Minnesota Title V MCH Needs Assessment Fact Sheets

Children with Special Health Needs

Knowledge of Child Development

Summer 2004

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Size of the Problem

In 2002, Minnesota had approximately 318,995[1] children under the age of 5 - each having at least one parent or guardian in their life.

The young child grows faster in the first three years than he or she ever will again. People (especially parents and other caregivers) are the essence of the infant's environment, and their protection, nurturing, and stimulation shape early development. Yet, m any parents are confused about how to help their children develop.

Most parents view the pediatric health care system as meeting the physical health needs of their young children. Parents want more information and support on child-rearing concerns, yet pediatric clinicians often fail to discuss non-medical questions with them.[2] Parents of children who are at risk for developmental, behavioral or social delays are significantly less likely to receive guidance with child-rearing concerns than parents whose children are not at increased risk.[3]

There is a correlation between child health status and parental frustration with the child's behavior. Parents of children in poorer health experience a greater degree of frustration than parent's whose children are in very good or excellent health. The presence of developmental risk factors is also correlated with parental frustration. Parents of children with risk factors linked to developmental problems report greater frustration with their children's behavior than parents of children without such risk factors.

Seriousness

Parent frustration and lack of understanding of child development are risk factors for child abuse and neglect. Parental frustration is associated with a greater inclination to use aversive discipline. For example, almost three times as many parents who reported being frequently frustrated also spanked frequently compared with parents who reported infrequent frustration.[4] Lack of parenting skills, unrealistic expectations about a child's capabilities, uncertainty on how to manage difficult behavior and of lack of understanding of child development increase the risk for child abuse.[5] Experiences of abuse and neglect can literally cause some genetically normal children to become developmentally delayed or to develop serious emotional difficulties leading to high costs to the family and society as a whole (health care, remedial education, out-of-home placement, incarceration).

Fostering the optimal development of a child is primarily a parental responsibility. Infant/child brain development depends largely on nutritional, medical, emotional, and intellectual support from his or her parents, extended family, and community. Parents of children with special health care needs cannot necessarily depend upon informal sources of information regarding child development. Nor can they necessarily depend on formal sources that may have been designed with the typically developing child in mind. Lack of information development given a particular diagnosis or condition will impede a parents' ability to foster the optimal development of their child with a special health care needs.

Interventions

Research shows that early childhood education significantly improves the scholastic success and educational achievements of poor children even into early adulthood. Moreover, high-quality, targeted interventions, such as preschool and home visiting programs, save money by preventing future expenses for remedial education, incarceration, and cash assistance .[6]

One of the most successful interventions for improving both maternal and child outcomes is the Nurse Home Visitation Program, designed by Dr. David Olds. During the home visits, the nurses covered topics ranging from personal health habits (e.g., reducing cigarette and drug use, adequate diet), to parenting behaviors (e.g., emphasizing sensitivity and responsivity), to home safety. Results of the study indicated significant differences in the level of child maltreatment and child cognitive developmental outcomes based on receiving a nurse home visitation intervention. Reviews of randomized trials of other home visitation programs indicate that, to produce comparable effects, the interventions must include all the elements that are part of this particular model, including the use of nurses rather than paraprofessionals.[7][8]

Head Start is a full-service program for preschool children and their families. Head Start primarily serves three and four year olds from low-income families. Some agencies also provide a program for infants, toddlers and pregnant mothers. All local Head Start programs must reserve space (at least 10%) for children with disabilities.

The overall goal of Head Start is to help young children be ready for school. Research has shown the lasting benefits of Head Start. Head Start works to strengthen all the influences on the child's development. Children learn through planned activities. Head Start services include education, health, nutrition, mental health and social services.

Early Head Start programs are designed to reinforce and respond to the unique strengths and needs of each child and family. Services include quality early education in and out of the home; home visits; parent education, including parent-child activities; comprehensive health services, including services to women before, during and after pregnancy; nutrition; and case management and peer support groups for parents.

The Early Learning Programs such as School Readiness, Early Childhood Family Education) and Early Childhood Screening) are geared to promoting children's healthy development and supporting their families during these formative years in preparation for school entrance.

The major risks to children's health and development, particularly after infancy, are largely preventable. The leading cause of death for children over age 1 is injury, including motor vehicle accidents, firearms, and drowning. Well-child care (or health supervision) provides a vehicle (Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents) for health professionals to promote healthy lifestyle choices, monitor children for physical and behavioral pathology, and provide age appropriate and individualized counseling (or anticipatory guidance).[9]

Status

Parental interest in information regarding child development has been demonstrated through the distribution of an average of 21,000 Developmental Wheels every three months. Developmental Wheels describe typical developmental expectations and provides preventive health information.

Early childhood parent education resources have been on the decline in recent years while interest and research across the state and nation.

Ready 4 K, BUILD, Foundation Early Care Initiatives and others have all increased awareness of and garnered support for early childhood care and education.

Thirty-six Local Public Health Agencies have identified parenting skills as a priority.

In recent years, Public Health Home Visiting Programs, Early Childhood Family Education, School Readiness, and Early Childhood Screening Programs are experiencing financial pressures. The impact upon programs serving young children with special health needs is unclear.


1. US Bureau of the Census. 2002 Population estimates. www.census.gov. [Attn: Non-MDH Link]
2. Taaffe Young, K., Davis, K., et al. "Listening to Parents A National Survey of Parents with Young Children". Archives of Pediatric and Adolescent Medicine, Vol 152: 255-262. March 1998.
3. Bethell, C., et al. "Measuring Quality of Preventive and Developmental Services for Young Children: National Estimates and Patterns of Clinicians' Performance". Pediatrics, Jun 2004; 113: 1973-1983.
4. Regalado, M et al. "Parents' Discipline of Young Children: Results From the National Survey of Early Childhood Health". Pediatrics, Jun 2004; 113: 1952 - 1958.
5. Bethea, L. "Primary Prevention of Child Abuse". American Family Physician. March 15, 1999. www.aafp.org. [Attn: Non-MDH Link] Accessed 8/13/04.
6. Ross A. Thompson, "Development in the First Years of Life", The Future of Children: Caring for Infants and Toddlers, Vol. 11, Number l The David and Lucile Packard Foundation, 2001
7. Korfmacher J, O'Brien R, Hiatt S, Olds D, "Public Health Home Visiting Differences in program implementation between nurses and paraprofessionals providing home visits during pregnancy and infancy: a randomized trial." Am J Public Health. 1999 Dec; 89 (12): 1847-51.
8. Olds DL, Henderson CR Jr, Phelps C, Kitzman H, Hanks C., "Effect of prenatal and infancy nurse home visitation on government spending." Med Care. 1993 Feb; 31(2): 155-74.
9. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents