America's Children: Key National Indicators of Well-Being, 2009
Children with Special Health Care Needs
Children with special health care needs (CSHCN) are defined as those children who have a chronic physical, developmental, behavioral, or emotional condition who also require health and related services of a type or amount beyond that required by children generally.147, 148 Based on this definition, CSHCN are identified by parents' reports that their child has a health problem expected to last at least 12 months and which requires prescription medication, more services than most children, special therapies, or which limits his or her ability to do things most children can do. The use of or need for specialized medical, educational, and social services associated with having a special health care need can have a significant impact on both families and service systems charged with meeting these needs.149 Understanding the extent and nature of special health care needs among children is critical not only for providing services today, but for planning to meet future demands.150
Indicator SPECIAL1.A: Percentage of children ages 0–17 with special health care needs by age and gender, 2005–2006
NOTE: Children are considered to have a special health care need if they have a parent-reported medical, behavioral, or other health condition that has lasted or is expected to last 12 months or longer and that has resulted in functional limitations and/or elevated use of or need for medical care, mental health or educational services, specialized therapy, or prescription medications beyond what is usual for other children of the same age.
SOURCE: Maternal and Child Health Bureau and National Center for Health Statistics, State and Local Area Integrated Telephone Survey, National Survey of Children with Special Health Care Needs, 2005–2006.
- In 2005–2006, an estimated 14 percent of children ages 0–17 had a special health care need.151, 152 Overall, 22 percent of all U.S. households with children had at least one child with special health care needs.153 The proportion of children with special health care needs increased from 13 percent in 2001 to 14 percent in 2005–2006.154
- The prevalence of special health care needs was higher among older children. Approximately 17 percent of children ages 12–17 had special health care needs while, 16 percent of children ages 6–11 and about 9 percent of children ages 0–5 were identified as having special health care needs.
- The prevalence of special health care needs was greater among males than females in 2005–2006. About 16 percent of males had a special health care need, compared to 12 percent of females.
- In 2005–2006, the proportion of CSHCN varied by race and ethnicity. The prevalence of special health care needs was highest among children of two or more races (18 percent), followed by White, non-Hispanic (15 percent), Black, non-Hispanic (15 percent), American Indian or Alaska Native (15 percent), and Native Hawaiian or Other Pacific Islander (12 percent) children. The prevalence of special health care needs was lowest among Hispanic and Asian children (8 percent and 6 percent respectively).
- The majority of CSHCN were covered by private health insurance (59 percent), while 28 percent had public health insurance only and approximately 7 percent were covered by some combination of public and private health insurance. About 3 percent were uninsured at the time of the survey. Among CSHCN with health insurance, one-third of parents reported that the coverage was not adequate.153
- The most commonly reported health conditions among CSHCN include allergies (53 percent); asthma (39 percent); attention-deficit and attention-deficit/hyperactivity disorder (30 percent); depression, anxiety, or other emotional problems (21 percent); and migraine or frequent headaches (15 percent).153
- About one-quarter of CSHCN have health conditions that usually or always affect their daily activities, while 38 percent have health conditions that moderately or sometimes affect their daily activities and 38 percent have health conditions that never affect their daily activities.
- A child's special health care need status is determined by parents' reports about the effects of their child's health problems. About 78 percent of CSHCN used or needed prescription medications, while only 18 percent used or needed special therapies. CSHCN could have met more than one criterion.
Indicator SPECIAL1.B: Percentage of children ages 0–17 with special health care needs experiencing an effect on daily activities, 2005–2006
NOTE: Children whose conditions never affected their daily activities reflect either the effects of treatment used to manage the condition or the nature of the condition.
SOURCE: Maternal and Child Health Bureau and National Center for Health Statistics, State and Local Area Integrated Telephone Survey, National Survey of Children with Special Health Care Needs, 2005–2006.
Indicator SPECIAL1.C: Percentage of children ages 0–17 with special health care needs meeting criteria used to determine special health care needs status, 2005–2006
NOTE: Percentages do not equal 100 percent because children with special health care needs may have met more than one criterion.
SOURCE: Maternal and Child Health Bureau and National Center for Health Statistics, State and Local Area Integrated Telephone Survey, National Survey of Children with Special Health Care Needs, 2005–2006.
SPECIAL1.A HTML Table, SPECIAL1.B HTML Table
147 McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P. W., Perrin, J.M., Shonkoff, J.P., and Strickland, B. (1998). A new definition of children with special health care needs. Pediatrics, 102, 137–139.
148 Children with special health care needs (CSHCN) were identified using the five-item CSHCN Screener. Children are considered to have a special health care need if they have a parent-reported medical, behavioral, or other health condition that has lasted or is expected to last 12 months or longer and that has resulted in functional limitations and/or elevated use of or need for medical care, mental health or educational services, specialized therapy, or prescription medications beyond what is usual for other children of the same age.
149 Newacheck, P. W. and Kim, S.E. (2005). A national profile of health care utilization and expenditures for children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 159, 10–17.
150 Lotstein, D.S., McPherson, M., Strickland, B., and Newacheck, P. W. (2005). Transition planning for youth with special health care needs: Results from the National Survey of Children With Special Health Care Needs. Pediatrics, 115, 1562–1568.
151 Estimates of the prevalence of children with special health care needs (CSHCN) using the CSHCN Screener have been found to vary between 4 percentage points and 6 percentage points, depending on survey methodology. Bethell, C., Read, D., Blumberg, S., and Newacheck, P. (2008). What is the prevalence of children with special health care needs? Toward an understanding of variations in findings and methods across three national surveys. Maternal and Child Health Journal, 12, 1–14.
152 All reports were made by the parent or caregiver who was most familiar with the child's health status and needs.
153 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal Child and Health Bureau. (2008). The National Survey of Children with Special Health Care Needs chartbook 2005–06. Rockville, MD: U.S. Department of Health and Human Services.
154 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal Child and Health Bureau (2008) unpublished tabulations.