According to the U.S. Census Bureau, an estimated 39.7 million Americans lived in poverty in 2017 (15). Based on this measure, the official poverty rate in the U.S. was near 14 percent overall (15). For children, almost half in the U.S. are living in or near poverty (1). When compared to adults, 1 in 5 live in poverty, versus 1 in 8 of adults, which translates to 15.5 million impoverished kids in the U.S. (2). Poverty is defined as making less than 100% of the Federal Poverty Level (FPL), as determined by the Census Bureau (14). For instance, the poverty threshold for the U.S. in 2018 was $20,780 for a family of three, and adding $4,320 for each additional person in the family after that (16). Extreme poverty describes those who earn less than 50% of the FPL, and low-income refers to those who make less than 200% of the FPL (16). For the purpose of this paper, we will discuss children living in low-income families as well as poverty, since both experiences introduce adverse childhood experiences, toxic stress, and health disparities (1).
Those typically living in poverty tend to be marginalized groups in society. For example, African American, Hispanic, and American Indian/Alaska Native children are 3 times more likely to live in poverty than are white and Asian children (1). Poverty is also higher for families headed by lone female parents, immigrant, families with disabled children and Aboriginal families (5). The prevalence of low income is higher among families with children of all age, but it is particularly higher among families with young children (5). For instance, the child poverty rate of children younger than 6 years in the United States was 24% in 2017, compared with 20% for all children younger than 18 years (10).
On average, children living in low-income families or neighborhoods have poorer health outcomes (5). Poverty can have profound effects on specific circumstances such a birth weight, infant mortality, language development, chronic illness, environmental exposure, and nutrition (1). Living in poverty can affect a child’s psychological development and ability to learn, and contribute to social, emotional and behavioral problems (5). Children and teens in poverty are also at greater risk for several negative outcomes such as poor academic achievement, abuse and neglect, development of unhealthy lifestyles (i.e. substance abuse, poor eating and exercise habits), and are more likely to face persistent socioeconomic inequalities themselves (9).
Numerous studies have demonstrated that poverty is associated with higher rates of poor health and chronic health conditions in children (7). For example, 4 to 5 million children, vast majority of whom are poor, reside in older homes with lead levels exceeding the accepted threshold for safety (7). More than 1.5 million of these children (tend to be younger than 6 years) have elevated blood lead levels (7). Poor kids are also more two times more likely to experience poor nutrition, which can be manifested by either an inadequate amount of food leading to food insecurity and hunger, or the lack of access to healthy foods (i.e., food deserts) and public areas for play (i.e., parks), which can lead to childhood obesity, and different forms of cardiovascular disease in adulthood (9). Poor kids are more likely to experience hunger and food insecurity, which can have lifelong effects such as lower reading and math scores, more physical and mental health problems, and more emotional and behavioral problems (2).
Living in poverty poses many stressors on the family and children. An excessive and prolonged exposure to toxic stress influences genomic function and brain development of circuitry and other important regulatory systems which can influence physiology, behavior, and health decades later (1). Some behavioral problems may include anxiety, depression, aggression, low self-esteem, attention-deficit hyperactivity disorder (ADHD), conduct disorder, impulsiveness, and difficulty getting along with peers (9). Early experiences with significant stress are critical because they can undermine the development of adaptive coping skills needed to deal with later challenges, cause maladaptive patterns instead, are the root of unhealthy lifestyles, and lead a higher likelihood of fragmented social networks (1).
Children who live in poverty tend to have a lower academic achievement than those who do not live in poverty. According to the National Center for Education Statistics, the dropout rate of students living in low-income families was 4.5 times greater than the rate of children from higher-income families (8.7 percent versus 2.0 percent) in 2016 (9). Overall brain functioning in children of lower SES is also lower than those of higher SES. In a study done by (7), children who live in poor families are 6 to 13 IQ score points lower, where variables were controlled for maternal age, parental marital status, education level and ethnicity (7). Further, schools with less resources tend to be in poorer communities and often struggle to meet the learning needs of their students and struggle to aid them in fulfilling their potential (9).
A major influence on family child poverty in the U.S. is the undersupply of the labor market. The conditions of the labor market are closely tied to poverty (12). The availability of jobs, and wages for less skilled workers is a key determinant of poverty (12). As of 2017, wages for lower income groups are reported to be falling (12). The labor market is very limited for parents who have not completed their education, resulting in low wages and less options for work for less skilled workers. According to (2), 86% of kids whose parents have less than a high school diploma live in low-income families, while 67% of kids who parents have a high school degree but no college education live in poverty, compared with less than a third (30%) of kids in poverty having at least one parent with some college or additional education (2). Because of lack of social mobility in the U.S, poor children tend to remain poor and live in neighborhoods of low opportunity (1). Wealthy children continue to be wealthy as adults and enjoy academic and employment advantages (1). The result is a dramatic decline of the possibility of economic improvement for the poor (1).
Another driving factor for child poverty is the cost of childcare. The rate of child poverty is 24% for children from age 0 to 6, compared with 20% for children 6 to 18 years old (10). Early childcare may cost as much as housing in most areas of the United States, accounting for 25% of the budget of a family with 2 children, and infant care can cost as much as college (1). Working families who do not have sufficient income to pay taxes are not eligible for financial support, and therefore some of the most at-risk children who might benefit from high-quality early education do not have access (1).
A guideline to the federal poverty line depends strongly on household size and composition. For instance, as of 2018 the FPL for a family/household of 3 people is $20,780, while a household of 4 is $25,100, and $29,420 for a family size of 5 people (16). Household composition also matters. Single-parent households have especially higher risks of poverty because of conflicts between parenting and market work (10). In addition, a full-time job from just one parent may not be enough to pull one’s family out of poverty (10). In contrast, children who live with two parents are 32% less likely to be poor or low income compared to children who live with one parent or neither parent (4).
In order to protect the health and welfare of children of poverty in the U.S., it is important to provide protective factors for the neural, social, and educational development of children. Quality childcare and early childhood education are extremely important in developing the cognitive and socio-emotional development of infants and toddlers (1). Several rich nations, such as Scandinavia, show that income support and work-enabling policies, like public childcare, can foster labor market participation (10). Countries like Scandinavia have strong parental work aids, universal subsidized childcare and family leave, and also strong and deep income support for children (10). The U.S. public expenditure on early childhood educational services was just 0.3% compared to 0.7% in Sweden and France (1). Early prevention can offset significant amount of health problems likely to occur in the future without it.
Governmental programs that help poor families have been shown to cut family poverty almost in half, from an estimated 31% to approximately 16% (1). Government interventions through well-designed income supports (cash transfers), but also tax systems and service provision can contribute to the efforts of those who cannot be supported through work alone, while still maintaining incentives for greater work effort (10). Collaborators with health care organizations may include education systems, social services, faith-based groups, and community development organizations (1).
It is also important to identify and build on family strengths and protective factors. Research suggests that noncognitive skills, such as perseverance, empathy and self-efficacy during adolescence can build on the cognitive skills developed during early childhood (1). Interventions such as adolescent mentoring, residential training, and apprenticeship programs can increase academic achievement, employment success, and other nonacademic accomplishments over the life span (1). In addition, the buffering protection afforded by stable, responsive relationships that help children develop a sense of safety, and help to restore their stress response back to baseline (3).
Child poverty is multidimensional: income from work, family composition, and government support either allieviate or reinforce child poverty levels (10). It is important to support and expand strategies that promote employment and that increase parental income (1). Programs that increase low-income parents’ earning have been shown to improve child outcomes (1). Support policies that help parents increase family income, including higher minimum wages, education and job-training programs, the earned income tax credit (EITC), the child tax credit, and child and dependent care tax credit (1). However, if not enough adults are working enough hours in the household or if wages are too low, work alone might be insufficient (10). In which case, support for policy measures that improve community infrastructure, including affordable housing and public spaces to ensure that all children have safe outdoor play areas as well as healthy, safe, and affordable housing (1).