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Go Back to Basics, Go Back to Schools

Jan 23, 2015, 9:00 AM, Posted by Katherine Vickery

Erin Maughan
Health Care in 2015 logo

If we want to create a Culture of Health in America, a 2015 priority must be to focus on ways to break down the barriers that separate us and keep us from being as effective and efficient as possible. Currently, health care systems, education, housing, and public health work in siloes; they are funded in siloes, and workers are trained in siloes. Yet, people’s concerns and lives are not siloed and a community health culture/system cannot be either.  One of the places to begin coordinated cultural change is in schools.

Schools are a smart choice to target because nearly 98 percent of school-age children, in their formative years, attend school and schools provide access to families and neighborhood communities. The Department of Education’s Full-Service Community Schools Program and Whole School, Whole Child, Whole Community Initiative reminds us that, in order for children to be educated, they need to be healthy and there must be a connection between school and community.

There are many school health initiatives in place, such as healthy food choices, physical fitness, healthy policies, school health services, community support, and after-school programs. The potential is there—but so are the siloes. But when schools are appropriately staffed with school nurses, the nurses help break down the siloes; that is because school nurses are extensions of health care, education, and public health and thus can provide or coordinate efforts to ensure a holistic, resource efficient, healthy school community.

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Misfortune at Birth

Nov 14, 2014, 8:00 AM, Posted by Eileen Lake

Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, are co-principal investigators of a study, supported by the Robert Wood Johnson Foundation (RWJF) Interdisciplinary Nursing Quality Research Initiative, that generated evidence linking nurse staffing and work environments to infant outcomes in a national sample of neonatal intensive care units.* A new documentary, “Surviving Year One,” examines infant mortality in Rochester, N.Y. and nationwide. It is being shown on PBS and World Channel stations (check local listings). Read more about it on the RWJF Culture of Health Blog here and here.

Eileen Lake (Smaller photo) Eileen Lake

Are some premature babies simply born in the wrong place? Premature babies are fragile at birth and most infant deaths in this country are due to prematurity.  It is well established that blacks have poorer health than whites in our country, but the origin of these disparities is still a mystery.  It’s possible that the hospital in which a child is born may tell us why certain population groups have poorer health.

A new study by University of Pennsylvania and Rutgers investigators that I led shows that seven out of ten black infants with very low birth weights (less than 3.2 lbs.) in the United States have the simple misfortune of being born in inferior hospitals. What makes these hospitals inferior?  A big component is lower nurse staffing ratios and work environments that are less supportive of excellent nursing practice than other hospitals.  Our study, which was funded by the RWJF Interdisciplinary Nursing Quality Research Initiative, indicates that the hospitals in which infants are born can affect their health all their lives. 

Jeannette Rogowski Jeannette Rogowski

A Brighter Future

What can be done to make these hospitals better?  A first step would be to include nurses in decisions at all levels of the hospital, as recommended by the Institute of Medicine to position nursing to lead change and advance health. Laws in seven states require hospitals to have staff nurses participate in developing plans for safe staffing levels on all units.

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Every Child Counts: Stopping Infant Loss

Nov 13, 2014, 3:08 PM, Posted by Sheree Crute

mother with son on her lap

“Matthew was born big and healthy, just under eight pounds,” Carol Jordan says.

That’s why it was such a shock to her to lose him on an otherwise average Sunday afternoon.

“We had just gotten home from church. My daughter Taylor and my other son Jacob settled in with their video games,” Carol recalls. “I breastfed Matthew and lay him down on his back in his bassinet. He was 3 and ½ months old. About 30 minutes later, I went to check on him. He was on his stomach and he was not breathing.”

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Babies are Dying in Rochester at Twice the National Average. Why?

Nov 7, 2014, 11:13 AM, Posted by Maria Hinojosa

America by the Numbers series on Infant Mortality Photo by: Paul de Lumen.

Rochester, N.Y., is the birthplace of Xerox, Bausch & Lomb, and Kodak, and home to two top-ranked research institutions, the University of Rochester and Rochester Institute of Technology. Nevertheless, babies die in this upstate New York city at a rate two times higher than the national average, and Rochester’s children of color are three times more likely than white infants to die before their first birthday. Why?

To come up with some answers, Futuro visited Rochester as part of its America by the Numbers series, made in partnership with Boston public TV station WGBH (check your local PBS and World Channel listings to see the series). We went knowing that the U.S. as a whole ranks 56th in the world for infant mortality, by far the lowest of any industrialized nation, despite the fact that we spend more on health care per capita than any other country, and the largest portion goes towards pregnancy and childbirth. This makes Rochester’s statistics even more tragic—an outlier in an outlier.

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Bringing Brain Science to the Front Lines of Care

Nov 4, 2014, 5:34 PM, Posted by Jane Isaacs Lowe, Martha Davis


The brain is an exquisitely sensitive organ—so sensitive that, as recent advances in brain science show us, children who are exposed to violence, abuse, or extreme poverty can suffer the aftereffects well into adulthood. They are more likely to develop cancer or heart disease as they age, for example.

But how to translate these findings into practices and policies that can strengthen families and children? How do caregivers help traumatized children and their families cope with adversity? How can the science be applied to what teachers, doctors, social workers, and others on the front lines do every day? And how should the science affect whole systems, so that every person, at every level, can do their part to help children and families thrive?

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The Importance of Emphasizing Healthy Habits for All Children

Aug 20, 2014, 11:00 AM


Human Capital Blog: Congratulations on your award from the Western Institute of Nursing! The award honors new nurse researchers. What does it mean for you and for your career?

Carolyn Montoya: In addition to being quite an honor, receiving the Carol Lindeman Award for new researchers from the Western Institute of Nursing motivates me to continue to pursue my research. I am sure people can relate to the fact that being in the student mode is so very intense that once you finish you need some recovery time. Then you start wanting to use the research skills you worked so hard to obtain, and this award has helped to re-energize my commitment to research.

HCB: The award recognizes your study on children’s self-perception of weight. Please tell us what you found.

Montoya: I was very interested to see if there was a difference between how Hispanic children viewed their self-perception in regard to weight compared with white children. Seventy percent of my study population was Hispanic, and my overall response rate was 42 percent. I found that Hispanic children, ages 8 to 11, are not better or worse than white children in their ability to accurately perceive their weight status. Most surprising, and a bit concerning, was the fact that one-third of the sample expressed a desire to be underweight.

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To Build a Culture of Health, There Is No Place Like Home

Aug 11, 2014, 3:36 PM, Posted by Kristin Schubert

mother with child speaking with a care coordinator

A century ago, it was normal for a doctor to make a house call to tend to a patient in need. By the time I was a child growing up in New Jersey in the 1970s and 80s, the practice had become virtually obsolete.

The case for bringing health care back into the home is becoming more compelling every day. One place where we see the potential to make a big impact is with new parents and newborns.

Last month, JAMA Pediatrics published new research from on the effects of nurse-home visits on maternal and child health. The randomized, clinical trial followed a group of low-income, primarily African American mothers and children living in disadvantaged, urban neighborhoods of Memphis over a 19-year period. Specifically, they wanted to see whether home visits conducted by the Nurse-Family Partnership before and after a birth influenced whether the mothers and children died prematurely.

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What Protects Our Children from the Effects of Stress?

Jul 28, 2014, 9:00 AM, Posted by Lorraine McKelvey

Lorraine McKelvey, PhD, is an associate professor of family and preventive medicine and pediatrics at the University of Arkansas for Medical Sciences. She is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections program (2008-2009) whose work focuses on vulnerable populations.


For children, stress can come from sources inside and outside the family. It was recently documented that nearly two out of every three children in the United States have witnessed or been victims of violence in their homes, schools, or communities. That’s a staggering statistic when we consider the well-established link between children’s exposure to stress and their long-term mental and physical health outcomes.


Indeed, we know that early exposure to adverse experiences can change the way that our brains develop and function. We also know that exposure to adversity increases the likelihood that children will develop psychosocial problems, like depression, aggression, and other antisocial behaviors. There is even evidence that exposure to stressors in childhood increases the likelihood of having heart disease and cancer in adulthood!

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Bedtime Story

Jul 1, 2014, 10:33 AM, Posted by Jeff Meade

Sarah Meade Reading Pic Sarah, having a read at Granny's house

The globby tears, the quavering voice, the pudgy outstretched hands, the plaintive word “please.” They all come to mind as vividly as if it were yesterday.

Our daughter Sarah was (and still is, at 27) a good soul, but like every small child, she had her moments. And when those “moments” more or less coincided with bedtime, the worst punishment we could mete out was to refuse to read her bedtime stories—or “sturries,” as she called them. We would kiss her good night, and adjourn to the living room, there to sit and look at each other guiltily as our little girl suffered the tortures of the damned.

We listened to that heartbreaking little plea, “But I HAVE to have sturries!” echoing down the hall, and our hearts would break, too. We felt like the worst parents ever

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To Address Childhood Obesity, Companies Must Join the Fight

May 7, 2014, 4:38 PM, Posted by Risa Lavizzo-Mourey

Headshot of Risa Lavizzo-Mourey from the Trenton Times. Risa Lavizzo-Mourey, MD, MPH

We’re seeing signs of promise in the effort to reverse the childhood obesity epidemic in the United States. Overall childhood obesity rates have leveled off—and they’ve even declined in some regions and among some age groups.

But it’s far too early to declare victory, writes RWJF President and CEO Risa Lavizzo-Mourey, MD, in a new post on the professional social networking site LinkedIn. The rate of obesity among U.S. teens, she notes, stands at a “shocking 21 percent, and Hispanic and African-American youth still have higher obesity rates than their white and Asian peers.”

To make more progress, Lavizzo-Mourey says, we need more people and organizations in the fight—particularly the business community.

So what more can be done? On Thursday, May 8, Lavizzo-Mourey and influential leaders from throughout the nation—including many from the business community—met to consider innovative approaches in a forum, “Closing the Gap in Childhood Obesity,” sponsored by RWJF and the Clinton Health Matters Initiative, in collaboration with Grantmakers in Health. The forum focused on developing solutions to the inequities that exist in childhood health and childhood obesity.