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AAP: Medical home integral to reduce harms of poverty, toxic stress among children

SAN DIEGO — AAP president James M. Perrin, MD, FAAP, emphasized the importance of the medical home and how comprehensive care can alleviate two significant threats to the promise of a child — toxic stress and poverty — during his address at the 2014 AAP National Conference and Exhibition.

“We know that poverty blunts the promise of a child, and that programs and policies can really make a difference,” Perrin said. “One reason our country has not made more progress is that our interventions often come too late. If there is one overarching theme from the past few decades of research about how to break the cycle of poverty in the United States, it’s the power of parenting and intervening early, ideally in the first year or two of life, or even before a child is born.”

James M. Perrin

The AAP is working to level the playing field among children of all backgrounds by finding new payment arrangements and using new technologies to benefit patient care. These efforts have the potential to improve functionality of school-based health centers and other outpatient programs, which may be some children’s only source of health care, and advance telemedicine practices, which can serve as an extension of care for all children.

“When it comes to making sure children get the care and caring they need, there is no place like a medical home, with its teams and systems that establish relationships with parents and provide care for the whole child,” Perrin said.

The AAP is expanding programs like Women, Infants and Children (WIC) and a Supplemental Nutrition Assistants Program (SNAP), advocating for new school lunch standards and improving health care access and coverage through the Children’s Health Insurance Program (CHIP) and the Affordable Care Act.

In addition to limiting health care access, poverty significantly affects a child’s learning abilities and as a result, their opportunities to become successful members of society. The greatest inequality in the United States, according to Perrin, is not wealth, but opportunity.

“By age 4, children in higher income families tend to have heard 30 million more words than children in less affluent families. If not addressed, this word gap leads to an achievement gap that can have lifelong consequences,” Perrin said.

The AAP is working in collaboration with Too Small to Fail, Reach Out and Read and the Scholastic Corporation to give caregivers and physicians the tools they need to promote reading out loud to children every day.

“Investing in children does pay off both in the short term and in the long term. Having healthy children makes parents more productive and perform better in the workforce. Investing in children has economic return, [and results in] less infectious disease, lower rates of disease and more young people growing up to be productive in the workforce,” Perrin said. — by Amanda Oldt

For more information:

Perrin JM. P1075. Presented at: The 2014 AAP National Conference and Exhibition; Oct. 11-14; San Diego.