When it’s my turn to be the pediatrician in the well-baby nursery at my hospital, my job is to counsel new parents about healthy newborn behaviors and assure them their babies are capable of basic survival. Breathing. Eating. Pooping. It is the same rhythm as newborn assessment: Look, listen, feel. For doctors, like me, it is easy to distinguish illness and health in healthy infants. Each infant is unique. I notice that each one has one eye, two mouths, and four limbs moving about. Each tiny baby has a small chest. I set my stethoscope on top and listen to the steady, sharp heartbeats. I feel each baby’s bones as I run my fingers across clavicles, along spines, atop skulls. The pure love mothers have for their children is something I can identify with.
To understand the effects of poverty, my colleagues in pediatrics and I use this rhythm daily. My hospital is a safety net. The median household income in the neighborhood outside our hospital’s manicured lawns is $36,572. Medicaid eligibility is almost universal for most of our Medicaid-eligible patients. Always listening to those with poverty insecurity has been our policy. These insecurity related to poverty abated when the child credit became effective last year. However, the stresses of January have returned since its expiration.
Again, essentials can be difficult to obtain. In our clinics, parents are more often in need of diapers. Our neonatal intensive unit (NICU), receives more requests from parents for help with diapers. Car seats are requested in three places: the NICU, the nursery and the clinic. We replenish the pile of newborn clothes in our hospital’s donation closet each time the pile dwindles, the bins labeled not by what they contain, but by the names of the churches who provided their contents. Again, I hear parents tell me that their babies are in need of transportation. They have three buses to get there. These are just a few of many reasons why the NICU nurse manager calls our formula representative every day to ask if they can source the rarest formulas possible for their most delicate patients.
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Although we are buoyed and supported by our village of policy-makers, community members, donors, non-profit organizations, and donors, it can be tempting to feel overwhelmed by the extent of the needs. Our social worker is able to provide breast pumps temporarily and our nurse manager can find transportation funds, but that’s not the point. Because the rhythms and routines of our lives are predetermined, we can easily find other solutions and these options. For a time, however, it was not necessary. While she waited for the electric pump to arrive on her insurance, I didn’t see a new mom pumping breastmilk drop by drop.
As I walk from room to room, my patients’ bodies appear indistinct. However, a recent study in April revealed that I could see the effects of poverty embedded within these bodies by looking deeper with more sensitive tools. The researchers used magnetic resonance imaging (MRI) to study the development of brains in newborn babies. This means that poverty has a negative impact on fetal growth. It is possible to overcome these effects. Examples abound. There are many examples. But, no baby should ever have to make the attempt.
Talking about research that differentiates foetuses on the basis of lived experience can prove difficult. It is tempting to blame mothers who are pregnant for any negative outcomes that their children experience. It isn’t a new idea to blame mothers for the negative outcomes their children experience. It is false to assume that women must be strong, capable of having healthy pregnancies despite social stressors or systemic racism. Living in poverty is not something that anyone wants to do. No one, not pregnant women nor children. Nobody.
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These new findings are not unexpected. It is clear that poverty during pregnancy, infanthood, and young childhood has a direct link to adverse health outcomes. The seminal report “From Neurons to Neighborhoods” provided cogent and coherent content about poverty’s effect on newborns and young children in 2000. It is remarkable that in the 22-years since that report was published, as well as all of the subsequent reports, there has been a slowing down in progress.
Slow progress does not mean no progress. It is morally imperative that all citizens support healthy births and healthy families. This financial imperative also serves to make sure healthy people are healthy. Healthy workers. California is piloting funding programs for pregnant women. Child tax credit is a federal program that was cost-effective and helped reduce child poverty. It also improved the quality of life for mothers who have children.
Although I’m not an expert in poverty, I’ve lived in a home and been fed my entire life. I do not research poverty’s effects like the study authors in St. Louis, nor am I an expert in early child development like those who authored “From Neurons to Neighborhoods.” But I have spent my pediatric career listening to my patients’ parents share their stories after I remove my stethoscope from my ears. These stories helped me see more than what my eyes can capture and to help those who serve.
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The child tax credit did not make everything better. The early-morning ritual on our postpartum unit of fathers, mindful of disturbing their partners’ sleep, leaving for jobs in warehouses, factories, retail stores, and then returning each evening to participate in newborn bonding they missed while working, never ceased. The patients who have been harmed by gun violence are being served by my colleagues in the pediatric and teen clinic. We could spend more time caring for our patients and sourcing essentials for our families last year, but we can see the benefits. For a while, our patients’ families spent less energy triaging poverty.
Every newborn assessment ends with me asking babies to demonstrate the basic reflexes they need for survival. There are three basic reflexes that babies need to survive: a grab, a squeeze, and a startle. When I press my pointer finger atop a newborn’s palm, he predictably grasps my finger. My grip is not broken if I hold my hand steady. People, babies, and even people are resilient. Predestined, our bodies will grab and grasp and hold onto whatever is offered to them. My only wish is that our nation placed more value in every palm.
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