PREVENTIVE HEALTHCARE AND PSYCHOSOCIAL NEEDS OF INFANTS AND TODDLERS IN LOWER-INCOME FAMILIES Lynn Olson, Neal Halfon, Moira Inkelas, Ritesh Mistry. American Academy of Pediatrics; Center for Healthier Children Families & Communities, UCLA.

BACKGROUND: Pediatricians provide the preventive care for an estimated 80% of infants and toddlers in the US, many of whom live in lower-income families.

OBJECTIVE: Describe differences between lower- and higher-income families by: demographics, parenting stresses, preventive care access, and health/developmental needs.

DESIGN/METHODS: The National Survey of Early Childhood Health (NSECH) 2000 is a nationally representative telephone survey of 2,068 parents (of children 4-35 mos) that profiles health supervision and health development needs. Annual income is categorized into 4 groups: a) >$17,500, b) $17,500-35,000, c) $35,001-$60,000, d) >$60,000.

RESULTS: 25% of children live in households with an annual income of >$17,500 and 27% with incomes of $17,501-35,000. Children in the lowest income households are substantially more likely to be Non-Hispanic Black (from lowest to highest income groups: 30%; 15%; 10%; 7% p<.001) or Hispanic (34%; 21%; 10%; 5% p<.001). Lower-income children are far more likely to have mothers with less than a high school education (47%; 20%; 7%; 4% p<.001), and live in households with one adult (28%; 10%; 2%; 1% p<.001). Lower-income parents are less likely to report they are coping very well with the demands of parenting (54%; 63%; 68%; 66% p< .05), and more likely to report not having emotional support (19%; 15%; 12%; 7% p<.001). Lower income parents report more trouble paying for their children?s health and medical expenses (18%, 14%; 12%; 4% p<.001) and supplies such as food and diapers for the child (34%; 29%; 16%; 9% p<.001); they were not more likely to report difficulty paying for prenatal care or the birth. Lower-income children are more likely to receive their regular care in a community health center (29%; 17%; 13%; 4% p< .0001) and less likely to be seen in a private office (52%; 72%; 80%; 92% p< .0001). Low income children were as likely to receive health supervision visits; however, their parents are less likely to report their child is in "excellent" health (44%; 50%; 58%; 64% p<.001). Lower-income parents are more likely to report "a lot" of concerns about their child?s development, eg, concern about speech development (37%; 28%; 18%; 19% p<.0001).

CONCLUSIONS: The parents of lower-income children are substantially more likely to report emotional and financial stress and to have concerns about their child?s health/development, underscoring a need for greater or specialized services.