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Children who live in poor families face pervasive challenges to their health and development. These challenges result in increased rates of illness, developmental delay, behavioral problems, school failure, and social dysfunction. Poverty, adverse exposures, and unmet basic needs amplify the impact of biological vulnerabilities on the child. However, as with other threats to health and development, poverty’s effects can be offset by individual, family, community, and professional buffering factors that offer both protection and support.

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The official poverty level is based on the estimated cost of food multiplied by 3; this is based on the assumption that food accounts for one third of a family’s income after taxes, which for a family of four is $20,650 or less. The level is adjusted for size of household but not for regional variations in cost of living or actual expenditures and income.1 Estimates from the National Center for Children in Poverty at Columbia estimate that 13 million children lived in poverty in 2006, an increase of 1.2 million children just since 2000. Contrary to stereotypes, almost two thirds of poor children have parents who work, and over one half of poor children live in the suburbs or in rural areas. There are enormous racial disparities in poverty: a greater proportion of African American and Latino children live in poverty (ie, 33% of all African American children and 27% of all Hispanic children live in poverty, versus 10% of white children), but in absolute real numbers there are more poor white than poor African American or Latino children. However, families whose incomes are even twice the federal poverty level have trouble making ends meet. Twenty-eight million children live in such “low-income” families.2

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The concept of “poverty” encompasses insufficient income and the range of conditions that poor families endure.3,4 Poverty’s impact varies, depending on whether it is normative within a given society; urban or rural; brief, intermittent, or chronic; relative; or at a level that compromises physical survival. Income inequality is now thought to be a more sensitive indicator of health problems than mean income. This may be mediated through social marginalization, the end product of the experience of social inequalities such as poor schools, poor health services, and poor homes. Some US families may have members who are disabled by mental illness, alcoholism, or other chronic conditions, and local economic stagnation or racism may limit their access to educational opportunities, quality health care, and better jobs, leading to multigenerational poverty.

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Families in such variable settings experience different social environments and have different expectations for themselves and their children. For example, families who fall under the poverty level for shorter periods because of transient unemployment may have more economic and psychological reserves with which to endure its effects than families who have been in poverty for several generations. Families living in urban poverty have increased exposure to lead, violence, household allergens, and airborne pollutants, while rural families ...

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