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Children who live in poor families face profound challenges to their health, development, and educational achievement. These challenges lead to increased rates of illness, developmental delays, 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, the effects of poverty can be offset by individual, family, community, and professional buffering factors that offer both protection and support. Pediatricians are in a prime position to screen for poverty-related complications and offer support through appropriate community referrals in order to mitigate the long-term detrimental consequences of poverty


The federal poverty level (FPL) is derived from 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 with two children in 2015 was $24,036 or less. The level was adjusted for size of household but not for regional variations in cost of living or actual expenditures and income. The 2014 Census data reported that 15.5 million children under the age of 18, or 21.1% of all US children, were considered to reside in “poor” households (ie, those with incomes below 100% of the FPL). Children living in “deep poverty” (50% of the FPL) numbered 6.8 million, or 9.3% of children in the United States. Even families whose incomes are twice the federal poverty level have trouble making ends meet. Thirty-one million children live in such “low-income” families. Poverty disproportionally affects children of color: 33% of all black children (3.6 million), 27% of all Latino children (4 million), and 40% of American Indian children (200,000) live in poverty, as compared to 10% of white children (4.2 million). Poverty may be cyclical for families, a brief experience, or a prolonged state, and as a result, about 37% of US children will experience poverty at some point during their childhood.


The concept of “poverty” encompasses insufficient income and the range of conditions that poor families endure. 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 is. This may be mediated through social marginalization, or 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, substance use disorders, or other chronic conditions, and local economic stagnation or systemic racism may limit their access to educational opportunities, quality healthcare, and better jobs, leading to multigenerational poverty.

Families in such variable settings experience ...

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