Children have never had it easy. A fair proportion have always been beaten, starved, raped or abandoned, and until quite recently even the loved ones faced daunting obstacles. At the beginning of this century, one American child in 10 didn't live to see a first birthday. Today, thanks to major strides in nutrition, sanitation and medical care, 99 out of 100 survive infancy. Yet astonishing numbers continue to die or suffer needlessly. Nearly one child in four is born into poverty, a formidable predictor of lifelong ill health, and a growing number lack such basic advantages as a home, two parents and regular access to a doctor. Every year thousands die violently, from abuse or preventable accidents. Millions go unvaccinated against common childhood diseases. Millions more are poisoned by cigarette smoke or household lead.
Decrying the situation has become a national pastime. Panels are assembled, studies conducted, articles written, speeches made. Yet by vital measures, American children remain the most neglected in the developed world. Their health and welfare are simply "not high on the agenda of this country," laments Dr. Reed Tuckson, a former Washington, D.C., health commissioner and now a vice president at the March of Dimes Birth Defects Foundation. "The federal government doesn't think this is as important as the savings and loan crisis." Here's proof.
According to newly released government figures, 9.1 out of every 1,000 American babies died during infancy last year (down from 9.7 per 1,000 in 1989). Such rates are a far cry from India's 97 deaths per 1,000 or Guinea's 143, but they're among the highest in the industrialized world - and they don't apply equally to all Americans. The death rate for black infants (17.6 per 1,000 births as of 1988) is more than twice that for whites (8.5 per 1,000). And some regions remain what the National Commission to Prevent Infant Mortality calls "disaster areas." Washington, Detroit and Philadelphia suffer higher infant-death rates than Jamaica or Costa Rica. Parts of the rural South fare even worse. "What we have here in the Mississippi delta is a Third World situation," says Mike Gibbs of Mississippi's Sharkey-Issaquena Health Alliance. Indeed, a baby born in Sharkey or Issaquena county is less likely to survive infancy than one born in Chile.
The main reason children die during infancy is that they're born too soon or too small. Babies with low birth weights (under 5.5 pounds) are 40 times more likely than others to die during their first month, and 20 times more likely to die within a year. Those who survive often grow up deaf, blind or mentally retarded. The problem has eminently preventable causes, including drug and alcohol abuse, smoking, poor nutrition and a lack of prenatal care. Yet low birth weight is as common today as it was a decade ago. Nearly 7 percent of all U.S. babies - a quarter million a year--are born too small. The rate is far higher, and rising, among minorities. In 1988 fully 13 percent of all black children came into the world dangerously underweight.
Low birth weight is not the only effect of parental substance abuse. Fetal alcohol exposure is the nation's leading known cause of mental retardation, surpassing both Down syndrome and spina bifida. Cigarette smoke not only poisons developing fetuses--causing a quarter of all low birth weights and a tenth of all infant deaths--but disables children who breathe it growing up. Smokers' kids are at increased risk for many respiratory diseases, including asthma. And babies born to cocaine users suffer devastating neurological problems.
The number of fetuses exposed to tobacco and alcohol hasn't changed much lately; America produces 5,000 to 10,000 children with full-blown fetal alcohol syndrome each year, and 10 times that number may suffer the similar but less severe symptoms of fetal alcohol effect. By contrast, cocaine use rose ominously among young women during the 1980s. Though recent findings suggest the problem has peaked, experts guess that a million women of childbearing age use the drug and that 30,000 to 100,000 deliver cocaine-exposed babies each year. At New York's Harlem Hospital, the frequency of cocaine use among expectant mothers jumped from 1 percent in 1980 to 20 percent in 1988. A 1989 survey suggested that 17 percent of Philadelphia's babies were born exposed.
Syphilis, gonorrhea and AIDS may sound like adult afflictions, but children are paying dearly for the surge in sexually transmitted diseases over the past decade. They're paying, too, for the decline of childhood immunization efforts. For less than $100 a child can gain immunity against polio, whooping cough, diphtheria, tetanus, measles, mumps and rubella. Virtually all America's kids receive these basic vaccines by the time they start school. Yet vast and growing numbers of 1- to 4-year-olds remain unvaccinated, especially in poor areas. Dr. Antoinette Eaton, president of the American Academy of Pediatrics (AAP), calls the situation "disastrous."
The government stopped tracking early-childhood immunization rates six years ago, but signs of trouble abound. As of 1985 the proportion of preschoolers receiving particular vaccines was 23 percent to 67 percent lower in this country than in Europe. Only half of America's 1- to 4-year-olds were being immunized against polio, according to the AAP, and a quarter received no vaccinations. Recent studies have identified inner-city neighborhoods where 50 to 70 percent of preschool children are unvaccinated. Not surprisingly, these lapses have triggered a major resurgence of once rare childhood diseases. Whooping cough is twice as common today as it was in 1970. Measles cases rose from 1,500 in 1983 to an astounding 25,000 last year.
This summer federal health officials are expected to acknowledge formally what researchers and activists have long maintained: that 3 million youngsters - one in six children under 7 - have dangerous levels of lead in their blood. A standard ingredient in wall paint until the late 1970s, lead still pervades many households, and mounting evidence suggests that blood levels once considered safe can cause neurological damage. Many experts now consider it the nation's foremost environmental hazard.
Children don't have to eat paint chips to be poisoned; a more common source is the dust that falls from old walls and window panes. Experts are also wary of water systems, lead crystal and imported cans and ceramics. Babies exposed to low doses of lead in the womb tend to be underweight and underdeveloped at birth. During grade school, lead-exposed kids exhibit behavioral problems, low IQ and deficiencies in speech and language. And research has shown that teenagers with histories of lead exposure drop out of school seven times as often as their peers.
Lead poisoning is most prevalent among the least privileged--a 1988 study suggested that more than half of low-income black children are afflicted--yet the hazard extends far beyond the ghetto. The study found that in the group with the lowest risk--whites living outside central cities--one of every 11 children had high levels of lead in his blood. Officials at the federal Centers for Disease Control in Atlanta have recommended lead screening for all children under 6, yet only one in 10 receives it. If the agency redefines lead poisoning as expected, the demand for a national testing program will surely grow.
No disease, drug or environmental hazard rivals traumatic injuries as a killer of children. Every year mishaps claim the lives of 8,000 American youngsters and permanently disable 50,000. Car and bicycle accidents are the main menace, with a death toll of 3,400. Burn injuries kill 1,300 - and 1,200 drown. Others die from choking or falls or gunshot wounds. Though most of these injuries are unintentional, child advocates resist calling them accidents. "Our contention," says former surgeon general C. Everett Koop, now chairman of the national Safe Kids Campaign, "is that 90 percent of permanent childhood injuries can be prevented."
The challenge is simply to make parents more vigilant. Koop's campaign stresses such basic precautions as installing smoke alarms (9 out of 10 fire deaths occur in houses that lack them), keeping toddlers away from swimming pools, turning pot handles toward the back of the stove where kids can't reach them and getting children to wear bicycle helmets. According to the National Center for Health Statistics, nearly 70 percent of all hospitalized bicyclists are treated for head trauma. Helmets reduce the risk of brain injury by almost 90 percent - yet only 5 percent of young bike riders wear them.
Injury would seem an equal-opportunity hazard, yet black children die from injuries at nearly twice the rate of others. Koop blames inadequate supervision and a lack of medical care - which is to say he blames poverty. "When I look back on my years in office," he says, "the things I banged my head against were all poverty."
Kids under 5 suffer more poverty than any other age group in America. Roughly one in four is poor, versus one in eight adults, and the consequences are manifold. Poor children are more likely to suffer from low birth weight, more likely to die during the first year of life, more likely to suffer hunger or abuse while growing up and less likely to benefit from immunizations or adequate medical care. Moreover, notes Dr. Peter Boelens of the Sharkey-Issaquena Health Alliance, poor kids grow up without ever "understanding what is necessary for healthy living."
Healthy People 2000, the federal government's public-health blueprint for the rest of the decade, seeks to reduce the nation's infant mortality rate to 7 deaths per 1,000 (from today's 9.1), to reduce the frequency of low birth weight to 5 percent (from today's 7 percent) and to ensure that 9 out of 10 (instead of 3 out of 4) expectant mothers get early prenatal care. Modest goals, yet few children's advocates expect them to be met. Too many better-armed interests are competing for the available federal dollars. "Children don't vote," says Florida Gov. Lawton Chiles, chairman of the National Commission to Prevent Infant Mortality, "and they do not contribute to political campaigns."
There are glimmers of hope. The Bush administration recently proposed a five-year, $171 million initiative to reduce infant mortality by half in 10 hard-hit cities - but proposed paying for it by taking money away from existing maternal and child-health programs. Congress blocked that move and has appropriated $25 million to fund the 10-city effort next year. No one is complaining, but the effort is only a start. "We want to encourage and celebrate Mr. Bush's initiative," says Tuckson, of the March of Dimes. "But if we recognize that reducing infant mortality is important, why not 20 cities?"
Or 40? There is no economy in neglecting children's health. Kids born underweight end up in intensive-care units, often at state expense. Many remain lifelong burdens to society. "Forget the humane reasons for providing prenatal health care," says Jennifer Howse, president of the March of Dimes. "There is a cold, hard business reason. It saves money."
As of 1988, infant death was twice as common in the U.S. as in Japan. American black children were dying at twice the rate of whites. Selected rankings:
Country Deaths per 1,000 live births Japan 5.0 Switzerland 6.8 Singapore 7.0 Canada 7.3 France 7.7 East Germany 8.1 U.S. Whites 8.5 United Kingdom 8.8 All U.S. 10.0 Czechoslovakia 11.9 China 12.0 Nigeria 13.8 U.S. Blacks 17.6
SOURCES: STATISTICAL OFFICE OF THE UNITED NATIONS; NATIONAL CENTER FOR HEALTH STATISTICS
Young children endure more poverty than any other age group in the population.
SOURCE: NATIONAL CENTER FOR CHILDREN IN POVERTY