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Many of these effects last a lifetime, and some may even result in death. The proportion of women receiving prenatal care in the first trimester rose substantially during the s, leveled off in the s, and then increased again during the early s from 76 percent in to 81 percent in Adequate prenatal care is associated with lengthened duration of gestation and reductions in low birthweight births, with some evidence of greater effectiveness for high-risk women.

Access to medical care, good nutrition, and a healthy environment are instrumental to a young child's physical health and growth. Conversely, inadequate nutrition during these crucial years increases the likelihood that a child will develop a wide range of physical, mental, and emotional problems. Low vaccination rates may make young children prone to preventable diseases such as measles or mumps, and exposure to lead may impair the development of a child's nervous system.

All of these issues are of particular importance during the first years of life. Medical Care Since , the Medicaid program has provided health insurance for poor families. In , nearly 30 percent of children under 6 were covered by Medicaid. Pregnant women and children, up to the age of 6, living in households with incomes up to percent of the Federal poverty line are now eligible for Medicaid.

Pregnant women receive special services under Medicaid including "enhanced" prenatal care in many states. Since , States receive vaccines free of charge from the Federal government for Medicaid-eligible and some other categories of children. Pregnant women with poor nutrition are more likely to have low birthweight babies, and children with poor nutrition often lack concentration and energy, experience dizziness, headaches, ear infections, and frequent colds. WIC targets pregnant women, infants, and young children at nutritional risk by providing supplemental foods, nutrition education, and access to health services.

An average of 7. Box 2. The Effects of Prenatal WIC Participation WIC is an important government program that provides health care and social service referrals to low-income pregnant women and to children aged 5 and under. To study the effect of this prenatal program on birth outcomes and Medicaid costs, Mathematica Policy Research, Inc.

Mothers included in the study participated in Medicaid and gave birth in or To analyze the effect of WIC, birth outcomes and Medicaid costs of WIC participants were compared to those of income-eligible nonparticipants. Statistical techniques were used to control for observable differences between the WIC participants and nonparticipants.

However, the two groups may differ in ways which were not observed by the researchers. WIC participants were one-third to one-half less likely than nonparticipants to have received inadequate prenatal care. Participation in the program was also associated with an increase in birthweight averaging between 25 to 68 grams , a lower incidence of pre-term births, and a longer gestational age.

Medicaid costs were also lower for WIC participants. Cessation of Smoking In , an estimated 16 percent of pregnant women in the United States smoked. Programs designed to convince women to quit smoking during pregnancy may be an exceptionally effective means of helping children.

A pregnant woman who smokes less than a pack a day is 53 percent more likely to have a low birthweight baby than a nonsmoker; a woman smoking more than a pack a day is more than twice as likely to do so. The cost-savings are most often associated with reductions in the incidence of low birthweight.

For example, the widespread use of vaccines has reduced the incidence of some diseases in the United States by more than 95 percent. The goal of this initiative is to fully vaccinate 90 percent of all two-year-olds by the year VFC provides all recommended vaccines free of charge to clinics and doctors who provide services to uninsured and Medicaid-covered children.

In response to this initiative, the percent of all two-year-olds who were fully immunized increased from 55 percent in to 75 percent in see Figure 1. This increase in immunization rates is correlated with the 35 percent drop in the incidence of preventable diseases in children under 5 from to The goals of home visiting programs vary considerably.

Some programs link families with social services while others assess the safety of the home, encourage healthy habits, answer questions about pregnancy, childbirth, and child-rearing, or help parents set goals and make plans. Home visits are often made during pregnancy and through the first 1 to 2 years after birth.

The more successful programs typically continue after the child is born and employ a comprehensive approach that addresses many of the above goals. A variety of Federal government Departments such as Education, Justice, and Health and Human Services fund home visiting programs for families with young children. The Head Start program discussed below administers one of the largest home-based programs, mostly to children in rural areas who would have difficulty participating in center-based care.

In , 24 States used Medicaid funds to provide prenatal or postnatal care through home visiting programs. The analyses differ widely in their assessments of these programs, in part due to immense heterogeneity in the intensity, scope, and focus of the interventions. An understanding of the specific differences among programs can help guide policy. Home visiting programs aimed at persuading pregnant adolescents to stop smoking are found to decrease the risk of low birthweight babies.

In addition, it had favorable effects for mothers, such as increases in schooling and reductions in future childbearing. The Elmira, NY, Home Visitation Program In the late s and early s, a randomized experiment was conducted in Elmira, New York to examine the effect of home visiting on health and social outcomes.

The study included teenage, unmarried, or poor women who were pregnant for the first time. The women were randomly assigned to one of four groups providing some combination of health screenings, free transportation to health providers, and home visits during pregnancy and in some cases through the child's second birthday.

In the most intensive intervention, nurses made home visits once every two weeks during pregnancy and once a week immediately after delivery, decreasing in frequency to once every six weeks at the end of two years. Home visitation was found to decrease smoking, improve diets and, for some groups, reduce the frequency of low birthweight or pre-term deliveries. Participants were also more likely to make use of the WIC nutritional supplementation program and to attend childbirth education classes.

The home visits increased the involvement of family members and friends in the pregnancy, birth, and early care of the child. Program costs were compared with changes in government expenditures during the first four years of the child's life. Almost one-third of the savings among low-income families was due to the reductions in the number of subsequent pregnancies. This study may underestimate the gains from the program, since neither nonmonetary benefits nor savings after age 4 are taken into account.

Even at lower levels, it is associated with reduced intelligence, learning disabilities, impaired hearing, behavioral problems, and slowed growth. Restrictions on lead in gasoline, food canning, and other uses have reduced blood lead levels by over 80 percent during the last 20 years. Current efforts focus on reducing exposure to lead-based paint and lead-contaminated dust.

Emotionally healthy children enter school with the skills to communicate with their peers and teachers and the confidence to make friends; they have high self-esteem, knowledge of socially acceptable behavior, and motivation to learn. When children are prepared to enter school, their early educational experience can be fruitful, enjoyable, and productive. Parenting During The First Months of Life To ensure emotional health, children need daily nurturing and guidance from trustworthy and caring adults.

In the first years of life, children need love and care from adults who listen and respond to their needs. Infants are dependent upon adults for touching, rocking, feeding, and warming, as well as stimulation through reading and talking. The FMLA grants 12 weeks of unpaid job-protected leave to new parents with qualifying employment histories working for covered employers.

During the month period ending in the summer of , approximately 17 percent of workers took time off work for a reason covered by the legislation. Larger percentages indicated positive rather than negative effects on employee productivity, turnover, and career advancement. Traditionally, such relationships have been provided by parents, particularly mothers, who stayed at home with their children. However, as women increasingly work outside the home and more children grow up in single parent households, full-time parental care is becoming less typical.

Accompanying this trend is the increased use of professional child-care. In , about 30 percent of children under 5 in families with employed mothers were cared for in centers, compared with only 13 percent in see Figure 2. However, children in poor families with employed mothers were one-third less likely to receive care in centers as were children in non-poor families. Another option for care outside the home is family day care -- care by nonrelatives in another home -- which accounted for an additional 17 percent of the care received by children under 5 with working mothers.

Parents also often face considerable uncertainty regarding the quality of child care provided. Moreover, as is to be expected, the quality of the care received matters greatly. They are more self-confident, proficient in language, advanced in cognitive development, and make better academic progress. Conversely, children in poor quality programs risk the development of poor school skills and heightened aggression.

Participation was associated with decreased number, severity, and chronicity of juvenile justice problems. Participation is associated with significant increases in measured intelligence. For example, the child development environment in more than one-third of classrooms surveyed in the National Child Care Staffing study was rated less than "minimally adequate", and only 12 percent of the classrooms received a score which met or exceeded the standard associated with "good" practices.

Since , Federal support has doubled and has almost tripled for low-income families. The program combines four previous Federal child care subsidy programs and allows States to design comprehensive, integrated service delivery systems to meet the needs of low-income working families. At least 4 percent of these funds must be spent on quality improvements in child care. A major purpose of the Social Services Block Grant is preventing neglect, abuse, or exploitation of children and adults.

Early Childhood Systems Early Childhood Systems HRSA invests in several programs the Early Childhood Systems portfolio that strengthen, align, and sustain family-centered systems at the state and community levels, using the health system as a key partner. These programs focus on the prenatal-to-age-3 P—3 period, which is a critical window of opportunity for prevention and intervention. Early childhood experiences that nurture positive health and development—starting prenatally—have lifelong impacts on health and well-being.

As a whole, programs within the portfolio support the healthy development of all children by addressing systemic barriers to coordination, reach, and equity. Programs support the needs of children and their caregivers together known as a two-generation approach. They also promote holistic health and well-being through partnerships that bridge medical, mental and behavioral health, early care and education, child welfare, and other human services and family supports.

Program details follow.

A growing body of research verifies that investments in young children nurture a child's physical and emotional development and that these investments can have big payoffs for families, government and society.

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