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Curr Probl Pediatr Adolesc Health Care. 2016 May;46(5):135-53. doi: 10.1016/j.cppeds.2016.02.004. Epub 2016 Apr 18.

Screening for Social Determinants of Health Among Children and Families Living in Poverty: A Guide for Clinicians.

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The Department of Pediatrics, The Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Nemours, Wilmington, DE. Electronic address:
The Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA.
The Division of General Pediatrics, Boston Children׳s Hospital, Boston, MA.
The Department of Pediatrics, Albert Einstein College of Medicine, The Children׳s Hospital at Montefiore, Bronx, NY.
The Department of Pediatrics, UCSF Benioff Children׳s Hospital Oakland, Oakland, CA.
The Department of Pediatrics, New York University, New York, NY.
The Department of Pediatrics, The Children׳s Hospital of Philadelphia, Philadelphia, PA.


Approximately 20% of all children in the United States live in poverty, which exists in rural, urban, and suburban areas. Thus, all child health clinicians need to be familiar with the effects of poverty on health and to understand associated, preventable, and modifiable social factors that impact health. Social determinants of health are identifiable root causes of medical problems. For children living in poverty, social determinants of health for which clinicians may play a role include the following: child maltreatment, child care and education, family financial support, physical environment, family social support, intimate partner violence, maternal depression and family mental illness, household substance abuse, firearm exposure, and parental health literacy. Children, particularly those living in poverty, exposed to adverse childhood experiences are susceptible to toxic stress and a variety of child and adult health problems, including developmental delay, asthma and heart disease. Despite the detrimental effects of social determinants on health, few child health clinicians routinely address the unmet social and psychosocial factors impacting children and their families during routine primary care visits. Clinicians need tools to screen for social determinants of health and to be familiar with available local and national resources to address these issues. These guidelines provide an overview of social determinants of health impacting children living in poverty and provide clinicians with practical screening tools and resources.

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