Pediatric guidelines now urge holistic health and wellbeing checks

New guidelines from the American Academy of Pediatrics released Wednesday recommend that, during routine checkups, physicians also screen children for signs of poverty. The move is part of a larger effort to improve mental health and physical development in adolescents. Hari Sreenivasan talks to Dr. Renee Jenkins, former president of the American Academy of Pediatrics, for more.

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    Finally, new guidelines are out today from the American Academy of Pediatrics. They recommend that, during routine checkups, physicians also screen children for poverty.

    Hari Sreenivasan has that.


    Census figures show one in five children in the country lives in poverty, which can contribute to higher rates of asthma and obesity, poor language development, and increased infant mortality.

    The new guidelines encourage doctors to ask patients about basic needs, such as food, heat and housing during well-child visits, and to help them connect with community resources that might be of help.

    Dr. Renee Jenkins is a former president of the American Academy of Pediatrics who currently teaches at Howard University Medical School, and joins me now.

    Dr. Jenkins, what does it mean to screen for poverty?

    DR. RENEE JENKINS, Former President, American Academy of Pediatrics: So, there are now tools that help us in the office when we do well-checks to really ask parents about food insecurity, housing insecurity, whether their young children are in childhood educational situations, like Head Start or Early Head Start, because we recognize that if we can intervene early on, very often, we can make a difference.


    Now, I know people are very comfortable sharing confidential information with their doctors, but how do you start this conversation, and do people open up to you about it?



    Generally, we start with something very broad, like, do you have any problem making ends meet, OK, and does this happen often or does it just happen sometimes?

    And then that opens up a conversation about what some of the issues might be. And I think we are trying to — what we're recommending is that we screen everyone. We ask an very open-ended question like that and then we see where that takes us.

    I'm sure some people are going to be uncomfortable to start to do that, but I think once patients understand that, each time I come, they're going to ask me something like that, because it's a common problem. And as you mentioned, you know, one in five children is living if poverty.

    And if it weren't for the safety programs, safety net programs that we have, it would be even more children. So we're just trying to connect parents to the safety net programs.


    So, how solid are the links between poverty and adverse health outcomes? What does the research show?


    The research shows that there really are.

    We have known for quite a long time about the relationship, for example, with asthma and poor housing, OK? We have also known about nutrition and how, when you're poor, you tend to buy cheaper foods. Healthy foods are pretty expensive. And so in order to make the food last for the entire month, you have got to do that.

    So we have always known that. But there is new information now about the stressors that children go through when they're in poverty and how these stressors do handicap them in terms of their developmental milestones.


    Now, you're also talking about longer-term issues.

    From the report, you talk about gene expression, brain function, language development and possible leads to psychiatric disorder. All of that comes from childhood poverty?


    Well, poverty certainly contributes to it.

    But when you take the big picture and you look at what's happening within the neighborhood that these poor children may live in and those kind of safe — unsafe issues, as well as the stressor on parents, parents, you know, want to provide the best for their children. And when they can't, that's stressful for them, also.

    Very often, there are not the same sort of ways that we relax when you are someone who has resources. People who are poor can't do that. And so they don't have ways to necessarily relieve the stresses that are associated with their living conditions.

    So we have got stressed parents, and obviously, it impact the child.


    Now, what you're describing is a much greater role for a pediatrician to play now. It's almost like they're doing some of the things that a social worker traditionally does in connecting needs with resources.


    That's true, but I think now there are — there is more availability.

    We have the Internet, where there are lots of resources. We have Web sites. There are 800-phone numbers, and so the recommendations are not to try to tackle all of it. OK? What we want people to do is, where is your comfort level? Is your comfort level the nutrition, so you can get your patients connected with the WIC program, Women, Infant and Children, or with the food stamp program?

    Or is your comfort level housing, so that you can refer someone to a resource for that? So, we're not asking people to do it all, but we're saying, you know, we can make a difference, we can start small, and, you know, here are some guidelines and here are some screening tools that you can use to do that.


    All right, Dr. Renee Jenkins, thanks so much.


    You're quite welcome. Thank you.

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