Child and Adolescent Health

1
Child and Adolescent Health

• Cheryl Duncan De Pinto, M.D., M.P.H.
• Medical Director, Child, Adolescent, and School
  HealthCenter for Maternal and Child Health

2
Children and Adolescents in Maryland
3
Family Structure and Living Arrangements

• 33 (nearly 500,000) of Maryland children under
  18 live in a single parent home.
• In December 2009, 8,429 children were in
  out-of-home placement through the MD Department
  of Human Resources.
• 11.8 were in group homes
• 76.9 were in family foster homes
• In 2009, 4,968 youth were admitted to secure
  detention facilities
• Source Kids Count Data Center MD Department of
  Juvenile Services

4
Health Insurance Coverage

• 10 of Maryland youth, birth-18 years, are
  uninsured.
• Source MD Health Care Commission, Health
  Insurance Coverage in Maryland Through 2007

5
Medical Home

• The American Academy of Pediatrics' description
  of a "medical home" lists seven defining
  components
• Accessible
• Continuous
• Comprehensive
• Family-centered
• Coordinated
• Compassionate
• Culturally effective

• 41.4 of Maryland children do not meet the AAP
  criteria for having a medical home.
• However, 93.9 of Maryland children have a usual
  place for sick and well care.
• Source 2007 National Survey of Childrens Health

6
Immunizations
7
Vaccination Coverage Among Adolescents
8
Lead Poisoning
9
Oral Health Status

• 31 of school children in Kindergarten and
  Grade 3 had at least one tooth with dental
  caries.
• 27 of school children in Kindergarten and
  Grade 3 had at least one tooth with a dental
  sealant.
• Oral Health Disparities
• Children more likely to have dental caries and
  less likely to have dental sealants
• Black, non-Hispanic children
• Children receiving free or reduced price meals
• Children residing on the Eastern Shore (both
  sealants and caries) or in Central Baltimore
  (sealants only)
• Children covered by Medicaid rather than private
  insurance (sealants)
• Children with either Medicaid or no insurance
  coverage (caries)
• Source Survey of the Oral Health Status of
  Maryland School Children, 2005-2006

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Oral Health Access to Care

• Dentist visit in the past 12 months
• Yes 83.1
• No 15.6
• Unknown 1.3
• Dental care service availability
• Yes 90.3
• No 8.1
• Unknown 1.6
• Source 2005-2006 Survey of the Oral Health
  Status of Maryland Children, University of
  Maryland School of Dentistry

Dental Coverage for School Children in Kindergarten or 3rd Grade Dental Coverage for School Children in Kindergarten or 3rd Grade
Medicaid 28.4
Private 59.6
No Coverage 11.1
Unknown 0.9
11
Mortality

• In 2007, there were 366 deaths to children ages
  1-17 in Maryland and the child death rate was
  28.6 deaths per 100,000 population.
• Highest child death rates (2005-2007)
• Black, non-Hispanic youth 33.4 per 100,000
• Older youth (15-17 years) 51.1 per 100.000
• Source MD DHMH, Vital Statistics Administration

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Mortality Unintentional Injuries
Top 3 Leading Causes of Death, by Age Group, 2005-2007 Top 3 Leading Causes of Death, by Age Group, 2005-2007 Top 3 Leading Causes of Death, by Age Group, 2005-2007 Top 3 Leading Causes of Death, by Age Group, 2005-2007 Top 3 Leading Causes of Death, by Age Group, 2005-2007
1-4 years 5-9 years 10-14 years 15-19 years
1 Unintentional injuries Unintentional injuries Unintentional injuries Unintentional injuries
2 Congenital malformations Malignant neoplasms Malignant neoplasms Homicide
3 Homicide Congenital malformations Diseases of the circulatory system Suicide

• Source MD DHMH, Vital Statistics Administration

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Injury-related deaths
Top 5 Causes of Fatal Injury to Youth, 1-17, Maryland, 2005-2007 Top 5 Causes of Fatal Injury to Youth, 1-17, Maryland, 2005-2007 Top 5 Causes of Fatal Injury to Youth, 1-17, Maryland, 2005-2007
Cause of Fatal Injury of Deaths of injury-related deaths
Motor vehicle accidents 193 37.4
Homicide by firearm 85 16.5
Homicide by other means 44 8.5
Drowning 38 7.4
Fire 35 6.8

• Source MD DHMH, Vital Statistics Administration

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Hospitalizations
of Hospitalizations due to Asthma
Children, 1-4 years 16.5
Children, 5-9 years 17.5
Children, 10-14 years 9.3

• Other Leading Causes of Hospitalizations
• Young children (1-4 years) Common childhood
  infections
• Middle children (5-9 years) Injuries
• Older children (10-14 years) Injuries
• Source HSCRC Hospital Inpatient Data, 2007

15
Mental Health Hospitalizations
Hospitalizations of Children Due to Mental Health Concerns, Maryland, 2007 Hospitalizations of Children Due to Mental Health Concerns, Maryland, 2007 Hospitalizations of Children Due to Mental Health Concerns, Maryland, 2007
Child Age of hospitalizations due to affective disorder of hospitalizations due to other mental conditions
5-9 Years 3.3 (150 hospitalizations)
10-14 Years 8.3 (414 hospitalizations) 2.9 (143 hospitalizations)

• Source HSCRC Hospital Inpatient Data, 2007
• Not a Top 10 Reason for Hospitalization for this
  Age Group

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Mental Health Early Childhood

• 1,094 of 30,094 children, ages 0-5 years cared
  for in child care sites were identified as
  having a mental health concern
• Of those, 414 children with more serious mental
  health concerns have been referred to other
  services.
• Child care centers, family child care homes,
  Head Start centers, preschools, and unregistered
  sites

• Source MSDE, Early Childhood Mental Health
  Project

17
School Readiness The Seven Domains

• Personal and Social Development
• Language and literacy
• Mathematical thinking
• Scientific thinking
• Social studies
• The arts
• Physical development

• Source MSDE Report, Children Entering School
  Ready to Learn School Readiness Information for
  School Year 2008-2009

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School Readiness
19
Health of School-aged ChildrenSchool Health
Services Annual Survey SY 2006-2007
Asthma 64,441
ADHD 34,319
Seizure disorder 3,713
Heart condition 3,060
Diabetes 1,793

• Source Maryland State Department of Education

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Childhood Asthma

• Source Maryland, BRFSS, 2001-2007
• Survey question changed in 2005.

21
Childhood Asthma
Source Maryland, BRFSS, 2001-2007 Survey
question changed in 2005.
22
Childhood Asthma
Sources HSCRC ambulatory care data, 2007
HSCRC hospital discharge data, Maryland Health
Care Commission, West Virginia Health Care
Authority, Pennsylvania Health Care Cost
Containment Council, and Delaware Department of
Health, 2005-2007.
23
Childhood Asthma
Sources HSCRC ambulatory care data, 2007
HSCRC hospital discharge data, Maryland Health
Care Commission, West Virginia Health Care
Authority, Pennsylvania Health Care Cost
Containment Council, and Delaware Department of
Health, 2005-2007.
24
Childhood Obesity
25
Childhood Obesity
26
Mental Health Depression and SuicideYRBS,
Maryland 2007
Felt sad or hopeless (signs of depression) 23
Seriously considered attempting suicide during the past 12 months 13
Attempted suicide in the past 12 months 7.5
Required medical attention due to suicide attempt 2.3
Source MD Youth Risk Behavior Survey, 2007
27
Substance Use-Related Risk Behaviors YRBS,
Maryland 2007
Rode in a vehicle driven by someone who had been drinking alcohol, at least once in the past 30 days 29
Tried cigarettes 50
Currently smoke cigarettes 17
Reported binge drinking at least once in the previous 30 days 24
Currently use marijuana 20
Have tried cocaine 6
Have tried heroine 2
Have tried inhalants (glue, aerosol cans, paint) 13
Source MD Youth Risk Behavior Survey, 2007
28
Violence and Bullying YRBS, Maryland 2007
In a physical fight at least once in the past year. 36
Carried a gun at least once in the past 30 days. 5
Carried a weapon on one or more of the past 30 days 19
Harassed or bullied on school property during the past 12 months. 26
Victims of teasing or name-calling because of their weight, size or physical appearance during the past 30 days. 29
Victims of teasing or name-calling in the past 30 days because of their race or ethnic background. 17
Harassed or bullied during the past 12 months due to their perceived sexual orientation. 13

• Source MD Youth Risk Behavior Survey, 2007