Early Life Income and Child Development

In terms of influenza pandemic planning, very few plans directly address the specific needs of children [39-40], yet they are identified as a high risk population because of functional needs for supervision, transportation, psychosocial supports, and communication, and their inability to live independently [17, 24, 41]. Children’s immune systems are less developed than those of adults, therefore they are often identified as a population at high risk for severe illness during pandemic or complications from vaccination [42]. However, their psychosocial risks are related to their

maturational development and capacity to cope with the social impacts of pandemic or another type of bioevent [43-44].

Of the pandemic plans reviewed, many addressed the need for pediatric planning during a pandemic, but few explain how this should be done. Children spend much of their time in groups; in school, day care, or group activities. This underscores the need to a) plan non- pharmaceutical interventions to protect them from exposure when social distancing is unlikely [87], and b) reduce the likelihood of infection through vaccination, which can be conveniently provided in schools [102].

There are numerous reasons why children are at risk during pandemic influenza [103], however, particular determinants of risk for children include their reliance on others for food, shelter, transport, and other basic requirements [42]. In households with lower levels of income, children are especially vulnerable to the socio-economic impacts of pandemic when they lack resources to prepare (eg. inability for families to stockpile food, medications, and household supplies) [16]. Homelessness is discussed in another section of the paper focused on social and physical environments, but it is important to acknowledge the specific risks for children who live with housing insecurity, such as those children who are living in shelters for survivors of domestic violence. The psychosocial impacts of pandemic influenza can present tremendous stressors for children who may not have developed skills to cope with the distress [43]. “Homeless children are much more likely to experience physical, mental, emotional, educational, developmental, and behavioral problems, and they are less likely to have obtained preventive health care services, such as routine immunizations, compared to children who are not homeless“ 11.

If school and daycare closures are implemented as a pandemic response intervention to reduce transmission in a community, many families face significant challenges ensuring their children are supervised. For some sectors (e.g. health care), this is particularly concerning as the majority of workers are female and assume responsibility for child care [36]. Children whose parents cannot afford missed income, to comply with quarantine measures, or to fulfill their caregiving duties may be at heightened risk of exposure to the contagion being in group care facilities [17]. Older siblings expected to provide care for younger siblings while the parents continue to work may also be placed at increased risk. Lack of supervision is another risk for children when parents must attend work but have no childcare support [28]. Participants in focus groups conducted by Baum et al. [28] “feared that economic pressures to go to work would lead to unsafe situations, such as children left home unattended, or would further spread disease by unsupervised teenagers intent on socializing despite school or business closures” (p.6).

Education and literacy are also factors which influence a parent’s ability to reduce exposure and ensure appropriate care for children during pandemic [91]. Children are reliant on parents and guardians for psychological support and decision-making, such as getting vaccinated or seeking treatment for symptoms [13, 86, 103]. In a survey study administered to a number of health professionals concerning vaccinations among children, education and communication for parents was listed at one of the needs recognized by health professionals [39].