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

Children and Adolescents in Maryland

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

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

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 Children’s Health

Immunizations

Vaccination Coverage Among Adolescents

Lead Poisoning

Oral Health: Status 31% of school children in Kindergarten and Grade 3 had at least one tooth with dental caries. 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. 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,

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: Survey of the Oral Health Status of Maryland Children, University of Maryland School of Dentistry Dental Coverage for School Children in Kindergarten or 3 rd Grade Medicaid28.4% Private59.6% No Coverage 11.1% Unknown0.9%

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 ( ): Black, non-Hispanic youth: 33.4 per 100,000 Older youth (15-17 years): 51.1 per Source: MD DHMH, Vital Statistics Administration

Mortality: Unintentional Injuries Top 3 Leading Causes of Death, by Age Group, years 5-9 years years years 1 Unintentional injuries 2 Congenital malformations Malignant neoplasms Homicide 3Homicide Congenital malformations Diseases of the circulatory system Suicide Source: MD DHMH, Vital Statistics Administration

Injury-related deaths Top 5 Causes of Fatal Injury to Youth, 1-17, Maryland, Cause of Fatal Injury # of Deaths % of injury-related deaths Motor vehicle accidents % Homicide by firearm % Homicide by other means 448.5% Drowning387.4% Fire356.8% Source: MD DHMH, Vital Statistics Administration

Hospitalizations % of Hospitalizations due to Asthma Children, 1-4 years 16.5% Children, 5-9 years 17.5% Children, 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

Mental Health: Hospitalizations 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) * 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

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

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

School Readiness

Health of School-aged Children School Health Services Annual Survey SY Asthma64,441 ADHD34,319 Seizure disorder 3,713 Heart condition 3,060 Diabetes1,793 Source: Maryland State Department of Education

Source: Maryland, BRFSS, *Survey question changed in Childhood Asthma

Source: Maryland, BRFSS, *Survey question changed in 2005.

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,

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,

Childhood Obesity

Mental Health: Depression and Suicide YRBS, 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

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

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% 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