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Prevalence of Children with Speacial Health Care Needs

In this Section:
By Children and Households | By Age and Sex | By Income and Race/Ethnicity

Children with special health care needs are defined by the U.S. Maternal and Child Health Bureau as:

“...those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”¹

This definition is broad and inclusive, incorporating children with a wide range of conditions and risk factors. One of the major goals of the National Survey of CSHCN is to determine the proportion of children, nationally and in each State, who meet this definition. However, because of the difficulty of including the range of factors that might place children at increased risk for special health care needs, the population of children “at risk” for chronic conditions has been excluded from this study.

This section reviews the survey’s findings about the prevalence of special health care needs among children.

Prevalence of CSHCN: By Children and Households

To identify CSHCN, the survey asked parents whether their child used more medical care, mental health services, or educational services than is usual for most children of the same age; whether the child used specialized therapies, mental health counseling, or prescription medications; or whether the child was limited or prevented in any way in his or her ability to do things most children of the same age can do, because of a medical, behavioral, or other health condition that is expected to last at least one year. These questions are part of the CSHCN Screener,³  which was developed by researchers, practitioners, family advocates, and policy makers to identify CSHCN in household surveys.

Based on the series of screening questions, a total of 12.8 percent of children under age 18 in the United States, or about 9.4 million children, are estimated to have special health care needs. Children with special health care needs are present in 20 percent of U.S. households with children.

Prevalence of CSHCN: By Age and Sex

The prevalence of special health care needs in children increases with their age. Among preschool children (ages 0 through 5), just under 8 percent have special health care needs. The rate is 14.6 percent among children ages 6 through 11. Among adolescents (ages 12 through 17), 15.8 percent have special health care needs. The higher prevalence of special health care needs among older children is likely to be attributable to conditions that are not diagnosed or that do not develop until later in childhood. These findings are not unique to this survey; similar age gradients have been reported for childhood disability using other national survey data.⁴

Special health care needs are more prevalent in boys than girls. Among boys, 15 percent have special health care needs, compared to 10.5 percent of girls. This may be related to the higher proportion of boys who are diagnosed with behavioral disorders.

Prevalence of CSHCN: By Income and Race/Ethnicity

The prevalence of special health care needs does not vary substantially among income groups. Among children in poverty, 13.6 percent have special health care needs, the same percent as children with family incomes of four times the poverty level or more. Poverty guidelines vary by family size. During 2001, the poverty guideline for a family of four was $17,650*.

The prevalence of special health care needs varies by the child’s race and ethnicity. The prevalence of special health care needs is highest among Native American/Alaska Native children, multiracial, and non-Hispanic White children; the differences among these three groups are not statistically significant**. Among non-Hispanic White children, 14.2 percent have special health care needs, and among non-Hispanic Black children, 13 percent have special health care needs. The lowest prevalence rates are found among Hispanic children (8.6 percent) and non-Hispanic Asian children (4.4 percent).

* Federal Poverty Level: For most households surveyed, 100 percent of poverty was defined as $11,610 for a family of two, $14,630 for a family of three, $17,650 for a family of four, etc. These reflect 2001 DHHS poverty guidelines.

** Statistical significance reflects the probability that an observed difference is due to chance alone. Generally, a finding is considered statistically signicant if there is less than a 5 percent probability that is due to chance.

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Home | Table of Contents | Introduction | Prevalence of CSHCN |
Health and Functional Status of CSHCN | Health Insurance Coverage |
Health Care Needs and Access to Care | Care Coordination | Family-Centered Care | Impact on Families | State Data Pages | Appendix | Footnotes