The health of children depends
partially on their access to health care
services. Despite the improved health
outlook for U.S. children in this century
because of the reduction in infectious
and contagious diseases, recent
economic and social changes have
called attention to new challenges to
children’s health and their need for
health services. Changes in family
structure, geographic mobility, and
economic well-being have placed many
children in need of health services
resulting from conditions relating to
hunger, poor housing conditions,
violence, and neglect (1). Since 1975,
the number of children living in poverty
has doubled. In addition, today
27 percent of U.S. children live in single
parent families (2). Health services and
interventions are needed to deal with
crises such as child abuse, which has
risen to 850,000 substantiated cases a
year; teen suicides, which have almost
doubled since 1970; and teen homicides,
which have doubled in the past decade.
In addition, although the rates of many
health conditions among children have
remained stable, rates of respiratory
conditions, especially asthma, have
increased dramatically, and
immunization rates for preschool
children remain below recommended
guidelines (2).
To meet current and emerging
health needs of children, the U.S.
Maternal and Child Health Bureau
sponsored the development of new
health care guidelines (1). These
guidelines recommend health care visits
for children at key developmental
stages. These visits should includ