Experiencing homelessness at any time during the pre- or postnatal period can negatively affect a young child's health. Researchers at Children's HealthWatch, based out of Boston Medical Center (BMC), found that children who experienced both pre- and post-natal homelessness and those who experienced homelessness for longer than six months were at highest risk of negative health outcomes. These findings, published in Pediatrics, illustrate the urgent need to intervene and rapidly house children and families experiencing homelessness to minimize the negative health outcomes.

Researchers interviewed 20,000 low-income caregivers of children under four years old who visited outpatient pediatric clinics in five cities across the U.S. between 2009 and 2015. The researchers asked questions to determine if a child experienced homelessness, how long they experienced homelessness, and when in the child's life they experienced homelessness. They then conducted an assessment of the child determining their overall condition; if/how often the child was hospitalized; if a child was over or underweight; and if the child experienced any developmental delays.

More than three percent of caregivers reported experiencing prenatal homelessness, 3.7 percent reported postnatal homelessness, and 3.5 percent reported both.

The study found children who experienced homelessness for more than six months were at high risk of poor health outcomes. Also at high risk were children who experienced homelessness during both the pre- and post-natal period, showing that the earlier and longer in development a child experiences homelessness may have a larger cumulative toll of poor health and development outcomes.

"These findings back up what we already knew about how the stress of homelessness affects children's heath," said Megan Sandel, MD, MPH, pediatrician at BMC and lead investigator at Children's HealthWatch, "but this helps us determine which children are at greatest risk, and makes the argument that policymakers and providers need to intervene to change the trajectory of a child's development."

Researchers also note the toll poor health outcomes caused by child homelessness can exact on health systems. Greater health care utilization, increased hospitalizations, and need for developmental interventions creates substantial family and societal health care expenses.

"As pediatricians, we should be regularly screening families for housing insecurity, including past history and future risk of homelessness," said Deborah Frank, MD, director of the GROW Clinic at BMC and senior author on the study. "Interventions that prevent homelessness for families and pregnant women can be extremely effective, and with data on the housing status of our patients, we can better advocate for more resources to drive innovations in addressing housing instability."