This month's issue is devoted primarily to pediatrics. The health of many children in the United States remains at risk. According to Health United States, 2006, more often, poverty causes poor health by its connection with inadequate nutrition, substandard housing, exposure to environmental hazards, unhealthy lifestyles, and decreased access to and use of healthcare services.1 According to this report, in 2004, 13 million children (17.8%) lived in poverty and another 16 million (21.4%) were classified as near-poor; 9% of children under 18 years of age had no health insurance at a point in time; and 26% were covered by Medicaid or the state Children's Health Insurance Program.1 Additionally, in 2003 to 2004, 6% of children under 6 years of age and 15% of children 6 to 17 years of age had not visited a primary care provider or health clinic within the past 12 months.
The Poor and Forgotten
Children who live in poverty are marginalized and may be more vulnerable to the negative impact of poor health. But children with adequate health insurance and a usual source of care are likewise vulnerable to disease. Of all children in 2004, only 83% between 19 and 35 months of age were up-to-date with the recommended immunization schedule. Health disparities between whites and nonwhites also reverberate throughout the report. In the full report, you will find a wealth of information about the health of all Americans arranged by the usual demographic categories.
Nurse managed health centers (NMHCs) have traditionally provided a safety net for the nation's poor and underserved. These centers disproportionately care for the uninsured, the underinsured, and individuals insured through special government programs. A primary goal of NMHCs is to increase access to affordable, quality healthcare and thereby improve the quality of life of patients-children and families. This issue is not just for nurse practitioners (NPs) in pediatric practices. When you help an adult prevent illness, maintain, or restore health, often you are also helping a child.
Educate Adults
Today, specialty NP roles include two distinctly prepared pediatric NPs (PNP)-the primary care PNP and the acute care PNP. The family NP, trained to provide care to individuals across the lifespan, is also able to address the healthcare needs of children. All NPs, no matter what their specialty, have the opportunity and a responsibility to advocate for the health of our children. If you do not work directly with children, you can educate your adult patients about the effects of their lifestyle behaviors on the health of children around them and help them identify risk factors for disease in their families.
The U.S. Surgeon General's Family History Initiative is an excellent resource (http://www.hhs.gov/familyhistory/). Families are asked to sit down together to discuss and record the family medical history. Common strategies NPs use with adult patients are to encourage: smoking cessation to reduce the incidence of respiratory illnesses in children due to second-hand smoke; healthier food choices and preparation so children develop healthier eating habits; physical activities in which their children can also participate; and relaxation time so they can refresh and enjoy their children. Any NP fortunate enough to care for an entire family is in a unique position to observe family dynamics and individual relationships; the mental health of a child is just as important as physical health.
Jamesetta Newland, PhD, APRN, BC, FNP, FAANP, FNAP
Editor-in-Chief [email protected]
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