How Can Pediatricians Help Homeless Youth?

A new set of guidelines published in Pediatrics from the American Academy of Pediatrics emphasizes the important role pediatricians play in acting as a conduit to healthcare services for homeless youth, according to MedPage Today.

Melissa Briggs, MD, and colleagues from the Council on Community Pediatrics wrote in the journal Pediatrics that pediatricians can aid with homeless youth's Medicaid and government and community services, programs that provide assistance to families with unmet social and economic needs, as well as shelter and care services.

The authors of the guidelines also emphasized that it is crucial for pediatricians to treat homeless children and adolescents and help them identify with issues such as homelessness, housing insecurity, underlying causes of homelessness through screening and asking sensitive questions about their family life.

The authors of the report observed that the number of families that moved from stable housing arrangements to the shelter system increased by 38.5 percent from 2007 to 2011, and over the same period, the number of children in shelters increased by 1.9 percent. The authors also noted that homeless pediatric patients may face difficulty accessing health care at all, and many suffer from inadequate nutrition, interruptions to education, trauma and strained family dynamics.

The U.S. Department of Health defines homelessness as "any person without fixed, regular, and adequate nighttime residence, such as children and teens sharing housing of others due to loss of housing, economic hardship, or similar reason," which is the definition the authors used.

This includes children and teens living in hotels, motels, camp grounds, emergency or transitional shelters, abandoned hospitals, and public or private places "not designed for or ordinarily used as a regular sleeping accommodation for human beings" such as parks, cars, bus or train stations and abandoned buildings, in addition to children awaiting foster care placement.

"People need to realize what a big issue this is," Lolita McDavid, MD, of the University Hospitals Rainbow Babies and Children's Hospital in Cleveland, said to MedPage Today. "There are 1.6 million homeless children in the U.S. - that's one out of 45 children. We need to know who they are and not to stigmatize them but to make sure they're getting what they need."

Major risks of homelessness among parents, according the authors, include unemployment, substance abuse, mental illness, domestic abuse and previous military service, and the effects on children and teens can be detrimental. Homeless children and teens can lead to a higher likelihood of chronic and acute health issues, including a number of illnesses including diarrhea, bronchitis, scabies, lice, and dental caries, as well as infectious, respiratory, gastrointestinal, and dermatological diseases.

In addition, the lack of nutritional foods in homeless populations can lead to malnutrition, stunted growth and obesity, and psychological problems are common to homeless pediatric patients, as these children are more often exposed to abuse and emotional distress, and many have decreased educational attainment, developmental and speech and language delays.

As for the role of pediatricians of homeless children, the authors listed several steps doctors can take when treating such patients. Helping them obtain access to and understand Medicaid is one important thing they can do, and pediatricians can familiarize themselves with the best practices for caring for such children, and deliver comprehensive care during their visits such as providing immunization right away instead of waiting until a follow-up appointment is made.

Pediatricians should also work with parents and families to set up care plans and help familiarize them with local and government assistance, the authors said. The authors also suggested pediatricians advocate to local, state and federal officials that changes need to take place in the legal system to help support and care for this population and allow them access to violence protection, low-income housing, education and food.

Click here to watch a video of Med Page Today's interviews with some of the pediatrician authors of the new report.