Healthcare needs

Health behaviors of American parents

School daycare

Many parents need to set a better example of healthy behavior for their children and to remain physically and mentally healthy for the crucial task of child-rearing. Parents with health or unhealthy behavior can affect their ability to care for their children and earn a living. The health of parents has economic consequences for their employers and for the taxpaying public as a whole.

A new study of parents’ health, medical care, and health-related behavior finds that large numbers of parents at all income levels take part in risky behaviors that are harmful to their own health and are likely to harm the health of their children. These behaviors include smoking, heavy drinking, and being overweight and sedentary.

Risky behaviors are most common among parents who are high school dropouts, separated or divorced parents, and those who receive welfare, and are comparatively infrequent among parents who are recently immigrated to the United States.

What are the risky behaviors among parents?

  • One of eight parents is in fair to poor health or has a health limitation of activities.
  • Ill health is equally common among mothers and fathers, but twice as many mothers (23 percent) as fathers (11 percent) have six or more doctors visits per year.
  • Working mothers and fathers tend to be in better health than those who are not employed outside the home.
  • Parent have more stress than physical problems.
  • One in eight (13 percent) and one in 16 fathers (6 percent) sought professional help for emotional problems in the last year.
  • Mothers receiving welfare are five times more likely to experience negative feelings than non-poor mothers, while poor mothers not receiving welfare are three times more likely to report such feelings.
  • Less than half of the mothers (46 percent) or fathers (45 percent) engaged in three of these five preventive habits: Always using seat belts while riding in a car, getting regular exercise, getting 7-8 hours of sleep per night, eating breakfast daily, and avoiding between-meal snacks.

What kind of health care do parents get?

  • Four in ten mothers and six in ten fathers do not have a regular source of care and have not seen a doctor in the past two years or a dentist in the past year.
  • One parent in seven lacks health insurance coverage.
  • Parents without medical insurance and those covered by Medicaid are in worse health than parents with private insurance.
  • A majority of parents, regardless of income level, report that during their last checkup, their doctors did not talk to them about important health topics such as diet, drinking, exercise and drug use.
  • For parents who engage in risky health behaviors, encouragement from a doctor or other medical professionals can motivate positive behavioral change.

What are the medical practices should be implemented to help parents?

  • Doctors and clinics should advocate necessary behavior changes when adults become parents.
  • The medical staff should outline the full range of positive health behaviors and encourage those engaged in risky behavior to change.
  • Public health officials’ ability to identify and foster effective ways for behavioral changes are impeded by the large number of adults without insurance coverage.
  • Public health officials should recognize and address the frequently unmet need for psychological care among vulnerable parents who lack health coverage.
  • Public information campaigns should be developed to encourage parents to be healthy role models for their children.

Child Trends – Research Brief (1999). The Healthy Behaviors of American Parents: Implications for Children.

Health care needs of children in the foster care system

What is the health of children who enter the foster care system?

  • Children who enter the foster care system are frequently in very poor health, not only due to the abuse or neglect that triggered their placement away from home, but also because of exposure to poverty, poor prenatal care, prenatal infection, prenatal parental substance abuse, lack of access to health care, parental mental illness, and direct and indirect exposure to family and/or neighborhood violence.
  • Children in foster care have consistently high rates of both physical and mental health and developmental problems, and exhibit more psychological and behavioral problems than children with similar backgrounds who have remained out of the foster care system.
  • Children placed in relative or kinship care are also at risk for ongoing health problems. Kinship caregivers tend to be older, less educated, less financially stable and in poorer health than nonrelative foster parents. When this placement is undertaken informally (e.g., no court involvement and no legal transfer of custody), the health, social and financial supports and oversight that the family receives are most likely inadequate.
  • Psychological and emotional problems can worsen during foster or relative care for some children.

What are the barriers to receiving health and mental health care for children in foster care?

  • Many agencies lack policies regarding health care in foster placements.
  • Foster care workers rely on foster parents to tend to the child’s health care needs, even when they have not been authorized to give legal consent for treatment.
  • Frequent moves among foster homes contribute to a lack of continuity and/or absence of health care.
  • Many health care providers, child protection workers, foster care workers and mental health professionals have little or no training on the health care issues of foster children.
  • The complexity of the individual child’s situation requires extra time and attention by health care providers who receive little reimbursement for their efforts.
  • Health care providers frequently have difficulty communicating with the rigid child welfare system and the Medicaid funding system.
  • What is needed to support the health care needs of children in foster care?
  • Integration of needs. Physical and social services must be viewed as one component of the larger cluster of economic and primary supports provided to families and in particular to foster care providers.
  • Integrate health care plans into child welfare plans.
  • Home visit models. Home health visiting services and the “well-baby” services provided by health practitioners or the family’s primary care physician are necessary to address health concerns and developmental problems in out-of-home placement.
  • Home health visiting services can be linked to a clinic, physician or social service agency and can monitor health problems, detect social problems, and link parents and foster parents with local health clinics.
  • Home health visits to foster care placements – both relative and nonrelatives – can improve children’s health.
  • Medical home. Identify a medical home for each child in the foster care system, thus providing care and reducing fragmentation of care.
  • Mandatory health and well-being assessment. Children new to the foster care system should have a comprehensive health, mental health and developmental assessment within 30 to 60 days of placement, including screenings for diseases and conditions related to poverty and abuse and using standardized measures.
  • Centralize foster child health records.
  • Develop and maintain a system of “health passports” containing essential health information for each child. The British model of child development and health record is excellent. The plan should be updated after each health encounter, or periodic review, and communicated to the child, the child’s parents, the caregiver and others needing the information.
  • Research models of the impact of foster care health education programs and the impact of specific health interventions on the well-being of children in foster care.


British Profiles of Child Assessment and Care Records. England.

Shonkoff, J. P. & Meisels, S. (Eds.) (2000). Handbook of early childhood intervention. (Second edition). New

York: Cambridge University Press.

Simms, M.D., Dubowitz, H., & Szilagyi, M.A. (2000). Health care needs of children in the foster care system. Pediatrics, 106(4), 909-918.

What is the Healthy Child Care America Project?

The American Academy of Pediatrics and the U.S. Department of Health and Human Services have joined in a campaign called Healthy Child Care America, intended to bring together families and child care providers in an effort to make it easier for parents to find and use health services, and to make childcare settings safer and healthier.

What can communities do to promote safe and healthy child care?

Healthy Child Care America suggests these 10 steps to quality child care:

  • Promote safe, healthy, and developmentally appropriate environments for all children in child care.
  • Increase immunization rates and preventive services for children in child care.
  • Help families access key public and private health and social service programs.
  • Promote and increase comprehensive access to health screenings.
  • Conduct health and safety education and promotion programs for children, families and child care providers.
  • Strengthen and improve nutrition services in child care.
  • Provide training and ongoing consultation in social and emotional health to child care providers and families.
  • Expand and provide ongoing support to child care providers and families caring for children with special needs.
  • Use child care health consultants to help develop and maintain healthy child care.
  • Assess and promote the health, training and work environment of child care providers.

What was learned about the mental and behavioral problems of uninsured and insured children receiving primary care?

  • About 14% of children in the United States are uninsured.
  • Uninsured children are less likely to have access to health care or a regular source of health care.
  • Little is known about the mental and behavioral health of uninsured children.
  • This significant study examined the management of child psychosocial problems in primary care practices for 24,183 children seen by 401 clinicians in all 50 states, the Commonwealth of Puerto Rico, and six Canadian provinces.
  • Source of study data. Each clinician provided information on a consecutive sample of 55 children ages 4 through 15. The study was limited to those children who came from practices with three or more uninsured children, resulting in a sample size of 13,401. Ninety-three percent were insured (n = 12,518) while 7% were uninsured (n = 883).
  • Measures used. Measurements included insurance status, reason for visit, clinician identification of a psychosocial problem, amount of time spent with patient, whether counseling or psychotropic medication was provided, whether a referral was made for mental health treatment. Parents filled out the Pediatric Symptom Checklist, a brief symptom checklist for primary care, and the Family Apgar Scale, a family-functioning measure assessing adult satisfaction with family support.


  • Uninsured children more likely to be Hispanic
  • Uninsured children more likely to have parents with less education.
  • Uninsured children tend to have poor to fair health, poor to fair grades, and more psychosocial problems reported by their parents.
  • Uninsured children less likely to have well-child visits.
  • There were no significant differences in percent, severity or treatment of patients with psychosocial problems identified by doctors for the insured and uninsured groups, even among those referrals where such a difference was expected.
  • These results suggest that visit rates to primary care providers and mental health professionals may differ between insured and uninsured children because of differences in access, but that once a child has achieved access, treatment outcomes might be similar.
  • However, parents of uninsured children tended to report significantly more behavioral problems in their children than did doctors. Perhaps doctors tend not to recognize some problems in uninsured children; perhaps these children have fewer clinician visits – especially well-child visits — and therefore a clinician’s sense of responsibility for the well-being of these patients is less well developed.


  • Among children served in primary care settings, uninsured and insured children have similar clinician-identified psychosocial and mental health problems, and these problems are treated similarly in the practice setting.
  • Improving access to continuous care to uninsured children, by providing them with insurance, will improve the likelihood of clinician recognition of psychosocial problems.


McInerny, T.K., Szilagyi, P.G., Childs, G.E., Wasserman, R.C., & Kelleher, K.J. (2000). Uninsured children with psychosocial problems: Primary care management. Pediatrics, 106(4), 930-936.