Although good medical care is essential in promoting a child's developmental health, it is not the only factor.
Social determinants of health (SDOH) —including nutrition, neighborhood and physical environment, education, and stress — also have significant impacts on clinical outcomes.
Unfortunately, poverty can have a negative effect on all of these factors and is a major cause of children failing to reach their full developmental potential.
In this article:
What is poverty?
In the United States, poverty is defined as having a household income below the U.S. Poverty Threshold, which changes based on household size. The Poverty Thresholds are released by the US Census Bureau in September of every year.
As of September 2022, the Poverty Thresholds were as follows:
Poverty Thresholds by Size of Family and Number of Related Children Under 18 Years Old: 2021 (in US dollars)
Source: U.S. Census Bureau
Today, 1 in 7 children (11.6 million people) live in poverty in the US. (Shrider et al. 2021) The largest groups experiencing poverty include the Latinx and Black communities. (Parolin et al. 2022).
Discussions of the impacts of poverty may also refer to an individual's socioeconomic status (SES), which includes factors such as income, education, place of residence, and occupation. Poverty and low SES are not the same things, but we will use them interchangeably for the purposes of this article.
What is Child Development?
Child development is the order and process of change in a child’s body, mind, speech, language, and emotion beginning from birth to adulthood (Kid Sense, 2019). Poverty significantly impacts these aspects of childhood development.
The physical effects of poverty
Impact of poverty during pregnancy and after birth
The effects of poverty on a child start before they are even born.
Low socioeconomic status (SES) mothers face numerous disadvantages due to their SES that play a large part in infant birth, including lack of hospital access, poor underlying maternal health, and exposure to environmental toxins.
As a result, women living in poverty face higher risks of miscarriage and stillbirth, and their children have higher rates of intrauterine growth restriction and premature birth, which can contribute to low birth weights.
After birth, these children have higher hospitalization rates, higher rates of disability diagnoses, and more severe disability diagnoses.
Impact of poverty on housing and neighborhood environments
Children from low-income households are more likely to live in communities that lack access to many of the resources that contribute to child development.
For example, they are more likely to live in neighborhoods that:
lack emergency care, curative care, and preventative care
have few or no convenient options for affordably buying healthy foods (known as "food deserts"), forcing residents to rely more on fast food and processed foods
Within the home, children in low SES households, especially those who live in housing built before 1978 (when the federal government banned the sale of lead-based house paint), are at greater risk of lead exposure. Exposure to lead is particularly dangerous for children, whose bodies absorb more lead and whose developing brains are more easily damaged. Moreover, very young children are more likely to put toys, objects, and hands in their mouths and accidentally ingest lead dust.
Ingesting even small amounts of lead can lead to:
Behavior and learning problems
Hyperactivity
Slowed growth
Hearing Problems
Anemia
Ingesting lead can even cause seizures and death.
Impact of poverty on food security and nutrition
Insufficient food is a major cause of developmental issues.
At the end of 2019, one in ten U.S. households was classified as food insecure, meaning they did not have “enough food for an active, healthy life for all household members” (Coleman Jensen et al. 2021).
The overall prevalence of food insecurity was higher in Black family households, one of the largest groups experiencing poverty (Coleman-Jensen et al. 2021).
Children with low SES have higher rates of iron, iodine, zinc, and protein deficiencies. This likely results from a combination of poverty, lack of access to healthier foods (see our mention of food deserts, above), and a lack of parent education about the importance to child health of eating a variety of micronutrient-rich foods.
These nutrient deficiencies impact both children’s overall energy levels and the functioning of their immune system, which protects against disease. (Coleman-Jensen et al. 2021)
Due to decreased energy, children with low SES tend to move less than children of average or higher SES, which means that they are less likely to exhibit higher levels of gross motor skills than physically active children.
Gross motor skills refer to larger muscle movements such as those for rolling, crawling, sitting, walking, running, jumping etc.
This lack of gross motor skills has been linked to higher rates of obesity in early childhood and adolescence, which can lead to lifelong health problems. (Hamilton et al. 2016)
Additionally, as a child grows from infancy to young childhood, motor and movement development also play a large impact in their engagement with their environment, which affects their social and cognitive development.
Impact of poverty on sleep
Children with low SES also get less quality sleep. They are less likely to follow a sleep hygiene routine because they have limited access to quiet spaces free of light and noise and limited ability to create consistent sleep routines.
In addition, studies have shown that children of low SES worry more about family, friends, and schoolwork (Bagley et al. 2015), which can negatively impact sleep.
Sleep plays a large part in both physical and mental well-being and development.
According to Dr. Hawkins from Johns Hopkins All Children’s Hospital, “research shows that kids who get adequate sleep have improved attention, behavior, learning, memory, and overall mental and physical health"--all factors that are related to academic success.
On the other hand, Dr. Hawkins states that "those without good sleep are more likely to develop high blood pressure, obesity, and even depression," which can all contribute to a lifetime of health problems.
The effects of poverty on a child's social/emotional and cognitive development
Toxic stress
Poverty and its associated challenges can be one cause of "toxic stress," which describes the prolonged stress that results from serious and ongoing adversity.
Studies have shown that children of low SES demonstrate increased cortisol levels, which means they have increased stress hormones (Lin et al. 2013).
Low SES children even have higher cortisol levels at birth, because their cortisol levels are tied to the cortisol levels of their mothers, who also experience the adverse effects of poverty.
Studies have shown that pregnant women of lower SES have increased cortisol beginning in their first trimester and lasting through birth. (Lin et al. 2013).
Toxic stress can cause a variety of physical, emotional, and cognitive issues for children.
It weakens the architecture of the developing brain, which can lead to lifelong learning, behavior, and physical and mental health problems.
It increases the likelihood that a child will experience depression, substance abuse, and even suicide in their lifetime.
And the cumulative effects can ultimately increase the chance that a person will eventually suffer from diabetes, heart disease, cancer, or other diseases.
Executive functioning skills
Children of low SES also demonstrate diminished executive functioning skills, which can include difficulties with:
Impulse control: Children may have trouble resisting automatic responses to something, such as blurting out an answer or an unruly comment.
Self-monitoring: These are the skills a child uses to understand their own actions and how to adjust them in the future, such as reviewing and fixing mistakes on a homework assignment.
Shifting attention between tasks
Emotional control: This refers to a child’s ability to assess a given situation and respond with a level that matches the level of the situation.
Beginning tasks independently
Processing information, planning, and organizing materials
Working memory: Examples of working memory include memorizing a phone number and following multiple verbal directions.
These executive functioning skills provide the foundation for the skills children need as they transition into adulthood.
Academic achievement
In the area of academic achievement, educational gaps are best measured through a combination of the following:
Parent education level
Parents with college educations tend to have higher incomes than those parents who do not have college educations, placing their children in a higher SES.
Child's race and socioeconomic status
Because race and SES are linked and operate together in informing family social, economic, and cultural contexts, most recent studies look at both factors.
According to the Department of Education, only 45.6% children of low SES enroll in preschool, compared with 60% of higher SES children. And, according to the National Longitudinal Study on Youth and Infant Development project, low SES during a child’s early years has a more powerful influence on the number of grades a child ultimately completes than low SES later in their school years.
This means that children who spend their early years in poverty continue to face academic difficulties as a result, even if their SES improves by the time they are in school.
Students from low-income households are five times more likely to drop out of high school than students from high income households.
In fact, in areas with high poverty, graduation rates approach only 50% of those who started high school. It is estimated that an increase in mean family income of $10,000 during the child’s first 5 years of life results in almost one more full year of schooling.
In addition, studies have shown that early education programs designed to serve low SES children, such as Head Start Programs, offer lower quality instructional support (Reid and Kagan, 2015) that continues to negatively impact students for the rest of their academic careers.
When tested in the fall of kindergarten, students from upper-income families scored significantly higher in math, reading, and science and their progress per month of school increased faster than children in low SES families.
And as children grow older, these gaps in academics only grow larger (Henry et al. 2020).
How can we close these gaps?
Improved medical care both during pregnancy and as children develop
Because child development begins even before a baby is born, we should increase access to higher-quality medical care for both pregnant women and their families.
One way to do this would be to increase the rates that Medicaid (the federal and state program that provides healthcare cost assistance for low-income individuals) pays to providers across the country.
There is no data directly comparing Medicaid to commercial rates, but Medicaid rates can be as much as 30% below Medicare rates (depending on the state), which in turn can be 30-90% lower than commercial rates.
The impact of this rate disparity is significant. Lower Medicaid payments mean that fewer providers are willing to accept Medicaid patients, who are disproportionately Black and Latinx.
Those providers who do accept Medicaid are at a financial disadvantage and may have trouble attracting and retaining highly qualified healthcare professionals and investing in new and innovative technology.
Raising Medicaid rates would permit families who depend on Medicaid to access higher-quality care and create incentives for providers to serve higher-need communities.
High-quality early childhood education
Research shows that educational support must start with high-quality, public-funded early childhood education.
Investment in birth-to-five early childhood education services can help alleviate the negative effects of poverty on child development and adult opportunity. Academic and emotional deficits at the start of primary school are harder to rectify later (Porter, 2013).
Programs specifically targeted towards access to early education in low SES communities, such as Head Start, can help to improve cognitive and achievement outcomes in all students.
However, these programs must be improved to effectively help children of low SES.
One way to improve these programs is to recruit and retain quality educators. This can only be achieved by improving employee working conditions, for instance by ensuring living wages, providing higher resources for educators and for classrooms, and improving student-to-teacher ratios (Morgan, 2019).
The funds to achieve these goals should come from both state and federal government to assure equity across programs.
Other ways that these programs can be improved to better assist low SES children would be to include free food programs for students, provide transportation to increase the number of households that can access programs, and implement family outreach services to gather insights towards diversity and collaboration (Reid and Kagan, 2015).
Access to safe housing
Third, low SES children need access to safe housing. One way to improve access is to improve the Section 8 housing program, also known as the Housing Choice Voucher.
Section 8 housing assistance must increase to match current inflation and provide better access to areas with moderately priced housing in neighborhoods that are considered safe and provide high opportunities for the family, such as access to jobs and higher-quality schools. (Ross, Shlay, and Picon 2012).
In addition, the government should work to eliminate other limitations in Section 8 housing reported by voucher holders, such as discrimination and the lack of access to information about the location of high-quality housing.
Currently, federal law does not mandate that landlords accept Housing Vouchers from tenants, and anti-discrimination laws around Source of Income vary from state to state.
Fixing these issues requires federal and state legislation that mandates higher quality of living standards, requiring landlords to upgrade and continually upgrade housing, which would decrease the amount of environmental toxin exposure faced by low-income children.
Closing thoughts
While there are many factors that contribute to a child’s success, it is evident that poverty has a negative impact on child development.
We must take steps to ensure all children have sufficient access to quality healthcare, housing, and education in order to give them the best chance at a bright future.
These changes will not come about on their own.
We must make protecting the future of our nation’s children a priority by advocating for these policies at the state and federal level.
Reach out to your state and local representatives.
Resources:
Arpey, N. C., Gaglioti, A. H., & Rosenbaum, M. E. (2017). How socioeconomic status affects patient perceptions of health care: a qualitative study. Journal of primary care & community health, 8(3), 169-175.
Bagley EJ, Kelly RJ, Buckhalt JA, El-Sheikh M. What keeps low-SES children from sleeping well: the role of presleep worries and sleep environment. Sleep Med. 2015 Apr;16(4):496-502. doi: 10.1016/j.sleep.2014.10.008. Epub 2014 Dec 16. PMID: 25701537; PMCID: PMC4395518.
Carlson, A. G., Rowe, E., & Curby, T. W. (2013). Disentangling fine motor skills’ relations to academic achievement: The relative contributions of visual-spatial integration and visual-motor coordination. The Journal of genetic psychology, 174(5), 514-533.
Centers for Disease Control and Prevention. (2021, October 29). Populations at higher risk. Centers for Disease Control and Prevention. Retrieved September 3, 2022, from https://www.cdc.gov/nceh/lead/prevention/populations.htm
Child poverty. UNICEF. (2022, March 9). Retrieved August 29, 2022, from https://www.unicef.org/social-policy/child-poverty
Cole CR, Grant FK, Swaby-Ellis ED, Zinc and iron deficiency and their interrelations in low-income African American and Hispanic children in Atlanta. The American Journal of Clinical Nutrition, Volume 91, Issue 4, April 2010, Pages 1027–1034.
Coleman-Jensen, Alisha, Matthew P. Rabbitt, Christian A. Gregory, and Anita Singh. Statistical supplement to household food security in the United States in 2020. No. 1962-2021-2625. 2021.
Dawkins, R. The importance of sleep for kids. The Importance of Sleep for Kids - Johns Hopkins All Children's Hospital. Retrieved September 2, 2022, from https://www.hopkinsallchildrens.org/ACH-News/General-News/The-importance-of-sleep-for-kids#:~:text=Studies%20have%20shown%20that%20kids,pressure%2C%20obesity%20and%20even%20depression.
Darmon, N., & Drewnowski, A. (2015). Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis. Nutrition reviews, 73(10), 643-660.
Environmental Protection Agency. Lead. available at https://www.epa.gov/lead
Hamilton, M., Liu, T., & ElGarhy, S. (2016). The relationship between body weight and motor skill competence in Hispanic Low-SES preschool children. Early Childhood Education Journal, 4. doi:10.1007/s10643-016-0785-y.
Henry, D. A., Betancur Cortés, L., & Votruba-Drzal, E. (2020). Black–White achievement gaps differ by family socioeconomic status from early childhood through early adolescence. Journal of Educational Psychology, 112(8), 1471.
Hines, C. T., Markowitz, A. J., & Johnson, A. D. (2021). Food insecurity: What are its effects, why, and what can policy do about it?. Policy Insights from the Behavioral and Brain Sciences, 8(2), 127-135.
Kid Sense. (2019). What is Child Development? - Kid Sense Child Development. Kid Sense Child Development. https://childdevelopment.com.au/areas-of-concern/what-is-child-development/
Mann C, Striar A. How Differences in Medicaid, Medicare, and Commercial Health Insurance Payment Rates Impact Access, Health Equity, and Cost. The Commonwealth Fund. available at https://www.commonwealthfund.org/blog/2022/how-differences-medicaid-medicare-and-commercial-health-insurance-payment-rates-impact
Morgan, H. (2019). Does high-quality preschool benefit children? What the research shows. Education sciences, 9(1), 19.
National Center for Education Statistics. Trends in high school dropout and completion rates in the United States: 1972–2009. https://nces.ed.gov/pubs2012/2012006.pdf
Parolin, Z., Curran, M., Matsudaira, J., Waldfogel, J., & Wimer, C. (2022). Estimating Monthly Poverty Rates in the United States. Journal of Policy Analysis and Management.
Porter, E. Investments in Education May Be Misdirected. 2013. Available online: https://www.nytimes. com/2013/04/03/business/studies-highlight-benefit--of-early-education.html (accessed on 1 November 2018).
Reid, J. L., & Kagan, S. L. (2015). A Better Start: Why Classroom Diversity Matters in Early Education. Poverty & Race Research Action Council.
Rogers, R., Eagle, T. F., Sheetz, A., Woodward, A., Leibowitz, R., Song, M., ... & Eagle, K. A. (2015). The relationship between childhood obesity, low socioeconomic status, and race/ethnicity: lessons from Massachusetts. Childhood Obesity, 11(6), 691-695.
Pope, M. L., Liu, T., & Getchell, N. (2011). Object-control skills in Hispanic preschool children enrolled in head start. Perceptual and Motor Skills, 112(1), 193-200.
Shrider, E. A., Kollar, M., Chen, F., & Semega, J. (2021). Income and poverty in the United States: 2020. US Census Bureau, Current Population Reports, (P60-273).
L. J., Lin, B., Coburn, S. S., MacKinnon, D. P., Gonzales, N. A., & Crnic, K. A. (2013). Prenatal stress, partner support, and infant cortisol reactivity in low-income Mexican American families. Psychoneuroendocrinology, 38(12), 3092-3101.
World Health Organization. (n.d.). Universal Health Coverage (UHC). World Health Organization. Retrieved November 9, 2022, from https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
