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Acad Pediatr. 2012 Jul-Aug;12(4):326-34. doi: 10.1016/j.acap.2012.03.004. Epub 2012 Jun 8.

Participation of children with special health care needs in school and the community.

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Department of Pediatrics, University of California, San Francisco, USA.



Children with special health care needs (CSHCN) are at risk for decreased participation in educational and social activities, which can negatively impact their lives. The objectives of this study were to document the presence of participation restrictions for CSHCN compared with other children and to determine how personal and environmental factors are associated with participation restrictions for CSHCN.


The 2007 National Survey of Children's Health was analyzed to evaluate 2 participation outcomes for children aged 6 to 17 years, ie, school attendance and participation in organized activities, and 2 participation outcomes for children aged 12 to 17 years, ie, working for pay and volunteering. Adjusted prevalences of participation restrictions were calculated for children with and without special health care needs. Logistic regression was used to identify factors independently associated with participation restrictions for CSHCN.


After adjustment for sociodemographic characteristics, a greater proportion of CSHCN (27.9%) reported missing more than 5 days of school than other children (15.1%). In contrast, no differences were found for participation in organized activities, working for pay, or volunteering. CSHCN with functional limitations were more likely to experience all 4 types of participation restrictions compared with other CSHCN and non-CSHCN. For CSHCN, the odds of certain participation restrictions were greater for those with functional limitations, in fair/poor health, with depressed mood, living at or near the federal poverty level, and living in homes not headed by two parents.


CSHCN with functional limitations and those with worse health status are at elevated risk of experiencing participation restrictions than other children. Social disadvantage furthers the likelihood that CSHCN will experience participation restrictions.

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