Children With Special Health Care Needs

Narrative

Children are considered to have a special health care need if, in addition to a chronic medical, behavioral, or developmental condition that has lasted or is expected to last 12 months or longer, they experience either service-related or functional consequences, including the need for or use of prescription medications and/or specialized therapies.1 In 2011–2012, 19.8 percent of U.S. children under the age of 18 had a special health care need, representing 14.6 million children.2 Previous research indicates that among households with children under the age of 18 years, nearly one-quarter (23.0 percent) include at least one child with special health care needs.3

The prevalence of special health care needs in 2011–2012 varied by sociodemographic characteristics. Significantly more males than females were reported to have such needs (22.5 versus 17.0 percent, respectively), as were school-aged children compared to children aged 0–5 years: Approximately one-quarter of children aged 6–11 and 12–17 years were reported to have a special health care need (22.7 and 25.1 percent, respectively) compared to 11.4 percent of those aged 0–5 years (Figure 1).

CSHCN by Age and Sex

Figure 1 Source

The proportion of children with reported special health care needs also varied by race and ethnicity, and primary language spoken in the home. Non-Hispanic Black children had the highest rate (24.2 percent), followed by non-Hispanic White children (21.6 percent), while Hispanic children had the lowest rate of special health care needs (14.7 percent). The prevalence of special health care needs was higher among children living in households where the primary language spoken was English (21.9 percent) compared to households where the primary language spoken was something else (8.7 percent).

Although the presence of special health care needs did not vary by economic status, children living in households where at least one adult had a high school diploma or higher were more likely to have such needs reported (approximately 20.5 percent) than those that lived in a household where no adult had completed high school (15.9 percent). The proportion of children with special health care needs was also lower for those living in a household with two biological or adoptive parents (16.4 percent) compared to children in other types of family arrangements (approximately 26 percent).

The complexity and severity of health impacts among children with special health care needs can vary greatly.4 Among children with such a need in 2011–2012, more than one-third (34.7 percent) had a condition that was managed with prescription medication only, while 16.6 percent had conditions that resulted in above-routine use of medical, mental health, or other services (Figure 2). Approximately one-quarter of this population needed or used both prescription medication(s) and greater levels of health services. Another 24.0 percent were the most severely affected children that had conditions resulting in functional limitations.

CSHCN by Type of Impact

Figure 2 Source

Data Sources

Figure 1. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau and Centers for Disease Control and Prevention, National Center for Health Statistics, National Survey of Children’s Health. Unpublished data. Analyzed by the Maternal and Child Health Bureau.

Figure 2. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau and Centers for Disease Control and Prevention, National Center for Health Statistics, National Survey of Children’s Health. Unpublished data. Analyzed by the Maternal and Child Health Bureau.

Endnotes

1 McPherson M, Arango P, Fox H, et al. A new definition of children with special health care needs. Pediatrics. 1998;102(1):137–139.

2 Note: Published estimates of the prevalence of special health care needs may vary depending by data source. The 2009–2010 National Survey of Children With Special Health Care Needs found the prevalence of such needs to be 15.1 percent among U.S. children.

3 Child and Adolescent Measurement Initiative. Data Resource Center. Accessed July 21, 2014.

4 Bramlett MD, Read D, Bethell C, Blumberg SJ. Differentiating subgroups of children with special health care needs by health status and complexity of health care needs. Maternal Child Health J. 2009 Mar;13(2):151-63.

Data

Statistical Significance Test

Calculate the difference between two estimates:

Calculated Z-Test Result 0.9567433 Not statistically significant

We follow statistical conventions in defining a significant difference by a p-value less than 0.05 where there is a less than 5% probability of observing a difference of that magnitude or greater by chance alone if there were really no difference between estimates. The 95% confidence interval includes a plausible range of values for the observed difference; 95% of random samples would include the true difference with fewer than 5% of random samples failing to capture the true difference.

This website allows comparisons between two estimates using the independent z-test for differences in rates or proportions. This test is appropriate for comparing independent populations across years (e.g., 2011 versus 2012) or subgroups (e.g., Male versus Female) on corresponding measures. To the extent possible, the functionality of this application has limited estimate comparisons based on appropriate use of the independent z-test. However, some tables present subgroup categories within broader categories that will allow comparisons between non-independent populations (e.g., low birth weight and very low birth weight). Users should exercise caution when interpreting these test results, which will frequently overstate statistical significance.

For some tables, the website does not allow for comparisons between two estimates, even though the data represent independent populations. Generally, this is because the standard errors were not publicly available at the time this website was created.

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