Poverty and children – I – Author Dr. Robert Saul

As community advocates, community activists and child health professionals, pediatricians were incensed to hear about the senseless exposure of thousands of children to lead in the water in Flint, Michigan. Lead exposure can seriously affect development of the nervous system and potentially cause permanent intellectual disability and/or behavior problems. It is sad to see such a preventable problem leading to potentially serious life-long consequences for our most vulnerable citizens.

Yet an equally serious (and arguably even more serious) toxin is “sprinkled” amongst too many of our children daily. That toxin is POVERTY.

Poverty affects far too many children and families. Right after the pandemic, programs such as fully refundable child tax credit, expanded earned income tax credit and expanded Supplemental Nutrition Assistance Program (SNAP) helped drive the poverty rate down to 5.2% in 2021.¹ As those extra benefits expired, the poverty rate rose to 12.3% in 2023.

Let’s put poverty into perspective. The definition is usually tied to the federal poverty level (FPL) which I consider a gross underestimation of our current economic realities. The 2025 100% federal poverty level for a family of 4 is $32,150.² By definition, a family income of over $32,150 is out of poverty. That is really hard to imagine in today’s economy that a family can provide shelter, medical care, food and other living expenses even when their income exceeds the federal poverty level. To qualify for certain assistance, families have to have incomes under certain levels (often a multiple of the FPL like 150% or 200%). It is still unimaginable that folks cannot just eke by at or near the FPL, let alone provide as many opportunities as parents want for their children.

In 2021, the ethnic differences for poverty in the US were stark. Poverty rates for whites were 8.8%, Hispanics 22% and Blacks 27%.³ These percentages should acknowledge that the poverty rate for any ethnicity should be as close to zero as possible but that our social inequities are too obvious. Realistically, we should accept zero tolerance when we consider our children and the hazards of poverty.

What does poverty do to harm children? The simple answer is “a lot.”

Children born into poverty are more likely to have a lower birth rate and higher risk of prematurity.
There is a greater risk for health problems early on.
They are more likely to have sustained some degree of childhood trauma that will have a significant impact.^4,5Remember that childhood trauma is not strictly abuse or neglect but could be due to a variety of missed opportunities because of fewer advantages in life or more difficulty for the family to provide safe, stable nurturing relationships (SSNRs).⁶ There might be significant learning problems and a higher risk for impulsive, defiant behaviors that will lead to lower high school graduation rates and a greater likelihood of an encounter with the juvenile justice system. Our task in providing care for such problems is not to ask “what is wrong with you” but rather “what happened to you.”
Poverty also has a devastating effect on children when they become adults. Children exposed to poverty in childhood have a greater risk of chronic disease as an adult. Diabetes, heart disease, hypertension and obesity often times develop because of the negative effects of poor nutrition, decreased educational exposure and decreased psychosocial nurturing that can occur in early childhood in the setting of poverty. So many of these diseases that we deal with in adulthood, diseases that we call adult-onset, are actually adult-manifest diseases from the ravages of poverty in early childhood. This latter point should be emphasized. Many diseases in adulthood are actually established early on in life and only manifest in adult life. They are not really adult-onset but adult-manifest from early changes to the developing child.
An additional component has to be considered in the exposure of our children to poverty. Scientific evidence now shows that early adverse childhood events can affect the fragile wiring of the brain in its early stages and can affect the expression of certain genes in the developing brain. These changes in the brain and in future gene expression can be permanent (but not irreversible) and have a dramatic effect in how children process conflicting information later in life. Children with these toxic exposures early on are more likely to have certain centers in the brain that are overactive or underactive. These overactive/underactive centers are areas in the brain that if left unchecked will lead to troublesome behaviors and difficulties in school and in society in general.

I articulated above many of the harmful aspects of poverty on children, emphasizing that poverty can be considered an environmental toxin that affects children in the short-term and the long-term. If that is the case, why don’t we treat this toxin more seriously? Why don’t we devote the necessary resources to bring about effective change? The skeptical reader will say that the war on poverty back in the 1960s did not bring about effective change. Well actually, the war on poverty did make a difference in the early days and there is evidence of some sustained changes in the adult population. But for children, we appear to be going backwards in the number of children living in poverty and the harmful effects of poverty.

In the article to follow, I want to emphasize some measures that we can take as a society to improve the lives of our children, especially reducing childhood poverty. But to end this article, I want to acknowledge three individuals who have devoted their careers to addressing childhood poverty. I have had the distinct pleasure and honor to have heard them all in person.

Dr. Benard Dreyer recently passed away after a distinguished pediatric career. He was an ardent child health equity proponent.⁷ His efforts to highlight the need to address poverty and present tangible solutions occupied his life up until the time of his death at age 78, working on an updated policy statement right up until the end.⁸I had the privilege to invite him to speak at a SC pediatric meeting on childhood poverty.

Dr. Benard Dreyer

Dr. James Perrin continues his career as a tireless pediatric advocate.⁹In addition to his multiple projects, Dr. Perrin has long addressed the issues of childhood poverty. When I gave a talk on childhood poverty, he helped provide material that was very helpful.

Dr. James Perrin

Bryan Stevenson of the Equal Justice Initiative is a devoted public servant addressing social inequities.¹⁰ His profound statement that the opposite of poverty is not wealth but that the opposite of poverty is justice should shake us all to realize that simply increasing financial resources is not enough as we tackle poverty.¹¹

Bryan Stevenson

The work of these men and so many others deserves our concerted efforts to make a difference and alleviate the toxin of poverty. I will discuss those efforts in the next article.

Poverty and children – I

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