Health & Development
An Excerpt From BBF’s “How Are Vermont’s Young Children & Families” 2017 Report
Access to health care, quality nutrition, timely vaccinations, and developmental screening are crucial to the healthy development of children.
Areas Where Vermont’s Young Children are Sustaining and Thriving
Access to Health Insurance
Vermont continues to have one of the highest rates of insured children in the country. Approximately 99% of children birth to 17 has health insurance of some type. Eighty-two percent of insured children in that same age group have parents that report their health plan has reasonable out-of-pocket costs, offers benefits or covered services that meet their children’s needs, and allows them to see needed health care providers.22 Ninety-four percent of all Vermont children have a preventative health visit in the first five years of life,23 and ninety percent of Vermont’s children receive at least one initial or periodic screening.24 This high level of engagement by families with primary health care supports the health and development of Vermont’s young children.
Prenatal Care and Low Birth Weight
Women accessing prenatal care during their first 13 weeks of pregnancy have a lower risk of complications and their babies are less likely to be born underweight. Reducing the risk of low birth weight is important: “low birth weight babies (weighing less than 2,500 grams/5.5. pounds) are more likely than babies with normal weight to have health problems as a newborn…[and] have a higher risk of chronic health conditions later in life.”25 Between2009and 2015, Vermont had a lower percentage of low birth weight babies than the United States as a whole (Table 3).
Vermont has seen a steady increase in the percentage of 19 to 35-month-old children who received all vaccinations recommended by the Centers for Disease Control. This is progress toward the state’s Healthy Vermonters 2020 goal of at least 80%. As shown in Figure 4, the percentage of young children receiving all recommended vaccines in 2009 was 23%. In 2016, it rose to 77%.
Health and Development Challenges
Prenatal Substance Use
Reducing the percentage of pregnant women who drink, smoke, and use controlled substances during pregnancy is a key aspect of Vermont’s public health goals for the decade. Prenatal alcohol exposure is one of the leading preventable causes of birth defects.26 Table 4 shows the trends in alcohol use prior to and during pregnancy in Vermont between 2009 and 2014.
Table 5 shows the historical trends in tobacco use prior to and during pregnancy in Vermont. Between 2013 and 2014, Vermont saw an overall decrease in the percentage of women who smoked during pregnancy. However, a Brief on Tobacco Use by the Vermont Division of Maternal and Child Health highlighted that there are marked differences in the rate of smoking during pregnancy based on education and insurance type. Of all women who smoked during pregnancy in 2014, 43% had less than a high school diploma. Only 4% of women who smoked during pregnancy received private insurance, compared to 31% who received Medicaid, 14% who received another form of public insurance, and 17% who were uninsured.27
Between 2008 and 2015, Vermont saw an overall increase in the rate of infants (per 1,000 live births) exposed to opioids (Figure 5). While there was a decline in the rate of opioid exposed infants in Vermont between 2014 and 2015, the rates remain high.
Vermont’s commitment to providing comprehensive treatment for opioid use disorder may mitigate the impact of this trend. The University of Vermont found that among women delivering infants exposed to opioids in-utero, 60% began treatment before conception and 95% began treatment by the time of delivery. Infants born to women in treatment do not have worse outcomes and there are no known negative long-term outcomes of in-utero opioid exposure.28 However, Vermont’s trends related to prenatal opioid use disorder remain concerning. As outlined in the Family & Social Relationships and Safety chapters, parental substance abuse is recognized as an adverse childhood experience and a risk factor for child abuse and neglect.
SPOTLIGHT ON SUBSTANCE ABUSE: Reducing the percentage of pregnant women who drink, smoke, or use controlled substances during pregnancy is a key focus for Vermont’s public health goals for the decade.
One in seven children experience food insecurity in Vermont.29 Children living in food insecure homes are at greater risk for poor health, nutritional deficiencies and obesity, as well as developmental delays, poor academic achievement, depression, and increased aggressive or hyperactive behavior.30
Children have been a priority in Vermont’s e ort to eliminate hunger. In 2013, Vermont became the first state in the nation to cover the student cost for school meals of children whose family incomes were between 135% and 185% of the federal poverty level. Since then, several other states have followed Vermont’s example. Each day, approximately 46,000 Vermont students eat school meals and from 2016 – 2017 Vermont schools served 7,779,277 school lunches. In addition, 69 Vermont schools offer school lunch at no cost to all students. Many Vermont schools now offer a full salad bar, and all lunches include servings of vegetables, fruits, whole grains, fresh milk, and a protein item.31
More Vermont students receive free and reduced-priced lunch today than during the 2011 – 2012 school years (Figure 6).
Strategies to Turn the Curve
Below are several strategies underway in Vermont to promote the healthy development of young children.
- Help Me Grow VT and Developmental Screening: Screening helps assess developmental progress of young children, improves early identification of developmental risks, and ensures that children and families are linked to appropriate resources and services. Help Me Grow Vermont (HMG VT) is a systems effort to increase developmental screening and improve access to existing services for parents with young children. As part of HMG VT, the Vermont Child Health Improvement Program (VCHIP) is engaged in several efforts to increase developmental screening among both health care providers and early childhood educators.
- Nutrition in Child Care Programs: According to Hunger Free Vermont, 9% of early care and learning providers offer meal programs through the federal nutrition program, while nearly half offer meal programs on their own.32 Hunger Free Vermont works with early care and learning providers to help them gain the skills they need to provide meals and snacks to children in their care and teach healthy eating habits and social skills during mealtime.
- Breastfeeding friendly workplaces: In 2017, Saint Albans became one of Vermont’s first designated “Breastfeeding Friendly” cities. Vermont requires employers to offer certain accommodations to breastfeeding mothers, and public breastfeeding is growing in acceptance in Vermont businesses and communities.33
- Vermont Farm to School and Early Care and Learning Statewide Network: This network provides leadership, coordination, and advocacy to advance new and existing farm to school efforts in Vermont early care and learning programs, classrooms, cafeterias, and communities. Eighty- three percent of Vermont school districts report they participate in farm to school activities; that’s 52 districts, 78 schools, and 12,347 students.34
LINK TO VERMONT’S EARLY CHILDHOOD ACTION PLAN: One Action Plan priority under Goal #1, “All Children Have a Healthy Start,” is to ensure that all children have access to adequate nutrition at home, in early care and learning programs, and during the summer.
Click here to view the full How Are Vermont’s Young Children & Families 2017 report
22 United Health Foundation. (2016). America’s health rankings. Retrieved from http://assets.americashealthrankings.org/app/uploads/hwc-complete-report.pdf.
23 National Survey of Children’s Health. (2016). Browse by survey topic. Retrieved from http://childhealthdata.org/browse/survey.
25 Vermont Insights. (2017). Low birth weight (Less than 2,500 grams/5.5 pounds) babies born by Vermont resident mothers by geography and year. Retrieved from http://vermontinsights.org/low-birth-weight-babies.
26 Vermont Agency of Human Services Department of Health. (2014). Health department’s ‘049’ campaign = zero alcohol for nine months of pregnancy [press release]. Retrieved from http://healthvermont.gov/ news/2014/090814_049.aspx
27 Vermont Department of Health. (2017). BRIEF: Tobacco use. Retrieved from http://www.healthvermont.gov/sites/default/ les/documents/pdf/DB.NPM14. Smoking.pdf.
28 Johnston, A. (Producer). (2015). Children born to opioid-dependent parents. [Presentation to: Joint Legislative Child Protection Oversight Committee]. Retrieved from http://legislature.vermont.gov/assets/ Documents/2016/ WorkGroups/Child%20Protection%20Oversight/ October%2020/W~Anne%20 Johnston%20MD~Children%20born%20 to%20opioid-dependent%20 parents~10-20-2015.pdf.
29 Hunger Free Vermont. (2017). 3SquaresVT & food insecurity [data from the 2014-2016 Current Population Survey]. Retrieved from http://dcf.vermont.gov/ sites/dcf/ les/OEO/training/3Squares.pdf.
30 Hunger Free Vermont. (2017). Hunger in Vermont. Retrieved from https://www.hungerfreevt.org/hungerinvermont/.
31 Vermont.gov. (2017). News releases: Share your photos for national school lunch week. Retrieved from http://vermont.gov/portal/government/article. php?news=6536.
32 Hunger Free Vermont. (2017). Hunger in Vermont. Retrieved from https:// www.hungerfreevt.org/hungerinvermont/.
33 Vermont Department of Health. (2012). Vermont workplaces support nursing moms. Retrieved from http://www.healthvermont.gov/sites/default/ les/ documents/2016/11/cyf_nursing_mothers_factsheet_2012.pdf.
34 Vermont Farm to School Network. (2017). Home. Retrieved from https://vermontfarmtoschool.org/.
F4. Vermont Insights. (2017). Point-in-time count and rate of children and youth in the Vermont Department for Children and Families (DCF) custody. Retrieved from http://vermontinsights.org/point-in-time-rate-children-in-dcf-custody.
F5. Vermont Insights. (2017). Point-in-time count and rate of children and youth in the Vermont Department for Children and Families (DCF) custody. Retrieved from http://vermontinsights.org/point-in-time-rate-children-in-dcf-custody.
F6. Vermont Insights. (2017). Vermont children, ages 19-35 months, receiving the full series of recommended vaccines (4:3:1:4:3:1:4) [narrative section]. Retrieved from http://vermontinsights.org/children-19-35-months-receiving-full- recommended-vaccine-series.
T3. Annie E. Casey Foundation, KIDS COUNT Data Center. (2017). Low birth-weight babies. Retrieved from http://datacenter.kidscount.org/data/ tables/5425-low-birthweight-babies?loc=47&loct=2#detailed/2/any/ true/573,869,36,868,867/any/11984,11985.
T4. Vermont Insights. (2017). Low birth weight (less than 2,500 grams/5.5 pounds) babies born by Vermont resident mothers by geography and year. Retrieved from http://vermontinsights.org/low-birth-weight-babies.
T5. Vermont Department of Health. (2011). Vermont PRAMS data brief, 2009 Vermont PRAMS facts. Retrieved from http://www.healthvermont.gov/sites/default/ les/documents/STAT_PRAMS_ rpt_Highlights_2009.pdf.