Series 15, Number

3 June 2002

Summary Statistics From the

National Survey of Early

Childhood Health, 2000
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Halfon N, Olson L, Inkelas M, et al. Summary statistics from the National

Survey of Early Childhood Health, 2000. National Center for Health Statistics.

Vital Health Stat 15(3). 2002.

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Summary statistics from the National Survey of Early Childhood Health,

2000.

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(DHHS publication ; no. (PHS) 2002-1164)

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1. Children—Health and hygiene—United States—Statistics. 2. Medical

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Series 15, Number 3

Summary Statistics From the

National Survey of Early Childhood

Health, 2000

Data From Special Surveys

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyattsville, Maryland

June 2002

DHHS Publication No. (PHS) 2002-1164
National Center for Health Statistics

Edward J. Sondik, Ph.D., Director

Jack R. Anderson, Deputy Director

Jack R. Anderson, Acting Associate Director for

International Statistics

Jennifer H. Madans, Ph.D., Associate Director for Science

Lawrence H. Cox, Ph.D., Associate Director for Research

and Methodology

Jennifer H. Madans, Ph.D., Acting Associate Director for

Analysis, Epidemiology, and Health Promotion

Edward L. Hunter, Associate Director for Planning, Budget,

and Legislation

Jennifer H. Madans, Ph.D., Acting Associate Director for

Vital and Health Statistics Systems

Douglas L. Zinn, Acting Associate Director for

Management

Charles J. Rothwell, Associate Director for Information

Technology and Services

Division of Health Interview Statistics

Jane F. Gentleman, Ph.D., Director

Anne K. Stratton, M.S., Associate Director for Planning and

Production

Eve Powell-Griner, Ph.D., Associate Director for Science

Susan S. Jack, M.S., Special Assistant for Data Quality and

User Services

Eve Powell-Griner, Ph.D., Acting Chief, Illness and

Disability Statistics Branch

Howard Riddick, Ph.D., Chief, Survey Planning and

Development Branch

Robert A. Hill, Chief, Systems and Programming Branch

Robert A. Wright, Chief, Utilization and Expenditure

Statistics Branch

Acknowledgments

The National Survey of Early

Childhood Health (NSECH) was made

possible with funding from The Gerber

Foundation. Additional funding was

provided by the American Academy of

Pediatrics (AAP) Friends of Children Fund,

and by the Federal Maternal and Child

Health Bureau (MCHB), the Health

Resources and Services Administration

(HRSA). Principal investigators are Lynn

Olson, Ph.D., and Neal Halfon, M.D.,

M.P.H.

The survey was conducted by the

National Center for Health Statistics

(NCHS), the Centers for Disease Control

and Prevention (CDC). The project director

was Marcie Cynamon.

The survey was designed by the

UCLA Center for Healthier Children,

Families, and Communities; the National

Center for Infancy and Early Childhood

Health Policy at UCLA; AAP; the

Foundation for Accountability (FACCT),

and NCHS.

This project would not be possible

without the substantial contributions of

many people. We especially thank our

collaborators: Christina Bethell (FACCT),

Stephen Blumberg (NCHS, CDC), Michael

Kogan (MCHB), Jeanne Santoli (National

Immunization Program, CDC), and Phyllis

Stubbs (MCHB).

This report was prepared in the

Division of Health Interview Statistics.

Stephen Blumberg served as content

reviewer. This report was edited by

Gail V. Johnson and typeset by

Annette F. Holman of the Publications

Branch, Division of Data Services.
Contents

Acknowledgments .......................................................................................... ii

Abstract .................................................................................................. 1

Introduction ............................................................................................... 1

The National Survey of Early Childhood Health................................................................ 2

Methods .................................................................................................. 2

Sample Design........................................................................................... 2

Sample Size and Response Rate............................................................................. 2

Survey Content .......................................................................................... 3

Weighting and Estimation .................................................................................. 3

Reporting ............................................................................................... 3

Demographic and Household Information ....................................................................... 3

Health Care Providers and Utilization .......................................................................... 4

Parental Preferences for Pediatric Care ......................................................................... 4

Importance of Well-Child Care................................................................................ 5

Parent Satisfaction With Child’s Health Care .................................................................... 5

Family-Centered Care ....................................................................................... 5

Content of Early Childhood Health Care ........................................................................ 5

Discussions About Immunization and Parent Safety Concerns....................................................... 6

Parental Home Injury Prevention Measures...................................................................... 6

Hours Spend in Child Care................................................................................... 6

Family Routines............................................................................................ 6

Family Activities and Interactions ............................................................................. 7

Breastfeeding .............................................................................................. 7

Child Health Status ......................................................................................... 7

Parent Concerns............................................................................................ 7

Provision of Developmental Assessment ........................................................................ 8

Parental Coping ............................................................................................ 8

Missed or Delayed Care ..................................................................................... 8

Trouble Paying for Health Services ............................................................................ 8

Trouble Paying for Nonhealth Services ......................................................................... 8

References ................................................................................................ 9

iii
Detailed Tables

Demographic and Household Information

1. Percent of young children (4–35 months of age) with selected characteristics: United States, 2000 ................. 10

2. Percent of young children (4–35 months of age) by selected characteristics of the mother: United States, 2000 ....... 10

3. Percent of young children (4–35 months of age) by selected characteristics of their household: United States, 2000 . . . 11

Health Care Providers and Utilization

4. Percent of young children (4–35 months of age) with a usual source and provider of health care by maternal race and

ethnicity: United States, 2000 ......................................................................... 11

Parental Perceptions of Pediatric Care

5. Percent of young children (4–35 months of age) by parent or guardian’s preferences for selected pediatric discussion

topics and by maternal race and ethnicity: United States, 2000 .............................................. 12

6. Percent of young children (4–35 months of age) by parent or guardian’s perceptions of the importance of well-child

care and by maternal race and ethnicity: United States, 2000 ................................................ 13

7. Percent of young children (4–35 months of age) by parent or guardian’s satisfaction with the child’s health care

and by child’s type of health insurance: United States, 2000 ................................................ 13

8. Percent of young children (4–35 months of age) whose parent or guardian would recommend their health care

provider by child’s type of health insurance: United States, 2000 ............................................ 14

9. Percent of young children (4–35 months of age) by parent or guardian’s perception of extent to which health care is

family-centered and by child’s type of health insurance: United States, 2000 ................................... 14

10. Percent of young children (4–35 months of age) by parent or guardian’s perception of extent to which health care is

family-centered and by maternal race and ethnicity: United States, 2000....................................... 15

Interaction With Health Care Providers

11. Percent of young children (4–35 months of age) by provision of preventive health care for nutrition issues and by

age of child: United States, 2000....................................................................... 16

12. Percent of young children (4–35 months of age) by provision of preventive health care for language development

issues and by age of child: United States, 2000 ........................................................... 17

13. Percent of young children (4–35 months of age) by provision of preventive health care for immunization issues and

by age of child: United States, 2000 .................................................................... 17

Family Interactions and Home Safety

14. Percent of young children (4–35 months of age) by selected home injury prevention measures and by age of child:

United States, 2000.................................................................................. 18

15. Percent of young children (4–35 months of age) by household income, by maternal employment, and by hours in

child care: United States, 2000 ........................................................................ 19

16. Percent of young children (4–35 months of age) who have consistent family routines by age of child:

United States, 2000.................................................................................. 20

17. Percent of young children (4–35 months of age) by frequency of selected family activities: United States, 2000 ...... 20

18. Percent of young children (4–35 months of age) by maternal education, child’s participation in WIC, and whether

the child has ever been breastfed: United States, 2000 ..................................................... 21

Parental and Child Health

19. Percent of young children (4–35 months of age), by age, child’s type of health insurance, and overall health status:

United States, 2000.................................................................................. 21

20. Percent of young children (4–35 months of age) by extent of parental concerns for selected developmental issues:

United States, 2000.................................................................................. 22

21. Percent of young children (4–35 months of age) whose parents are ‘‘a lot’’ or ‘‘a little’’ concerned with selected

developmental issues, by age of child: United States, 2000.................................................. 23

22. Percent of young children (4–35 months of age) who have received a developmental risk assessment: United States,

2000.............................................................................................. 24

23. Percent of young children (4–35 months of age) by maternal race and ethnicity, by age of child and parent or

guardian’s perceptions of their success coping with the day-to-day demands of parenthood: United States, 2000 ...... 24

iv
24. Percent of young children (4–35 months of age) by extent of parent or guardian’s self-reported well-being:

United States, 2000.................................................................................. 25

25. Percent of young children (4–35 months of age) by availability of emotional support for parent or guardian, age of

child, and maternal race and ethnicity: United States, 2000 ................................................. 25

Financial Welfare and Barriers to Care

26. Percent of young children (4–35 months of age) who missed or delayed medical care by child’s type of health

insurance: United States, 2000......................................................................... 26

27. Percent of young children (4–35 months of age) by extent of difficulty paying for selected health services for the

child and by child’s type of health insurance: United States, 2000 ........................................... 26

28. Percent of young children (4–35 months of age) by extent of difficulty paying for selected health and nonhealth

services for the child and by household income: United States, 2000 ......................................... 27

v
Objectives

This report presents statistics from Summary Statistics From the

the 2000 National Survey of Early

Childhood Health (NSECH) on selected National Survey of Early measures for children 4–35 months of

age. The topics covered include usual

source of care, parental perceptions of Childhood Health, 2000

pediatric care, interactions with health

care providers, family activities, home by Neal Halfon, M.D., M.P.H., University of California, Los Angeles safety, parental and child health,

financial welfare, and barriers to care. (UCLA); Lynn Olson, Ph.D., American Academy of Pediatrics; Moira

Inkelas, Ph.D., Ritesh Mistry, M.P.H., Harvinder Sareen, M.P.H.,

Source of Data Linda Lange, Dr.P.H., Miles Hochstein, Ph.D., and Janel Wright,

The NSECH is a random-digit-dial University of California, Los Angeles (UCLA)

telephone survey of a national sample

of young children 4–35 months of age.

One age-eligible child per household

was the subject of the interview, and Introduction Predictability and consistency highlight

the parent or guardian who is primarily the importance of routines in a young

responsible for the child’s medical care child’s life and how routines affect the

was the survey respondent. The Through preventive health child’s daily life in organizing a child’s

NSECH was a survey module of the counseling and education about attention, sleep, eating, and other

State and Local Area Integrated child development, child health behaviors. Encouragement and mastery

Telephone Survey and was conducted

care providers play an important role in highlight a range of behaviors that

by the National Center for Health

Statistics (NCHS). The questionnaire helping parents promote children’s include emotional regulation, the ability

was designed by the UCLA Center for healthy development. Recent research on to communicate effectively and establish

Healthier Children, Families, and the impact of familial context and relationships, and various cognitive

Communities in collaboration with the routines on the cognitive, emotional, and abilities.

American Academy of Pediatrics, the social development of children has Research on pediatric providerFoundation for Accountability, and strongly influenced pediatricians’ patient interactions indicates that most

NCHS. recommendations addressing child of the concerns that parents bring to

development (1–5). These have their pediatric provider are psychosocial

Highlights progressed from a narrow focus on in nature. This has been demonstrated

Parents of most young children 4–35 developmental monitoring and the by two recent national surveys. A recent

months of age believe well-child visits provision of basic information to parents survey of parents by Zero to Three

are very important. Most young children to a broader focus that includes (What Grown-Ups Understand About

have a usual source of well-child care, psychosocial issues of the family (5). Child Development) (13) shows high

although not all have a regular clinician. The research literature suggests that levels of parental knowledge regarding

Parents of most young children believe children’s optimal development is their important role in their infants’ and

that health care providers should

discuss less traditional topics with them, facilitated in a family context, and toddlers’ development. However, these

such as alcohol or drug abuse, and characterized by predictability and very same parents are unsure about their

social support for parents. However, consistency (6,7), warmth and support specific role in their child’s emotional,

many children are not receiving (8–10), encouragement of mastery (11), social, and intellectual development. A

important anticipatory guidance and and physical safety (12). Warmth and vast majority reported that they would

developmental services. There are support refer to the emotional context of like to improve their parenting skills

disparities in the content of health care the family, such as the emotional regardless of their confidence in their

by race/ethnicity, health insurance availability of parents, and their skills.

coverage, and maternal education level. responsiveness and attunement to the In the Commonwealth Survey of

There are also differences by maternal emotional state of their young child. Parents of Young Children (14), many

education and socioeconomic parents reported not receiving

characteristics in the proportion of anticipatory guidance from their

young children who experience positive Keywords: child health c health provider on psychosocial topics such as

developmental environments, as provider contacts c anticipatory how to discipline a child, how to indicated by consistent routines, regular guidance c quality of care c child encourage a child to learn, and how to reading, and participation in regular development c early childhood c deal with a child’s sleeping and eating family activities. access to care patterns. From a list of different

Page 1
Page 2 [ Series 15, No. 3

anticipatory guidance topics, fewer than

50% of parents reported receiving

information on most topics. For some

items, fewer than 25% of parents

reported receiving guidance on these

topics from their child’s physician. In

contrast, 54% of parents reported that

they could use more information about

how to help and encourage their child to

learn, 52% wanted more information

about how to discipline their child, and

20–40% indicated a desire for other

anticipatory guidance. This survey

indicates the great need and demand for

information, guidance, and interventions

for families to help ensure the optimal

development of children.

Parents can get this information

from a variety of sources such as

relatives, friends, and community

information sources. However, how

parents process and learn from this

information may depend on whether or

not information is provided in a

consistent and effective manner that

facilitates learning and positive change

in familial context.

A recent survey of pediatricians

conducted by the American Academy of

Pediatrics (AAP) (1) found that

pediatricians agree it is important to

assess children’s development and

improve parents’ understanding of

development issues. Pediatricians report

that they routinely assess children’s

developmental milestones and parental

concerns regarding development, and

that they do conduct clinical

assessments of development. However,

pediatricians raise significant concern

about the economic feasibility of

providing such developmental services

in the context of their pediatric

practices. This suggests there may be

disparities in the developmental content

of care for young children.

Before they reach age 3, most

children in the United States will have

seen a doctor numerous times for

routine and sick visits. Thus, child

health care providers are in a critical

position to identify developmental issues

and to disseminate information to

parents. Yet, to date, there is a paucity

of information on the content of

pediatric care as perceived by parents of

young children. This leaves us without

baseline performance and quality

information upon which improvement

efforts could be launched.

The National Survey of

Early Childhood Health

The National Survey of Early

Childhood Health (NSECH) addresses

this information gap. It is designed to

improve understanding of household

experiences with preventive pediatric

care and the ways in which families

promote their children’s health in the

home. It is a telephone survey of a

national random sample of 2,068 young

children (4–35 months of age).

The major research questions

addressed by the survey are:

+ What are the concerns of parents

and what are the health care needs

of young children?

+ Are these health care needs and

these parental concerns being

addressed when children visit health

care providers?

+ What is the quality of

developmental and psychosocial care

that young children receive?

+ What factors are associated with the

receipt of better quality, more

comprehensive pediatric care?

+ What is the prevalence of selected

home health behaviors in early

childhood?

+ What is the relationship between

parental/home health behaviors and

experiences with pediatric health

care delivery?

These research questions address

two major areas of interest—those

concerning the delivery of preventive

pediatric care to households with young

children and those concerning the

promotion of early childhood health by

families in their homes. The primary

purpose of this survey, as indicated by

the research questions, is to characterize

the content of care and the parent’s (and

child’s) experiences with pediatric

preventive health care. This preventive

health care can be provided by any

pediatric health care providers (broadly

defined), and is not limited to care

provided by pediatricians, pediatric

specialists, or medical doctors. The

second purpose of this survey is to

understand the relationship between

health promotion in the pediatric office

and health promotion in the home.

Methods

Details concerning the

questionnaire and survey

methods are available in a

companion report entitled Design and

Operation of the National Survey of

Early Childhood Health, 2000 (15). This

section simply provides an overview of

these topics.

Sample Design

The target population for the study

consisted of households with children

4–35 months of age. Telephone

households from all 50 States were

identified via random-digit-dialing.

These households were screened for

children within the eligible age range.

The sponsors of this survey were

also interested in African-American and

Hispanic children’s experiences with

child health care providers. To get more

precise estimates for these populations,

households with African-American or

Hispanic children were oversampled. To

obtain the oversample, after identifying

households with age-eligible children

from all 50 States, interviewers further

screened households for an

African-American or Hispanic child. If

more than one eligible child resided in a

sampled household, one child was

randomly selected for interview using a

programmed random sampling

algorithm.

Two samples of children were

therefore selected for the survey. Details

on sample allocation are available in the

Design and Operation report (15). For

the present report, data from both

samples have been combined for all

analyses.

Sample Size and Response

Rate

Interviews were completed with the

parents and guardians of 2,068 children

4–35 months of age. Of these
Series 15, No. 3 [ Page 3

interviews, 1,208 were from the main

sample and 860 were from the minority

oversample. The majority of respondents

were mothers of the sample children

(87%); the remaining respondents were

fathers (11%), grandparents (2%), or

other guardians (less than 1%). The

Council of American Survey Research

Organizations (CASRO) response rate,

derived from the product of the

interview completion rate, the screener

completion rate, and the telephone

number resolution rate, was 65.6%.

Survey Content

The NSECH includes questions that

are also present in a variety of other

studies, such as the National Health

Interview Survey (NHIS); the National

Survey of Children with Special Health

Care Needs; the Medical Expenditure

Panel Survey; the Consumer Assessment

of Health Plans Survey; the

Commonwealth Survey of Families with

Young Children (14); the

Commonwealth Pediatric Developmental

Services Survey; and the FACCT

Promoting Healthy Development (PHD)

Survey (16) (which was expanded and

adapted into the Promoting Healthy

Development Survey PLUS [PHDS

PLUS] as NSECH was being

developed).

The seven sections of the NSECH

questionnaire included:

+ Demographic and household

information

+ Health care utilization

+ Parental perception of pediatric care

+ Interactions with health care

providers

+ Family interactions and home safety

+ Parental and child health

+ Financial welfare and health

insurance

The survey respondent was the

parent or guardian primarily responsible

for the sampled child’s medical care.

The questionnaire was translated

into Spanish by one translator and then

back-translated into English by another

translator. The use of two contractors

assured that each translation was done

independently of the other.

Discrepancies were resolved in

consultation with the two translators. In

addition, a team of experienced

Spanish-language telephone interviewers

and supervisors reviewed the Spanish

instrument for accuracy and cultural

appropriateness.

NSECH was conducted as a module

of the State and Local Area Integrated

Telephone Survey (SLAITS). Therefore,

the questionnaire was designed to

immediately follow a completed

National Immunization Survey (NIS)

interview or screener. The NIS was

established to monitor the vaccination

levels of very young children both

within 78 State and local areas and

across the United States (17). This

survey is conducted by the National

Immunization Program and by the

National Center for Health Statistics

(NCHS). NIS screens an extremely large

number of households in order to find

its relatively rare target population of

households with children 19–35 months

of age; nearly a million households are

screened by telephone each year to

obtain 34,000 completed household

interviews. The large initial sample of

telephone numbers in NIS provides a

cost-effective opportunity to survey

other populations in addition to the rare

population that eventually screens into

NIS. The survey mechanism that uses

the NIS sample frame for collecting data

about these other populations is known

as SLAITS and is administered by

NCHS.

Weighting and Estimation

For producing population-based

estimates, each child for whom complete

data were available was assigned a

sampling weight. This weight combined

the base weight, which reflects the

probability of selection of a

respondent’s telephone number, with an

adjustment for households that have

multiple telephone numbers, and with

adjustments that compensate for

nonresponse. Finally, weights were

adjusted to match known population

control estimates and to adjust for the

noncoverage of nontelephone

households.

Reporting

In this report, data tables show the

percentages weighted to represent

children 4–35 months of age nationally

(not to represent households with young

children). The reported percentages thus

are an accurate reflection of U.S.

children 4–35 months of age.

Standard errors are shown for all

percents in tables. Percents with relative

standard errors greater than 30% are

considered unreliable and are indicated

with an asterisk(*). The relative standard

errors are calculated as follows:

Relative standard error =

(SE/EST)100 where SE is the standard

error of the estimate and EST is the

estimate.

The next sections of this report

highlight key estimates from the tables.

Statistical tests of differences among

point estimates were not used in this

report. However, key results are

highlighted in the text when large

differences in point estimates were

observed. For ease of presentation, the

text refers to children’s parents, but the

estimates include other guardians when

the parent was not the respondent to the

survey.

Demographic and

Household

Information

Weighted to U.S. population

estimates, children 4–9 months

of age comprise 19% of

children 4–35 months of age.

Twenty-eight percent of children within

this age range are 10–18 months of age,

and 53% are 19–35 months of age. (See

tables 1–3.)

+ Most children 4–35 months of age

(71%) have mothers who are 25

years of age or older. Twenty-one

percent of these young children have

mothers who are 35 years of age or

older and 7% have mothers who are

younger than 20 years of age.

+ Most children 4–35 months of age

(69%) have mothers who are
Page 4 [ Series 15, No. 3

married. Twenty-two percent of

these young children have mothers

who have never been married while

about 9% have mothers who are

divorced or separated.

+ Most children 4–35 months of age

have mothers who are white

non-Hispanic (63%). Fourteen

percent of these young children have

mothers who are black non-Hispanic

and 18% have mothers who are of

Hispanic origin.

+ Forty-six percent of children 4–35

months of age have mothers who

received post high school education.

Thirty-four percent of these young

children have mothers who are high

school graduates only and 21% have

mothers with less than a high school

education.

+ Approximately 55% of children

4–35 months of age have mothers

who are employed either part-time

or full-time.

+ Thirty-five percent of children 4–35

months of age live in households

with income of up to $25,000.

About 14% of these young children

are in households with income of

greater than $75,000. Ten percent of

these young children have parents

who either did not know their

household income or refused to

report it.

+ Ten percent of children 4–35 months

of age are in households with only

one adult. Most young children

(75%) are in households with two

adults, and about 30% are in

households with no other children

under 18 years of age.

Health Care Providers

and Utilization

Having a regular provider has

been associated with access to

services and continuity of care,

which are important for the receipt of

quality pediatric preventive health care.

(See table 4.)

+ Nearly all children 4–35 months of

age have a particular place for

well-child care. However, fewer than

one-half of children 4–35 months of

age (46%) see a particular person

for well-child care. Of the young

children who see a particular person,

about 76% see a pediatrician.

+ About 74% of children 4–35 months

of age usually go to a private or

group practice for care. More than

80% of children in households

where the mother is white

non-Hispanic go to a private or

group practice for care, whereas

only 54% of children in households

where the mother is Hispanic go to

a private or group practice for care.

+ About 32% of children in

households where the mother is

Hispanic go to community health

centers or public clinics for care,

compared with about 12% of

children in households where the

mother is white non-Hispanic.

Parental Preferences

for Pediatric Care

Parents were asked whether their

child’s health care providers had

asked about parents’ well-being,

economic problems, substance use, and

community violence. (See table 5.)

+ Parents of about 77% of children

4–35 months of age have been

asked by their child’s health care

providers about smoking in the

household. Health care providers

asked about smoking for 86% of

children 4–35 months of age where

the mother was black non-Hispanic,

85% where the mother was

Hispanic, and 72% where the

mother was white non-Hispanic.

+ Parents of most children 4–35

months of age (89%) believe that

health care providers should ask

parents about alcohol or drug use in

the home even though parents of

fewer children (44%) have been

asked. The proportion of children

whose parents have been asked

ranges from 35% of young children

where the mother is white

non-Hispanic, to 59% where the

mother is black non-Hispanic, and

67% where the mother is Hispanic.

+ On the topic of parenting support,

parents of most children 4–35

months of age (85%) believe that a

child’s health care providers should

ask whether a parent has someone to

turn to for emotional support, with

parents of many children (79%)

believing that the provider should

ask whether the spouse or partner

was supportive of parenting efforts.

However, parents of fewer than

one-half of the children 4–35

months of age have been asked

about these issues, with few

differences among children based on

the race/ethnicity of the mother.

+ Parents of children 4–35 months of

age report the following issues as

having been discussed least

frequently by the child’s health care

providers: whether the family was

having trouble paying for basic

needs (parents of 12% of these

young children) and violence in the

community (parents of 10% of these

young children).

+ The proportion of children 4–35

months of age whose health care

providers asked about violence in

their community ranges from 22%

of children where the mother is

Hispanic, to 15% where the mother

is black non-Hispanic, to 6% where

the mother is white non-Hispanic.

+ Overall, although parents of

relatively few children 4–35 months

of age have been asked about family

or community issues, parents of at

least one-half of these young

children believe that providers

should ask about these issues. For

example, parents of 56% of these

young children believe that

providers should ask about violence

in the community. This ranges from

52% of children where the mother is

white non-Hispanic, and 55% of

children where the mother is black

non-Hispanic, to 66% of children

whose mothers are Hispanic. Parents

of approximately 75% of children

4–35 months of age believe that

providers should ask whether the

family was having trouble paying

for basic needs.
Series 15, No. 3 [ Page 5

Importance of

Well-Child Care

Parents were asked for their

opinion of the importance of

well-child care visits, which were

described as ‘‘visits that are made to a

doctor or health care provider who takes

care of your child when he/she is not

sick, but needs a checkup or a shot.’’

Families who believe that well-child

care is very important may be more

receptive to the health care providers’

recommendations. There may be

differences in the importance parents

place on well-child care based on the

health care needs of the child. (See

table 6.)

+ Parents of most children 4–35

months of age (86%) believe

well-child checkups are very

important for the child’s health and

development.

+ There are no notable differences in

the reported value of well-child care

for children based on the

race/ethnicity of the child’s mother.

Parent Satisfaction

With Child’s

Health Care

The NSECH includes several

different measures of parent

satisfaction with the child’s health

care. Pediatricians often report that they

do not have enough time with parents to

talk about development and

psychosocial and other nonmedical

issues (1). Thus parents were asked

whether they felt their child’s health

care provider (which may or may not be

a pediatrician) had spent enough time

with them during their last well-child

visit. Parents were also asked about their

overall satisfaction with their child’s

health care providers, and whether they

had been able to ask all of their

questions at the last well-child visit.

(See tables 7 and 8.)

+ Parents of about 1 out of 10

children 4–35 months of age (12%)

believe that they did not have

enough time with their child’s health

care provider during the last

well-child visit.

+ Parents of about 22% of the children

4–35 months of age who are

uninsured believe that they did not

have enough time with the provider

in the last well-child visit. Parents of

about 11% of the children 4–35

months of age who have private

insurance, and parents of about 11%

of these young children who have

public insurance, believe that the

visit was not long enough.

+ While satisfaction was generally

high, parents of children 4–35

months of age who are uninsured

tend to have lower levels of

satisfaction. For example, parents of

16% of these young children were

not able to ask all their questions at

the last well-child visit.

+ Parents of about 48% of uninsured

children 4–35 months of age rated

the checkups highly (10 on a scale

of 1–10), while parents of about

40% of privately insured young

children and 44% of publicly

insured young children give this

rating.

+ About one-half of the children 4–35

months of age have a particular

person for well-child care. Parents

of most of these young children

with a particular person say that

they would be ‘‘very likely’’ to

recommend the provider. Parents of

most children 4–35 months of age

who are privately insured say that

they would be very likely to

recommend the provider (85%),

while parents of 73% of the publicly

insured children, and parents of 71%

of the children with ‘‘other’’

insurance, are very likely to

recommend the provider.

Family-Centered Care

Family-centered care is an approach

to health care that emphasizes the

development of collaborative

relationships between parents and health

care providers that empower parents to

make educated decisions about their

child’s care.

Families who perceive that their

child’s health care providers respect

them and take time with them may be

more receptive to messages about how

to improve the health of the children

and their environment. This may be

especially true for psychosocial health

care content. Parental perceptions of

family centeredness also have been used

to measure quality. Variations in family

centeredness may reflect disparities in

health care quality, or may imply

differences in how receptive parents

with different circumstances may be to

health messages. (See tables 9 and 10.)

+ Parents of most children 4–35

months of age (66%) believe that

their child’s health care providers

always take time with them, and

parents of 55% of these children

believe that the providers always

respect their expertise as a parent.

Parents of fewer children 4–35

months of age (40%) believe that

the providers always understand

their parenting preferences.

+ In general, parents of children 4–35

months of age who are currently

uninsured have lower levels of

family-centered care. Parents of only

42% of such children believe that

their child’s health care providers

always take time with them.

+ While parents of most children 4–35

months of age (66%) believe that

their child’s health care providers

always take time with them, parents

of 50% of children whose mother is

Hispanic state that this is always the

case.

Content of

Early Childhood

Health Care

Pediatric health care providers are

in a critical position to identify

child developmental issues and to

disseminate information on parenting.

There has been growing interest in the

child health care providers’ role in

promoting early literacy, for example.
Page 6 [ Series 15, No. 3

NSECH asked parents whether

respondents had discussed these and

other topics with their child’s health

care providers. (See tables 11 and 12.)

+ Parents of about 64% of children

4–9 months of age discussed the

importance of reading to children

with the child’s health care

providers at some point since the

child’s birth. Rates of discussion

during the past 12 months were

similar for children 10–18 months of

age and for children 19–35 months

of age.

+ Parents of about 79% of children

4–9 months of age discussed the

child’s communication with the

child’s health care providers at some

point since the child’s birth. Of the

children 4–9 months of age whose

parents did not discuss

communication issues, parents of

52% of these children believed that

this discussion would have been

helpful.

+ Parents of about 54% of children

10–18 months of age discussed

bottle weaning with their child’s

health care providers in the past 12

months. Of the children 10–18

months of age whose parents did not

discuss bottle weaning, parents of

35% of these children believed that

this discussion would have been

helpful.

+ Parents of most children 4–9 months

of age (91%) discussed

breastfeeding with their child’s

health care providers since the

child’s birth.

Discussions About

Immunization and

Parent Safety

Concerns

While most U.S. children do

receive all recommended

immunizations, some children

do not receive their immunizations on

time due to a number of reasons. A

combination of provider practices and

family behaviors contribute to delayed

or low rates of immunizations. NSECH

examined whether or not parents discuss

immunizations with their child’s health

care providers, and whether or not

parents delay or skip immunizations for

the child due to safety concerns. (See

table 13.)

+ Parents of nearly all children 4–35

months of age discussed

immunizations with their child’s

health care providers.

+ Parents of 8% of children 4–35

months of age delayed or skipped a

child’s immunization within the past

12 months due to safety concerns.

Parental Home Injury

Prevention Measures

Many childhood injuries occur in

the home environment and are

preventable. NSECH asked

whether parents had taken specific

age-appropriate injury prevention

measures at home. (See table 14.)

+ Parents of most children 4–35

months of age put stoppers or plugs

in electrical outlets as an injury

prevention measure.

+ Parents of most children 4–35

months of age (78%) put

locks/latches on cabinets that

contain cleaners or medicines, and

parents of most young children

(73%) put up baby gates, window

guards or other barriers.

+ Parents of about one-half of children

4–35 months of age (53%) turned

down the hot water thermostat

setting as an injury prevention

measure.

+ Parents of about one-half of the

children 4–35 months of age (48%)

put padding around hard surfaces or

sharp edges. Parents of a similar

proportion of young children (47%)

have Syrup of Ipecac in the home.

Hours Spent in

Child Care

The number of hours a child

spends in child care is influenced

by several factors, such as

parental (usually maternal) employment

status, household income, and the

availability of child-care resources for

parents. (See table 15.)

+ About 61% of children 4–35 months

of age spend time in child care.

+ In general, children 4–35 months of

age in households where the mother

is employed full time spend more

hours in child care per week than

children in households where the

mother is employed part time or not

employed at all.

+ About 38% of children 4–35 months

of age whose mothers are employed

full time spend 21–40 hours in child

care. Children whose mothers are

not employed often spend no time in

child care (59%).

+ In general, children 4–35 months of

age in households with higher

incomes and where the mother is

employed full time spend more

hours in child care.

+ About 44% of children 4–35 months

of age in households with income

under $17,500 and where the mother

is employed full time spend at least

21 hours in child care per week,

compared with 58% of young

children in households with incomes

of $35,001–$60,000, and 61% of

children in households with incomes

greater than $60,000.

Family Routines

Child routines, such as bedtimes

and mealtimes, may influence

several child health outcomes

associated with school readiness.

NSECH asked parents to report on

bedtime, mealtime, and naptime routines
Series 15, No. 3 [ Page 7

of the child—specifically, whether these

routines stayed the same or changed on

a daily basis. (See table 16.)

+ Most children 4–35 months of age

have consistent routines for naptime,

mealtime, and bedtime.

Family Activities and

Interactions

Shared family activities are known

to influence several child health

outcomes. The positive influence

of these activities is magnified by their

frequency and consistency. NSECH

asked parents about the frequency of

specific family activities. (See table 17.)

+ Parents of 52% of children 4–35

months of age read stories to the

child every day.

+ Parents of a larger proportion of

these young children (75%) play

music or sing songs with the child

every day.

+ Over one-half of the children 4–35

months of age (57%) eat the midday

or evening meal with the family

everyday, whereas fewer children

4–35 months of age (25%) eat

breakfast with the family every day.

Breastfeeding

The NSECH asked parents about

breastfeeding: whether it was ever

initiated for the child, what the

duration was, and what role the child’s

health care providers played in

encouraging breastfeeding. (See

table 18.)

+ About 67% of children have ever

been breastfed.

+ The proportion of children 4–35

months of age for whom

breastfeeding was ever initiated is

higher (79%) among those children

whose mothers had greater than a

high school education than among

those children whose mothers were

high school graduates (60% of these

young children) or had less than a

high school education (52%).

+ Breastfeeding rates were higher

among children 4–35 months of age

whose parents have never received

Women, Infants, and Children

(WIC) Program benefits (80%) than

among those children whose parents

have received WIC benefits (56%).

Child Health Status

Different measures have been used

to capture the health status of

children, such as limitations of

activity and global health status

measures. These different measures can

produce varying estimates. NSECH

permits the comparison of selected

health status measures with parent

concerns, with health care services

received by the child, and with health

care services desired by the parent. (See

table 19.)

+ Most children 4–35 months of age

(85%) are believed to be in

excellent or very good health. Only

4% of these young children are

believed to be in fair or in poor

health.

+ Few differences in overall health

status were found between child age

groups. Children in the youngest age

group are more frequently believed

to be in excellent health.

+ Most children 4–35 months of age

who are privately insured are

believed to be in excellent or very

good health (90%). Somewhat fewer

publicly insured children are

believed to be in excellent or very

good health (77%).

Parent Concerns

The NSECH asked parents what

concerns they have about their

child, using 11 items drawn from

or derived from the Parent’s Evaluation

of Developmental Status (PEDS) (18).

The PEDS is a tool to identify children

at risk for developmental, behavioral, or

social delays. Therefore, it is meant to

be used as a risk assessment tool that

will identify children who either have or

are more likely to have problems in the

future. Researchers interested in using

the PEDS as a risk assessment tool

should consult the PEDS documentation

for scoring instructions (19). Health care

providers wishing to use PEDS in

practice to assess risk status, or to make

decisions about developmental status for

individual children, must use the clinical

version of the test, which can be

obtained from Ellsworth & Vandermeer

Press, LLC. In this report, the PEDS is

used simply as a list of concerns parents

may have about their child. (See

tables 20 and 21.)

+ Parents of children 4–35 months of

age most frequently have concerns

about how the child behaves (48%

of these young children); how the

child talks and makes speech sounds

(45%); the child’s emotional

well-being (42%); and how the child

gets along with others (41%).

+ Concerns about motor skills are

least frequently reported for these

children. Parents of 28% of children

4–35 months of age have concerns

about how the child uses his or her

arms and legs. Parents of a similar

proportion of these children have

concerns about the child’s use of his

or her hands and fingers to do

things.

+ Concerns about how the child

behaves tend to increase with the

child’s age. Parents of about 56% of

children 19–35 months of age have

‘‘a lot’’ or ‘‘a little’’ concern,

compared with 35% of children 4–9

months of age, and 44% of children

10–18 months of age.

+ The proportion of children 4–35

months of age whose parents have

concerns about motor skills differed

somewhat by age group. Parents of

about 34% of children 4–9 months

of age have concerns about how the

child uses his or her arms and legs,

compared with 34% of children

10–18 months and 23% of children

19–35 months of age.

+ Few differences are apparent

between children 4–9 months, 10–18

months, and 19–35 months of age in

parental concerns such as whether

the child can do what other children

his or her age can do.
Page 8 [ Series 15, No. 3

Provision of

Developmental

Assessment

I

n surveys conducted by AAP,

pediatricians reported that they

routinely assess children’s

developmental milestones and parental

concerns regarding development (1).

Pediatricians also reported that they

conduct clinical assessments of

children’s development. Some studies

suggest that many parents do not

understand what is meant by

‘‘development’’ (16).

Parents may recall an assessment

being done, however. NSECH examined

the extent to which parents report

evidence that such an assessment was

ever done. (See table 22.)

+ Parents of about 45% of children

4–35 months of age recall that a

developmental assessment was being

done.

+ About one-third (35%) of young

children have been asked by their

health care providers to pick up

small objects or do related tasks,

suggesting that a developmental

assessment was being carried out.

Parental Coping

The age of the child places

different kinds of care-giving

demands on parents who are

raising young children. Thus, there may

be differences in how well parents

report they are coping with the demands

of parenting, by the age of the child.

(See tables 23–25.)

+ Parents of most children 4–35

months of age believe that they are

coping with parenting very well or

somewhat well.

+ Parents of the youngest children

tend to report higher levels of

coping. Parents of about 69% of

children 4–9 months of age believe

they are coping very well, compared

with 67% of children 10–18 months

of age, and 57% of children 19–35

months of age.

+ Parents of the youngest children

who have white non-Hispanic or

Hispanic mothers are more likely to

believe they are coping very well

than are the parents of children

closer to 35 months of age. There is

little difference in maternal coping

reported for children with black

non-Hispanic mothers across child

age groups.

+ Parental coping is somewhat lower

for children 4–35 months of age

with Hispanic mothers than for

children with white non-Hispanic or

with black non-Hispanic mothers.

Missed or

Delayed Care

Barriers to the receipt of health

care are difficult to measure and

usually are based on parent

perception of unmet need. Parents were

asked if their child needed health care

but did not receive it. Parents were also

asked if their child received care for a

problem or concern but received that

care later than they would have wanted.

(See table 26.)

+ Only 5% of children 4–35 months

of age ever missed needed care.

About 11% of children received

medical care for a problem or

concern that was provided later than

the parent would have wanted.

+ A higher percentage of uninsured

than insured children 4–35 months

of age had care delayed or did not

get needed care.

Trouble Paying for

Health Services

Health insurance is an important

predictor of children’s access to

health care. Even when children

are insured, however, the family may

face financial difficulties in paying for

health-related expenses. In the NSECH,

parents were asked about their child’s

insurance status, whether the child had

experienced gaps in coverage, and

whether the family had experienced

trouble paying for medical expenses.

(See tables 1 and 27.)

+ About 93% of children 4–35 months

of age have health insurance.

+ About one-half (51%) of children

4–35 months of age have private

health insurance while 28% are

covered by public health insurance.

Fourteen percent of these young

children are insured through other

sources or through a combination of

public and private insurance, and

7% are uninsured.

+ For 92% of children 4–35 months of

age, parents had no trouble paying

for prenatal care. However,

compared with privately insured

children (6%) and publicly insured

children (8%), a greater percentage

of currently uninsured children have

parents who had trouble paying for

prenatal care (20%).

+ For about 88% of children 4–35

months of age, parents had no

trouble paying for medical expenses

for the child’s birth. However,

compared with privately insured

children (13%) and publicly insured

children (8%), a greater percentage

of currently uninsured children have

parents who had trouble paying for

medical expenses for the child’s

birth (24%).

+ Parents of 13% of children 4–35

months of age have trouble paying

for the child’s health and medical

expenses.

+ Parents of a greater percentage of

uninsured children (39%) have

trouble paying for health and

medical expenses than parents of

insured children (about 11%).

Trouble Paying for

Nonhealth Services

Families also may face financial

difficulties in paying for other

expenses not directly related to

health. (See table 28.)
Series 15, No.

3[ Page9

+ Parents of more than three-quarters

of children 4–35 months of age had

no trouble paying for formula,

diapers, or clothing. However,

parents of about one-fifth of these

young children had some trouble

paying for these items. Parents of

about 34% of children 4–35 months

of age living in households with

annual income up to $17,500 and

parents of 29% of young children

living in households with annual

income of $17,501–$35,000 had at

least some trouble paying for these

items.

+ Parents of 84% of children 4–35

months of age had no trouble paying

for child care. More young children

in the lowest income households

have parents who say they had

trouble paying for child care (20%)

than children in the highest income

households (11%).

References

1. American Academyof Pediatrics.

Periodic survey of fellowsno 46. 2001.

2. American Academyof Pediatrics.

Guidelines for health supervision III.

1997.

3. American Academyof Pediatrics.

Recommendations for preventive

pediatric health care. Pediatrics.

96(2):373–374. 1995.

4. GreenM (ed.). Bright futures:

Guidelines for health supervision of

infants, children, and adolescents.

Alexandria,VA:National Center for

Education Materials and Child Health.

1994.

5. National Research Council and Institute

of Medicine. From neurons to

neighborhoods: The science of early

childhood development. Committee on

integrating the science of early

childhood development. JP Shonkoff&

DA Phillips, eds. Board on children,

youth, and families, Commission on

behavioral and social sciences and

education.Washington, DC:National

Academy Press. 2000.

6. Ainsworth MDS, Blehar MC,Waters E,

Wall S. Patterns of attachment.

Hillsdale, NJ: Erlbaum. 1978.

7. Martin B. Parent-child relations. In FD

Horowitz (ed.), Review of child

development research (Vol. 4).

Chicago: University of Chicago Press.

1975.

8. Boyce WT. Social support, family

relations and children. InS Cohen,L

Syme (eds.), Social support and health.

Reading, MA: Academic Press. 1985.

9. Cohen S,WillsTA. Stress, social

support, and the buffering hypothesis.

Psychol Bull 98:310–57. 1985.

10. Parry G, Shapiro DA. Social support

and life events in working class

women: Stress buffering or independent

effects? Arch Gen Psychiatry,

43:315–23. 1986.

11. Bandura A. Self-efficacy in changing

societies. NewYork: Cambridge

University Press. 1995.

12. Garbarino J, Kostelny K. Children’s

response to war: What do we know? In A Leavitt, NA Fox (eds.), The

psychological effects of war and

violence on children. Hillsdale, NJ:

Erlbaum. 1993.

13. Zero to Three. What grown-ups

understand about child development.

Alexandria,VA: Zero to Three. 1997.

14.Young KT, Davis K, Schoen C, Parker

S. Listening to parents:A national

survey of parents with young children.

Arch Pediatr and Adolesc Med

152:255–62. 1998.

15. Blumberg SJ, Olson L, Osborn L, et al.

Design and operation of the National

Survey of Early Childhood Health,

2000. National Center for Health

Statistics.Vital Health Stat 1(40). 2002.

16. Bethell C, Peck C, Schor E. Assessing

health system provision of well-child

care: The promoting healthy

development survey. Pediatrics

107:1084–94. 2001.

17. Zell ER, Ezzati-Rice TM, Battaglia MP, Wright RA. National immunization

survey: the methodology ofa

vaccination surveillance system. Public

Health Rep115:65–77. 2000.

18. Glascoe FP. Parents’ evaluation of

developmental status:Amethod for

detecting and addressing developmental

and behavioral problemsin children.

Nashville, TN: Ellsworth&

Vandermeer Press Ltd. 1997.

19. Glascoe FP. Collaborating with parents:

Using parent’s evaluation of

developmental status to detect and

address developmental and behavioral

problems. Nashville, TN: Ellsworth&

Vandermeer Press, LLC. 1998.
Page 10 [ Series 15, No. 3

Table 1. Percent of young children (4–35 months of age) with selected characteristics: United States, 2000

Percent of 

young Standard 

children error of Unweighted 

Selected characteristic of the child (weighted) percent sample size 

Age in months 

4–9 months ........................................... 19 1.2 432 

10–18 months ......................................... 28 1.3 674 

19–35 months ......................................... 53 1.5 962 

Sex 

Male ............................................... 52 1.6 1,078 

Female ............................................. 48 1.6 990 

Race and ethnicity 

White non-Hispanic ...................................... 61 1.3 718 

Black non-Hispanic ...................................... 15 0.9 477 

Other non-Hispanic ...................................... 4 0.6 

Hispanic ............................................. 19 0.8 817 

Child’s type of health insurance 

Private only........................................... 51 1.5 935 

Public only ........................................... 28 1.4 630 

Other insured1 ......................................... 14 1.0 324 

Uninsured ............................................ 7 0.8 178 

1Includes both public and private or other type of insurance. 

Table 2. Percent of young children (4–35 months of age) by selected characteristics of the mother: United States, 2000

Percent of 

young Standard 

children error of Unweighted 

Selected characteristic of the mother (weighted) percent sample size 

Age in years 

Under 20 years ........................................ 7 0.8 151 

20–24 years .......................................... 22 1.3 444 

25–29 years .......................................... 26 1.3 563 

30–34 years .......................................... 25 1.4 495 

35 years and over ....................................... 21 1.2 405 

Marital status 

Married ............................................. 69 1.4 1,312 

Divorced, widowed, or separated ............................. 9 1.0 177 

Never married ......................................... 22 1.2 571 

Race and ethnicity 

White non-Hispanic ...................................... 63 1.3 818 

Black non-Hispanic ...................................... 14 0.8 440 

Other non-Hispanic ...................................... 5 0.7 72 

Hispanic ............................................. 18 0.9 728 

Education 

Less than high school .................................... 21 1.3 443 

High school graduate ..................................... 34 1.5 655 

More than high school graduate .............................. 46 1.5 970 

Employment 

Full-time employment ..................................... 35 1.4 785 

Part-time employment .................................... 20 1.2 368 

Not employed ......................................... 46 1.5 908 

56 
Series 15, No. 3 [ Page 11 

Table 3. Percent of young children (4–35 months of age) by selected characteristics of their household: United States, 2000

Percent of 

young Standard 

children error of Unweighted 

Selected characteristic of the household (weighted) percent sample size 

Annual income 

Up to $7,500 .......................................... 7 0.7 153 

$7,501–$17,500 ........................................ 16 1.1 377 

$17,501–$25,000 ....................................... 12 1.0 301 

$25,001–$35,000 ....................................... 13 1.1 265 

$35,001–$45,000 ....................................... 10 0.9 190 

$45,001–$60,000 ....................................... 11 1.0 197 

$60,001–$75,000 ....................................... 7 0.9 122 

Over $75,000 ......................................... 14 1.0 242 

Don’t know/refused ...................................... 10 0.9 221 

Number of adults 18 years and over 

1 ................................................. 10 0.9 228 

2 ................................................. 75 1.3 1,438 

3 or more ............................................ 14 1.0 399 

Number of children under 18 years 

1 ................................................. 30 1.4 662 

2 ................................................. 36 1.5 719 

3 ................................................. 23 1.4 447 

4 or more ............................................ 11 1.0 240 

Table 4. Percent of young children (4–35 months of age) with a usual source and provider of health care by maternal race and ethnicity:

United States, 2000

Maternal race and ethnicity 

Usual source and provider of health care 

White 

non-Hispanic 

Black 

non-Hispanic Hispanic 

All races and 

ethnicities 

Percent of young children 

Usual source of care 

Private/group practice ...................................... 82 68 54 74 

Urgent care/walk-in clinic .................................... *2 4 3 2 

Community health center/public clinic ............................. 12 19 32 17 

Hospital clinic ........................................... 4 9 10 6 

Particular doctor or health care provider for well-child care 

Yes .................................................. 49 39 34 46 

No .................................................. 51 61 66 54 

Provider type, for children who see a particular health care provider 

Pediatrician ............................................. 74 82 83 76 

Family practitioner ......................................... 19 *7 11 17 

Other ................................................. 6 *11 *6 7 

Standard error of percent 

Usual source of care 

Private/group practice ...................................... 1.8 2.9 2.6 1.4 

Urgent care/walk-in clinic .................................... 0.6 1.1 0.7 0.5 

Community health center/public clinic ............................. 1.5 2.5 2.5 1.2 

Hospital clinic ........................................... 0.9 1.5 1.8 0.7 

Particular doctor or health care provider for well-child care 

Yes .................................................. 2.2 3.0 2.2 1.5 

No .................................................. 2.2 3.0 2.2 1.5 

Provider type, for children who see a particular health care provider 

Pediatrician ............................................. 2.7 4.4 2.8 2.0 

Family practitioner ......................................... 2.4 2.1 2.2 1.8 

Other ................................................. 1.5 4.2 1.9 1.2 

*Figure does not meet standard of reliability or precision. 
Page 12 [ Series 15, No. 3 

Table 5. Percent of young children (4–35 months of age) by parent or guardian’s preferences for selected pediatric discussion topics and

by maternal race and ethnicity: United States, 2000

Maternal race and ethnicity 

White Black All races and 

Selected discussion topic non-Hispanic non-Hispanic Hispanic ethnicities 

Percent of young children 

Parent physical health 

Providers asked about topic in past 12 months ..................... 38 46 40 39 

Providers should discuss topic ............................... 71 71 82 73 

Parent emotional support 

Providers asked about topic in past 12 months ..................... 30 40 32 32 

Providers should discuss topic ............................... 86 80 85 85 

Spouse or partner supportive of parenting efforts 

Providers asked about topic in past 12 months ..................... 35 47 45 39 

Providers should discuss topic ............................... 80 75 82 79 

Violence in the community 

Providers asked about topic in past 12 months ..................... 6 15 22 10 

Providers should discuss topic ............................... 52 55 66 56 

Difficulty paying for children’s needs 

Providers asked about topic in past 12 months ..................... 10 19 15 12 

Providers should discuss topic ............................... 76 72 67 75 

Smoker in the household 

Providers asked about topic in past 12 months ..................... 73 86 85 77 

Providers should discuss topic ............................... 95 94 93 94 

Drug or alcohol user in the household 

Providers asked about topic in past 12 months ..................... 35 59 67 44 

Providers should discuss topic ............................... 88 85 92 89 

Standard error of percent 

Parent physical health 

Providers asked about topic in past 12 months ..................... 2.1 3.1 2.5 1.5 

Providers should discuss topic ............................... 2.0 3.0 1.7 1.4 

Parent emotional support 

Providers asked about topic in past 12 months ..................... 2.0 3.2 2.4 1.4 

Providers should discuss topic ............................... 1.5 2.2 2.0 1.1 

Spouse or partner supportive of parenting efforts 

Providers asked about topic in past 12 months ..................... 2.1 3.2 2.6 1.5 

Providers should discuss topic ............................... 1.7 2.8 2.1 1.2 

Violence in the community 

Providers asked about topic in past 12 months ..................... 1.2 2.4 2.1 0.9 

Providers should discuss topic ............................... 2.3 3.2 2.6 1.6 

Difficulty paying for children’s needs 

Providers asked about topic in past 12 months ..................... 1.3 2.5 1.8 0.9 

Providers should discuss topic ............................... 1.9 2.7 2.3 1.4 

Smoker in the household 

Providers asked about topic in past 12 months ..................... 1.9 1.9 2.1 1.3 

Providers should discuss topic ............................... 1.0 1.6 1.6 0.8 

Drug or alcohol user in the household 

Providers asked about topic in past 12 months ..................... 2.1 3.0 2.5 1.5 

Providers should discuss topic ............................... 1.4 2.3 1.3 1.0 
Series 15, No. 3 [ Page 13 

Table 6. Percent of young children (4–35 months of age) by parent or guardian’s perceptions of the importance of well-child care and by

maternal race and ethnicity: United States, 2000

Maternal race and ethnicity 

White Black All races and 

Importance of well-child care non-Hispanic non-Hispanic Hispanic ethnicities 

Percent of young children 

Very important ......................................... 85 88 86 86 

Important ............................................ 10 10 12 11 

Somewhat important ..................................... 4 *2 *2 4 

Not important .......................................... *0 – – *0 

Standard error of percent 

Very important ......................................... 1.6 2.0 1.8 1.1 

Important ............................................ 1.3 1.8 1.7 0.9 

Somewhat important ..................................... 1.0 1.0 0.8 0.7 

Not important .......................................... 0.0 . . . . . . 0.0 

– Quantity zero.

0 Quantity more than zero but less than 0.5.

0.0 Quantity more than zero but less than 0.05.

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

Table 7. Percent of young children (4–35 months of age) by parent or guardian’s satisfaction with the child’s health care and by child’s type

of health insurance: United States, 2000

Child’s type of health insurance 

Private Public Other All young 

Selected characteristic only only insured Uninsured children 

Percent of young children 

Satisfaction with length of visit 

Not enough time ................................... 11 11 11 22 12 

About the right amount of time .......................... 89 87 88 78 88 

Too much time .................................... *0 *2 *1 – *1 

Did parent/guardian get to ask the questions he/she wanted? 

Yes ........................................... 95 *96 *96 84 95 

No ........................................... 5 *4 *4 16 5 

Rating of quality of child’s check-ups 

10 ........................................... 40 44 36 48 41 

9 ............................................ 21 16 17 *17 19 

8 ............................................ 23 21 31 16 23 

1–7 ........................................... 16 18 16 19 17 

Standard error of percent 

Satisfaction with length of visit 

Not enough time ................................... 1.4 1.7 2.1 4.7 1.0 

About the right amount of time .......................... 1.4 1.9 2.1 4.7 1.0 

Too much time .................................... 0.0 1.0 0.4 . . . 0.3 

Did parent/guardian get to ask the questions he/she wanted? 

Yes ........................................... 1.0 1.3 1.8 4.3 0.8 

No ........................................... 1.0 1.3 1.8 4.3 0.8 

Rating of quality of child’s check-ups 

10 ........................................... 2.2 3.0 3.8 5.9 1.6 

9 ............................................ 1.7 2.0 3.0 5.0 1.2 

8 ............................................ 1.8 2.3 3.8 3.5 1.3 

1–7 ........................................... 1.7 2.3 2.6 4.3 1.2 

– Quantity zero.

0 Quantity more than zero but less than 0.5.

0.0 Quantity more than zero but less than 0.05.

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.
Page 14 [ Series 15, No. 3 

Table 8. Percent of young children (4–35 months of age) whose parent or guardian would recommend their health care provider by child’s

type of health insurance: United States, 2000

Child’s type of health insurance 

Private Public Other All young 

Parent or guardian recommend provider only only insured Uninsured children 

Parent of young children who see a particular health care provider 

Would recommend provider 

Very likely ....................................... 85 73 71 68 79 

Somewhat likely ................................... 13 22 21 25 17 

Somewhat unlikely or very unlikely ....................... *2 *5 *8 *7 4 

Standard error of percent 

Would recommend provider 

Very likely ....................................... 2.2 3.4 4.6 8.4 1.7 

Somewhat likely ................................... 2.1 3.1 3.9 7.5 1.5 

Somewhat unlikely or very unlikely ....................... 0.7 1.6 3.2 3.7 0.8 

* Figure does not meet standard of reliability or precision. 

NOTE: Only 46% of young children were reported to have a particular doctor or health care provider that they see for well-child care (see table 4). Children without a particular doctor or health care 

provider were excluded from the calculations for this table. 

Table 9. Percent of young children (4–35 months of age) by parent or guardian’s perception of extent to which health care is familycentered and by child’s type of health insurance: United States, 2000

Child’s type of health insurance 

Private Public Other All young 

Selected component of family-centered health care only only insured Uninsured children 

Percent of young children 

Providers take time to understand child’s needs 

Always ......................................... 68 68 65 42 66 

Usually/sometimes ................................. 30 30 33 45 32 

Never ......................................... *1 2 *2 *13 2 

Providers respect parent/guardian’s expertise on child 

Always ......................................... 57 56 53 42 55 

Usually/sometimes ................................. 40 39 45 50 41 

Never ......................................... 3 5 *2 *8 4 

Providers ask how parent is feeling as a parent 

Always ......................................... 23 35 25 26 27 

Usually/sometimes ................................. 47 36 37 26 41 

Never ......................................... 29 29 39 48 32 

Providers understand parent/guardian’s parenting preferences 

Always ......................................... 40 43 33 34 40 

Usually/sometimes ................................. 40 35 41 33 38 

Never ......................................... 20 22 26 33 22 

Standard error of percent 

Providers take time to understand child’s needs 

Always ......................................... 2.0 2.6 3.7 5.4 1.4 

Usually/sometimes ................................. 2.0 2.5 3.7 5.6 1.4 

Never ......................................... 0.4 0.5 0.6 4.4 0.4 

Providers respect parent/guardian’s expertise on child 

Always ......................................... 2.2 2.9 3.9 5.3 1.6 

Usually/sometimes ................................. 2.2 2.9 3.9 5.6 1.5 

Never ......................................... 1.0 0.1 0.9 3.4 0.6 

Providers ask how parent is feeling as a parent 

Always ......................................... 1.8 3.0 3.4 5.6 1.4 

Usually/sometimes ................................. 2.2 2.7 3.6 4.3 1.5 

Never ......................................... 2.0 2.6 3.9 5.6 1.4 

Providers understand parent/guardian’s parenting preferences 

Always ......................................... 2.2 3.0 3.5 5.3 1.5 

Usually/sometimes ................................. 2.2 2.7 3.9 5.3 1.5 

Never ......................................... 1.8 2.3 3.4 5.4 1.3 

* Figure does not meet standard of reliability or precision. 
Series 15, No. 3 [ Page 15 

Table 10. Percent of young children (4–35 months of age) by parent or guardian’s perception of extent to which health care is familycentered and by maternal race and ethnicity: United States, 2000

Maternal race and ethnicity 

White, Black, All races 

Selected component of family-centered health care non-Hispanic non-Hispanic Hispanic and ethnicities 

Percent of young children 

Providers take time to understand child’s needs 

Always ......................................... 70 73 50 66 

Usually/sometimes ................................. 29 25 42 32 

Never ......................................... *1 *2 8 2 

Providers respect parent/guardian’s expertise on child 

Always ......................................... 55 58 55 55 

Usually/sometimes ................................. 43 36 40 41 

Never ......................................... *3 7 5 4 

Providers ask how parent is feeling as a parent 

Always ......................................... 25 35 28 27 

Usually/sometimes ................................. 45 38 33 41 

Never ......................................... 30 27 39 32 

Providers understand parent/guardian’s parenting preferences 

Always ......................................... 41 38 39 40 

Usually/sometimes ................................. 39 34 34 38 

Never ......................................... 20 28 27 22 

Standard error of percent 

Providers take time to understand child’s needs 

Always ......................................... 1.9 2.7 2.6 1.4 

Usually/sometimes ................................. 1.9 2.7 2.5 1.4 

Never ......................................... 0.3 0.7 1.9 0.4 

Providers respect parent/guardian’s expertise on child 

Always ......................................... 2.2 3.1 2.6 1.5 

Usually/sometimes ................................. 2.1 3.0 2.5 1.5 

Never ......................................... 0.8 1.5 1.2 0.6 

Providers ask how parent is feeling as a parent 

Always ......................................... 2.0 3.1 2.3 1.4 

Usually/sometimes ................................. 2.1 3.0 2.4 1.5 

Never ......................................... 2.0 2.6 2.5 1.4 

Providers understand parent/guardian’s parenting preferences 

Always ......................................... 2.1 3.2 2.5 1.5 

Usually/sometimes ................................. 2.1 2.9 2.3 1.5 

Never ......................................... 1.7 2.7 2.4 1.3 

* Figure does not meet standard of reliability or precision. 
Page 16 [ Series 15, No. 3 

Table 11. Percent of young children (4–35 months of age) by provision of preventive health care for nutrition issues and by age of child:

United States, 2000

Age of child 

4–9 10–18 19–35 

Preventive heatlh care topic months months months 

Percent of young children 

Providers talked with parent/guardian about breastfeeding 

Yes .................................................... 91 . . . . . . 

No, and would have been helpful ................................. *3 . . . . . . 

No, and would not have been helpful ............................... 6 . . . . . . 

Providers talked with parent/guardian about weaning child from bottle 

Yes .................................................... . . . 54 . . . 

No, and would have been helpful ................................. . . . 16 . . . 

No, and would not have been helpful ............................... . . . 30 . . . 

Providers talked with parent/guardian about food or feeding issues 

Yes .................................................... 92 93 73 

No, and would have been helpful ................................. 6 4 7 

No, and would not have been helpful ............................... *2 4 20 

Standard error of percent 

Providers talked with parent/guardian about breastfeeding 

Yes .................................................... 1.9 . . . . . . 

No, and would have been helpful ................................. 1.3 . . . . . . 

No, and would not have been helpful ............................... 1.4 . . . . . . 

Providers talked with parent/guardian about weaning child from bottle 

Yes .................................................... . . . 2.7 . . . 

No, and would have been helpful ................................. . . . 1.8 . . . 

No, and would not have been helpful ............................... . . . 2.6 . . . 

Providers talked with parent/guardian about food or feeding issues 

Yes .................................................... 1.6 1.3 2.1 

No, and would have been helpful ................................. 1.5 1.0 1.2 

No, and would not have been helpful ............................... 0.7 0.9 1.9 

* Figure does not meet standard of reliablity or precision. 

. . . Category not applicable. 
Series 15, No. 3 [ Page 17 

Table 12. Percent of young children (4–35 months of age) by provision of preventive health care for language development issues and by

age of child: United States, 2000

Age of child 

4–9 10–18 19–35 

Preventive health care topic months months months 

Percent of young children 

Providers talked with parent/guardian about 

how child communicates (his/her) needs? 

Yes ......................................................... 79 . . . . . . 

No, and would have been helpful ...................................... 11 . . . . . . 

No, and would not have been helpful .................................... 10 . . . . . . 

Providers talked with parent/guardian about the words 

and phrases child uses and understands? 

Yes ......................................................... . . . 68 72 

No, and would have been helpful ...................................... . . . 16 13 

No, and would not have been helpful .................................... . . . 16 15 

Providers talked with parent/guardian 

about the importance of reading to child? 

Yes ......................................................... 64 63 61 

No, and would have been helpful ...................................... 16 17 11 

No, and would not have been helpful .................................... 20 20 28 

Standard error of percent 

Providers talked with parent/guardian about 

how child communicates (his/her) needs? 

Yes ......................................................... 2.8 . . . . . . 

No, and would have been helpful ...................................... 1.8 . . . . . . 

No, and would not have been helpful .................................... 2.3 . . . . . . 

Providers talked with parent/guardian about the words and 

phrases child uses and understands? 

Yes ......................................................... . . . 2.3 2.1 

No, and would have been helpful ...................................... . . . 1.8 1.5 

No, and would not have been helpful .................................... . . . 1.8 1.7 

Providers talked with parent/guardian about 

the importance of reading to child? 

Yes ......................................................... 3.2 2.6 2.2 

No, and would have been helpful ...................................... 2.4 1.8 1.3 

No, and would not have been helpful .................................... 2.8 2.2 2.1 

. . . Category not applicable. 

Table 13. Percent of young children (4–35 months of age) by provision of preventive health care for immunization issues and by age of

child: United States, 2000

Age of child 

Preventive health care for immunization issues 

4–9 

months 

10–18 

months 

19–35 

months 

All young 

children 

Percent of young children 

Providers talked with parent/guardian about immunizations ............... 99 98 94 96 

Parent/guardian delayed or missed immunizations due to safety concerns ...... 8 9 7 8 

Standard error of percent 

Providers talked with parent/guardian about immunizations ............... 0.3 0.5 1.1 0.6 

Parent/guardian delayed or missed immunizations due to safety concerns ...... 1.9 1.5 1.1 0.8 
Page 18 [ Series 15, No. 3 

Table 14. Percent of young children (4–35 months of age) by selected home injury prevention measures and by age of child: United States,

2000

Age of child 

4–9 10–18 19–35 All young 

Selected home injury prevention measures months months months children 

Percent of young children 

Put up baby gates, window guards, or other barriers 

Yes ................................................ 58 77 77 73 

No ................................................ 35 22 22 24 

Not applicable ......................................... 7 *1 *1 2 

Put locks/latches on cabinets that contain cleaners or medicine 

Yes ................................................ 63 83 82 78 

No ................................................ 29 16 16 19 

Not applicable ......................................... 9 2 *2 3 

Put padding around hard surfaces or sharp edges 

Yes ................................................ 54 51 44 48 

No ................................................ 38 46 53 48 

Not applicable ......................................... 9 3 3 4 

Put stoppers or plugs in electrical outlets 

Yes ................................................ 86 94 94 92 

No ................................................ 12 5 6 7 

Not applicable ......................................... *3 *1 0 1 

Turned down the hot water thermostat setting 

Yes ................................................ 57 43 57 53 

No ................................................ 38 54 41 44 

Not applicable ......................................... 5 3 3 3 

Has Syrup of Ipecac at home 

Yes ................................................ 44 47 48 47 

No ................................................ 56 53 52 53 

Standard error of percent 

Put up baby gates, window guards, or other barriers 

Yes ................................................ 3.0 2.0 1.9 1.3 

No ................................................ 3.2 1.9 1.8 1.3 

Not applicable ......................................... 1.7 0.4 0.5 0.4 

Put locks/latches on cabinets that contain cleaners or medicine 

Yes ................................................ 3.2 1.8 1.7 1.2 

No ................................................ 2.9 1.8 1.6 1.2 

Not applicable ......................................... 2.1 0.5 0.6 0.5 

Put padding around hard surfaces or sharp edges 

Yes ................................................ 3.3 2.6 2.3 1.5 

No ................................................ 3.2 2.6 2.3 1.5 

Not applicable ......................................... 2.2 0.9 0.8 0.6 

Put stoppers or plugs in electrical outlets 

Yes ................................................ 2.1 1.1 1.2 0.8 

No ................................................ 1.9 1.0 1.2 0.8 

Not applicable ......................................... 1.0 0.4 0.1 0.2 

Turned down the hot water thermostat setting 

Yes ................................................ 3.2 2.6 2.2 1.5 

No ................................................ 3.2 2.6 2.2 1.5 

Not applicable ......................................... 1.2 0.6 0.6 0.4 

Has Syrup of Ipecac at home 

Yes ................................................ 3.3 2.6 2.3 1.5 

No ................................................ 3.3 2.6 2.3 1.5 

* Figure does not meet standard of reliability or precision. 

0 Quantity more than zero but less than 0.5. 
Series 15, No. 3 [ Page 19 

Table 15. Percent of young children (4–35 months of age) by household income, by maternal employment, and by hours in child care:

United States, 2000

Hours in child care 

Zero 1–20 21–40 41 or 

Household income and maternal employment hours hours hours more hours 

Percent of young children 

Up to $17,500 

Employed full time ................................. 20 35 30 *14 

Employed part time ................................. 26 34 37 *2 

Not employed .................................... 62 31 6 *1 

$17,501–$35,000 

Employed full time ................................. 18 30 40 12 

Employed part time ................................. 38 39 18 *4 

Not employed .................................... 67 27 *4 *2 

$35,001–$60,000 

Employed full time ................................. 16 26 40 18 

Employed part time ................................. 21 44 34 0 

Not employed .................................... 57 41 *2 – 

More than $60,000 

Employed full time ................................. *12 26 45 16 

Employed part time ................................. 24 56 15 *4 

Not employed .................................... 47 50 *2 *1 

Total1 

Employed full time ................................. 19 28 38 15 

Employed part time ................................. 27 45 25 *3 

Not employed .................................... 59 36 4 *1 

All young children .................................. 39 35 20 6 

Standard error of percent 

Up to $17,500 

Employed full time ................................. 4.8 5.0 4.9 4.4 

Employed part time ................................. 7.0 7.5 7.8 1.6 

Not employed .................................... 4.2 4.0 1.8 0.4 

$17,501–$35,000 

Employed full time ................................. 3.8 4.8 4.7 2.8 

Employed part time ................................. 7.8 7.6 4.9 2.8 

Not employed .................................... 4.2 4.0 1.2 1.4 

$35,001–$60,000 

Employed full time ................................. 3.4 4.1 4.8 3.6 

Employed part time ................................. 5.7 7.3 7.4 0.3 

Not employed .................................... 5.9 5.9 1.1 . . . 

More than $60,000 

Employed full time ................................. 4.2 5.0 5.4 4.0 

Employed part time ................................. 6.5 7.0 4.1 3.8 

Not employed .................................... 5.7 5.8 1.5 0.6 

Total1 

Employed full time ................................. 2.1 2.2 2.4 1.8 

Employed part time ................................. 3.3 3.6 3.0 1.3 

Not employed .................................... 2.3 2.3 0.7 0.4 

All young children .................................. 1.5 1.5 1.2 0.7 

– Quantity zero.

0 Quantity more than zero but less than 0.5.

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.

1Children with missing information for household income are included in total.
Page 20 [ Series 15, No. 3

Table 16. Percent of young children (4–35 months of age) who have consistent family routines by age of child: United States, 2000

Age of child 

4–9 10–18 19–35 All young 

Family routine months months months children 

Percent of young children 

Child’s bedtime is same everyday ........................ 79 78 68 73 

Child’s naptime is same everyday ........................ 56 71 67 66 

Child’s mealtimes are same everyday ..................... 68 76 77 75 

Standard error of percent 

Child’s bedtime is same everyday ........................ 2.6 2.2 2.2 1.4 

Child’s naptime is same everyday ........................ 3.3 2.4 2.2 1.5 

Child’s mealtimes are same everyday ..................... 3.1 2.3 1.9 1.3 

Table 17. Percent of young children (4–35 months of age) by frequency of selected family activities: United States, 2000

Frequency of activity 

Family activity Everyday 

3–6 days 

per week 

1–2 days

per week Never

Percent of young children 

Read stories to child ..................................... 52 27 15 6 

Play music or sing songs with child ............................ 75 17 6 1 

Take child on outing ..................................... 37 46 16 *1 

Family eats midday/evening meal together ....................... 57 28 12 3 

Eat breakfast together .................................... 25 13 36 26 

Standard error of percent 

Read stories to child ..................................... 1.5 1.4 1.1 0.6 

Play music or sing songs with child ............................ 1.4 1.2 0.7 0.4 

Take child on outing ..................................... 1.5 1.5 1.1 0.3 

Family eats midday/evening meal together ....................... 1.5 1.4 1.0 0.5 

Eat breakfast together .................................... 1.3 1.1 1.5 1.4 

* Figure does not meet standard of reliability or precision. 
Series 15, No. 3 [ Page 21 

Table 18. Percent of young children (4–35 months of age) by maternal education, child’s participation in WIC, and whether the child has

ever been breastfed: United States, 2000

Ever Never 

Selected characteristics breastfed breastfed 

Percent of young children 

Mother’s education 

Less than high school ............................................. 52 48 

High school graduate .............................................. 60 40 

More than high school ............................................. 79 21 

Child ever received WIC1 program benefits 

Yes ......................................................... 56 44 

No ......................................................... 80 20 

All young children ................................................ 67 33 

Standard error of percent 

Mother’s education 

Less than high school ............................................. 3.5 3.5 

High school graduate .............................................. 2.7 2.7 

More than high school ............................................. 1.8 1.8 

Child ever received WIC1 program benefits 

Yes ......................................................... 2.1 2.1 

No ......................................................... 1.9 1.9 

All young children ................................................ 1.5 1.5 

1WIC is Women, Infants, and Children. 

Table 19. Percent of young children (4–35 months of age), by age, child’s type of health insurance, and overall health status: United States,

Overall health status of child 

Child’s age and type of health insurance Excellent 

Very 

good Good Fair/poor 

Percent of young children 

Child’s age 

4–9 months ........................................... 62 24 13 *2 

10–18 months ......................................... 53 31 12 4 

19–35 months ......................................... 51 33 12 4 

Child’s type of health insurance 

Private only........................................... 59 31 9 *1 

Public only ........................................... 45 32 17 6 

Other insured ......................................... 54 33 10 *2 

Uninsured ............................................ 48 18 24 *10 

All young children ....................................... 54 31 12 4 

Standard error of percent 

Child’s age 

4–9 months ........................................... 3.1 2.6 2.2 0.7 

10–18 months ......................................... 2.6 2.5 1.6 0.9 

19–35 months ......................................... 2.3 2.2 1.4 0.9 

Child’s type of health insurance 

Private only........................................... 2.2 2.1 1.2 0.4 

Public only ........................................... 2.9 2.8 2.0 1.6 

Other insured ......................................... 3.8 3.6 1.8 1.0 

Uninsured ............................................ 5.6 3.4 5.1 3.4 

All young children ....................................... 1.5 1.4 1.0 0.6 

* Figure does not meet standard of reliability or precision. 

2000
Page 22 [ Series 15, No. 3 

Table 20. Percent of young children (4–35 months of age) by extent of parental concerns for selected developmental issues: United States,

2000

Extent of concern 

A lot Not 

Selected developmental issue or a little at all 

Percent of young children 

How child talks and makes speech sounds ......................... 45 55 

How child sees or hears1 .................................... 32 68 

How child understands what parent/guardian says ..................... 35 65 

How child uses his or her hands and fingers to do things ................ 28 72 

How child uses his or her arms and legs ........................... 28 72 

How child behaves ........................................ 48 52 

How child gets along with others ................................ 41 59 

How child is learning to do things for himself/herself .................... 33 67 

How child is learning preschool or school skills ....................... 38 62 

Whether child can do what other children can do ..................... 34 66 

Child’s emotional well-being1 .................................. 42 58 

Standard error of percent 

How child talks and makes speech sounds ......................... 1.5 1.5 

How child sees or hears1 .................................... 1.4 1.4 

How child understands what parent/guardian says ..................... 1.4 1.4 

How child uses his or her hands and fingers to do things ................ 1.3 1.3 

How child uses his or her arms and legs ........................... 1.3 1.3 

How child behaves ........................................ 1.6 1.6 

How child gets along with others ................................ 1.5 1.5 

How child is learning to do things for himself/herself .................... 1.4 1.4 

How child is learning preschool or school skills ....................... 1.8 1.8 

Whether child can do what other children can do ..................... 1.5 1.5 

Child’s emotional well-being1 .................................. 1.5 1.5 

1Item is not included in Parents’ Evaluation of Developmental Status measures. 

NOTE: The majority of these items were adapted from the Parents’ Evaluation of Developmental Status (PEDS), © 1997. Scale adapted with permission. (Glascoe FP. Parents’ evaluation of 

developmental status: A method for detecting and addressing developmental and behavioral problems in children. Nashville, TN: Ellsworth & Vandermeer Press Ltd.) The PEDS is a tool to identify 

children at risk for developmental, behavioral, or social delays. Therefore, it is meant to be used as a risk assessment tool that will identify children who either have or are more likely to have problems 

in the future. Researchers interested in using the PEDS as a risk assessment tool should consult the PEDS documentation for scoring instructions. (Glascoe FP. Collaborating with parents: Using 

parents’ evaluation of developmental and behavioral problems. Nashville, TN: Ellsworth & Vandermeer Press, LLC. 1998.) Health care providers wishing to use PEDS in practice to assess risk status, 

or to make decisions about developmental status for individual children, must use the clinical version of the test, which can be obtained from Ellsworth & Vandermeer Press, LLC. 
Series 15, No. 3 [ Page 23 

Table 21. Percent of young children (4–35 months of age) whose parents are ‘‘a lot’’ or ‘‘a little’’ concerned with selected developmental

issues, by age of child: United States, 2000

Age of child 

4–9 10–18 19–35 

Selected developmental issue months months months 

Percent of young children 

Parent is a lot or a little concerned with: 

How child talks and makes speech sounds ......................... 40 49 44 

How child sees or hears1 .................................... 33 36 30 

How child understands what parent/guardian says ..................... 35 39 33 

How child uses his or her hands and fingers to do things ................ 31 34 23 

How child uses his or her arms and legs ........................... 34 34 23 

How child behaves ........................................ 35 44 56 

How child gets along with others ................................ 29 41 45 

How child is learning to do things for himself/herself .................... 34 36 32 

How child is learning preschool or school skills ....................... 30 40 39 

Whether child can do what other children can do ..................... 32 38 33 

Child’s emotional well-being1 .................................. 40 41 44 

Standard error of percent 

Parent is a lot or a little concerned with: 

How child talks and makes speech sounds ......................... 3.2 2.6 2.2 

How child sees or hears1 .................................... 3.0 2.5 2.0 

How child understands what parent/guardian says ..................... 3.0 2.6 2.1 

How child uses his or her hands and fingers to do things ................ 3.0 2.5 1.8 

How child uses his or her arms and legs ........................... 3.1 2.5 1.8 

How child behaves ........................................ 3.1 2.6 1.8 

How child gets along with others ................................ 2.9 2.6 2.3 

How child is learning to do things for himself/herself .................... 3.2 2.5 2.1 

How child is learning preschool or school skills ....................... 4.3 3.3 2.5 

Whether child can do what other children can do ..................... 3.0 2.6 2.1 

Child’s emotional well-being1 .................................. 3.2 2.6 2.2 

1Item is not included in Parents’ Evaluation of Development Status measures. 

NOTE: The majority of these items were adapted from the Parents’ Evaluation of Developmental Status (PEDS), © 1997. Scale adapted with permission. (Glascoe FP. Parents’ evaluation of 

developmental status: A method for detecting and addressing developmental and behavioral problems in children. Nashville, TN: Ellsworth & Vandermeer Press Ltd.) The PEDS is a tool to identify 

children at risk for developmental, behavioral, or social delays. Therefore, it is meant to be used as a risk assessment tool that will identify children who either have or are more likely to have problems 

in the future. Researchers interested in using the PEDS as a risk assessment tool should consult the PEDS documentation for scoring instructions. (Glascoe FP. Collaborating with parents: Using 

parents’ evaluation of developmental and behavioral problems. Nashville, TN: Ellsworth & Vandermeer Press, LLC. 1998.) Health care providers wishing to use PEDS in practice to assess risk status, 

or to make decisions about developmental status for individual children, must use the clinical version of the test, which can be obtained from Ellsworth & Vandermeer Press, LLC. 
Page 24 [ Series 15, No. 3

Table 22. Percent of young children (4–35 months of age) who have received a developmental risk assessment: United States, 2000

Percent of Standard error 

Developmental risk assessment young children of percent 

Providers ever said they were doing a developmental asessment .................. 45 1.6 

Providers ever had child pick up small objects or throw a ball or recognize different colors . . . 35 1.5 

Table 23. Percent of young children (4–35 months of age) by maternal race and ethnicity, by age of child and parent or guardian’s

perception of their success coping with the day-to-day demands of parenthood: United States, 2000

Perception of coping success 

Very Somewhat 

well 

Not very well or 

Maternal race and ethnicity and age of child well not well at all

Percent of young children 

White non-Hispanic 

4–9 months ........................................... 71 29 *0 

10–18 months ......................................... 69 31 – 

19–35 months ......................................... 59 39 *2 

Black non-Hispanic 

4–9 months ........................................... 78 21 *1 

10–18 months ......................................... 72 27 *1 

19–35 months ......................................... 69 30 *1 

Hispanic 

4–9 months ........................................... 58 36 *5 

10–18 months ......................................... 58 40 *1 

19–35 months ......................................... 44 52 *4 

All races and ethnicities 

4–9 months ........................................... 69 29 *1 

10–18 months ......................................... 67 32 *0 

19–35 months ......................................... 57 40 2 

Standard error of percent 

White non-Hispanic 

4–9 months ........................................... 4.3 4.3 0.4 

10–18 months ......................................... 3.6 3.6 . . . 

19–35 months ......................................... 3.1 3.1 0.8 

Black non-Hispanic 

4–9 months ........................................... 5.3 5.2 0.9 

10–18 months ......................................... 4.5 4.5 0.6 

19–35 months ......................................... 4.1 4.1 0.6 

Hispanic 

4–9 months ........................................... 5.6 5.4 3.8 

10–18 months ......................................... 4.2 4.1 0.8 

19–35 months ......................................... 3.6 3.7 1.5 

All races and ethnicities 

4–9 months ........................................... 3.0 3.0 0.8 

10–18 months ......................................... 2.5 2.5 0.2 

19–35 months ......................................... 2.3 2.2 0.5 

– Quantity zero.

0 Quantity more than zero but less than 0.5.

* Figure does not meet standard of reliability or precision.

. . . Category not applicable.
Series 15, No. 3 [ Page 25 

Table 24. Percent of young children (4–35 months of age) by extent of parent or guardian’s self-reported well-being: United States, 2000

Extent of self-reported well-being during the past month 

Little 

All of Most of A good bit Some of of the None of 

Emotional state the time the time of the time the time time the time 

Percent of young children 

Been a very nervous person? .......................... 2 4 4 17 35 38 

Felt calm and peaceful? .............................. 9 39 18 20 11 2 

Felt downhearted and blue? ........................... 2 4 3 20 35 36 

Felt so down in the dumps that nothing could cheer parent up? ..... *1 *1 *0 4 11 82 

Been a happy person? ............................... 21 53 11 10 3 *1 

Standard error of percent 

Been a very nervous person? .......................... 0.4 0.6 0.6 1.2 1.5 1.5 

Felt calm and peaceful? .............................. 0.8 1.4 1.3 1.3 1.1 0.3 

Felt downhearted and blue? ........................... 0.4 0.7 0.6 1.3 1.5 1.4 

Felt so down in the dumps that nothing could cheer parent up? ..... 0.2 0.3 0.2 0.6 1.0 1.2 

Been a happy person? ............................... 1.2 1.6 1.0 1.0 0.6 0.3 

* Figure does not meet standard of reliability or precision. 

0 Quantity more than zero but less than 0.5. 

NOTE: Mental Health Index (MHI-5) Short form © 1992 (Stewart AL, Ware JE Jr. Measuring functioning and well-being: The medical outcomes study approach, pp. 373–403 RAND Corporation, 

Durham, NC: Duke University Press). Used with permission. (Lorig K, Stewart A, Ritter P, et al. Outcome measures for health care interventions, pp. ix–x, 50–1. Thousand Oaks, CA: Sage 

Publications. 1996). 

Table 25. Percent of young children (4–35 months of age) by availability of emotional support for parent or guardian, age of child, and

maternal race and ethnicity: United States, 2000

Maternal race and ethnicity 

Availability of emotional support and age of child 

White 

non-Hispanic 

Black 

non-Hispanic Hispanic 

All races 

and 

ethnicities 

Percent of young children 

There is someone that parent/guardian can 

turn to for emotional help while parenting 

4–9 months ........................................... *96 *84 71 89 

10–18 months ......................................... 94 90 69 88 

19–35 months ......................................... 90 89 60 84 

There is someone that parent/guardian can count on 

to watch child if parent/guardian needs a break 

4–9 months ........................................... *96 *85 82 92 

10–18 months ......................................... 87 *94 85 88 

19–35 months ......................................... 90 89 79 87 

Standard error of percent 

There is someone that parent/guardian 

can turn to for emotional help while parenting 

4–9 months ........................................... 2.0 6.3 5.1 1.9 

10–18 months ......................................... 1.8 3.0 3.8 1.5 

19–35 months ......................................... 2.0 2.5 3.6 1.6 

There is someone that parent/guardian can count on to 

watch child if parent/guardian needs a break 

4–9 months ........................................... 1.5 6.6 4.7 1.7 

10–18 months ......................................... 2.8 2.1 3.0 1.9 

19–35 months ......................................... 1.9 3.0 3.0 1.6 

*Figure does not meet standard of reliability or precision. 
Page 26 [ Series 15, No. 3 

Table 26. Percent of young children (4–35 months of age) who missed or delayed medical care by child’s type of health insurance:

United States, 2000

Child’s type of health insurance 

All 

Private Public Other young 

Missed or delayed medical care during the past 12 months only only insured Uninsured children 

Percent of young children 

Child needed medical care and did not get it ...................... 4 4 6 14 5 

Child got medical care later than parent/guardian would have liked ........ 10 10 15 15 11 

Standard error of percent 

Child needed medical care and did not get it ...................... 0.9 0.8 1.7 3.5 0.6 

Child got medical care later than parent/guardian would have liked ........ 1.3 1.4 2.6 3.6 0.9 

Table 27. Percent of young children (4–35 months of age) by extent of difficulty paying for selected health services for the child and by

child’s type of health insurance: United States, 2000

Child’s type of health insurance 

Extent of difficulty paying for selected services 

Private 

only 

Public 

only 

Other 

insured Uninsured 

All 

young 

children 

Percent of young children 

Prenatal care during pregnancy? 

No trouble at all ............................ 94 92 92 80 92 

Some trouble or a lot of trouble .................. 6 8 8 20 

Medical expenses for child’s birth? 

No trouble at all ............................ 87 92 92 76 88 

Some trouble or a lot of trouble .................. 13 8 8 24 12 

Child’s health and medical expenses? 

No trouble at all ............................ 89 89 91 61 87 

Some trouble or a lot of trouble .................. 11 11 9 39 13 

Standard error of percent 

Prenatal care during pregnancy? 

No trouble at all ............................ 1.0 1.5 2.1 0.5 0.8 

Some trouble or a lot of trouble .................. 1.0 1.5 2.1 0.5 0.8 

Medical expenses for child’s birth? 

No trouble at all ............................ 1.6 1.7 1.8 4.8 1.1 

Some trouble or a lot of trouble .................. 1.6 1.7 1.8 4.8 1.1 

Child’s health and medical expenses? 

No trouble at all ............................ 1.5 1.8 2.1 5.6 1.1 

Some trouble or a lot of trouble .................. 1.5 1.8 2.1 5.6 1.1 

8 
Series 15, No. 3 [ Page 27 

Table 28. Percent of young children (4–35 months of age) by extent of difficulty paying for selected health and nonhealth services for the

child and by household income: United States, 2000

Household income 

More 

Up to $17,501– $35,001– than All 

Extent of difficulty paying for selected services $17,500 $35,000 $60,000 $60,000 incomes 

Percent of young children 

Prenatal care during pregnancy? 

No trouble at all ................................... 90 92 91 *96 92 

Some trouble or a lot of trouble ......................... 10 8 9 *4 8 

Medical expenses for child’s birth? 

No trouble at all ................................... 88 89 85 91 88 

Some trouble or a lot of trouble ......................... 12 11 15 9 12 

Child’s health and medical expenses? 

No trouble at all ................................... 82 86 88 *96 87 

Some trouble or a lot of trouble ......................... 18 14 12 *4 13 

Supplies like formula, food, diapers, clothes, and shoes? 

No trouble at all ................................... 66 71 84 92 78 

Some trouble or a lot of trouble ......................... 34 29 16 8 22 

Child care? 

No trouble at all ................................... 80 83 82 89 84 

Some trouble or a lot of trouble ......................... 20 17 18 11 16 

Standard error of percent 

Prenatal care during pregnancy? 

No trouble at all ................................... 1.7 1.4 2.1 1.7 0.8 

Some trouble or a lot of trouble ......................... 1.7 1.4 2.1 1.7 0.8 

Medical expenses for child’s birth? 

No trouble at all ................................... 2.4 1.8 2.5 2.4 1.1 

Some trouble or a lot of trouble ......................... 2.4 1.8 2.5 2.4 1.1 

Child’s health and medical expenses? 

No trouble at all ................................... 2.7 1.9 2.2 1.6 1.1 

Some trouble or a lot of trouble ......................... 2.7 1.9 2.2 1.6 1.1 

Supplies like formula, food, diapers, clothes, and shoes? 

No trouble at all ................................... 3.1 3.0 2.5 2.0 1.4 

Some trouble or a lot of trouble ......................... 3.1 3.0 2.5 2.0 1.4 

Child care? 

No trouble at all ................................... 2.9 2.5 2.9 2.2 1.2 

Some trouble or a lot of trouble ......................... 2.9 2.5 2.9 2.2 1.2 

* Figure does not meet standard of reliability or precision.