, there are 1.6 million homeless children in the United States. Children now make up almost 40% of the homeless population and families with children are the most rapidly growing segment of the homeless population.

That’s a lot of kids and families. And, as children are often not included in homeless statistics, the number is probably higher. Why don’t we hear about it more? Well, homeless families tend to be the invisible segment of the homeless population. They fly under the radar. They move from place to place. They “double up” with friends or relatives for a few months, and then stay in a shelter or motel for a while. They sleep in their car. Parents may not even report that they are homeless to teachers or health care providers for fear of losing their children. There are various reasons that families become homeless. Certainly worsening poverty, due to job loss or changes in welfare programs, is a major cause of housing loss for families. But, domestic violence or parental separation is also very often to blame.

Once families become homeless, it is very difficult to escape. Even if the parents are lucky enough to find a job, it will likely pay only minimum wage. Adequate housing is still out of reach for these families. This is true regardless of the state, city, or town the family lives in; and the gap between income and housing costs is even greater in areas with a high cost of living.

Experiencing homelessness profoundly affects a child’s physical, psychological, and educational health. Homeless children have higher incidence of trauma-related injuries, poorly controlled asthma, developmental delays, growth problems, and anemia, among other health problems. Homeless children are far less likely to have a medical home or adequate health insurance. They are far more likely to utilize the ER for care at a later stage of illness. Homeless adolescents have much higher risk of being victims of violence or sexual abuse and have higher rates of substance use, HIV, and teen pregnancy.

Homeless children, regardless of cognitive ability, do far worse in school. They are more likely to change schools during the year or miss more school days, greatly affecting their ability to do well academically and flourish socially. Even simple things, like being asked by a teacher to draw their room or describe their house, become awkward and painful.

What’s being done about this? Sadly, not much. Per the State Report Card on Child Homelessness, only seven states have extensive plans relating to services for homeless families. In the current economic and political climate, the number of homeless children and families continues to increase and the services provided to them are shrinking.

What can we do?

If you or someone you know is at risk of homelessness:
- Talk to someone you trust- a physician, teacher, church staff, or social worker. Learn about emergency assistance programs in your area.
- If you will be homeless in a few days or weeks, The National Coalition for the Homeless has a list of things to do. It includes making sure you have a current and available ID, packing a bag of essentials for each family member, and applying for public and transitional housing. Search the Coalition’s directory of homeless advocacy organizations and shelters.

If you are a person who cares about these kids and families:
- Learn about the “hidden homeless” and start talking to friends and colleagues. Work to change misperceptions about homelessness. Find out how your state is doing in terms of providing services to homeless families.
- Consider volunteering with or donating to an organization that fights to end homelessness. National organizations include The National Coalition for the Homeless, The National Law Center on Homelessness and Poverty, and The National Center on Family Homelessness. Find a local organization to work with here or via internet search.
- The National Coalition for the Homeless has a great list of other creative ways to get involved.
- Finally, contact your congressperson and tell them you support H.R. 32 The Homeless Children and Youth Act of 2011. This bi-partisan bill changes the definition of “homeless person” to include certain adolescents and youth that are currently excluded for technical reasons. Their inclusion would allow them to access much needed services. If I can’t convince you, perhaps these kids can. They testified about their experience being homeless at the H.R. 32 hearing on child and youth homelessness, held by the U.S. House of Representatives’ Financial Services Subcommittee on Insurance, Housing, and Community Opportunity last December.

Heidi Román, MD

Heidi Román MD, FAAP is a mother and pediatrician who practices in San Jose, California. She has special interest and experience working with under-served families from diverse racial and socio-economic backgrounds. Dr. Román is a passionate child health advocate who works towards improved health for all kids, both in and out of the clinic. She writes about everything from parenting to policy at mytwohats.wordpress.com.