WE MUST IMPROVE U.S. CHILDREN’S HEALTH

QUICK TAKES

📊1. The Numbers Don't Lie

US children are dying at nearly double the rate of other wealthy nations. We have 54 excess child deaths per day compared to OECD peers. Meanwhile, depression in high schoolers has skyrocketed from 26% to 40% in just 16 years. We have a generation in crisis.

🏗️ 2. It's Not Just Individual Choices

When virtually every health metric declines simultaneously across an entire population, we're looking at systemic issues. The US has the highest income inequality among developed nations, and this directly correlates with worse child health outcomes. We need public health solutions, not just personal responsibility.

☣️ 3. The Toxin Connection is Real

Environmental toxins are driving childhood obesity, early puberty, and chronic diseases. Sustained family actions like consistently choosing glass over plastic and avoiding processed foods require dedication but can make a meaningful difference while we push for policy changes.

😴 4. We Need to Improve Sleep and Mental Health

Screen time is wrecking sleep, and poor sleep is fueling depression. 90% of studies show adverse effects of screen time on sleep. The fix is hard, unfortunately: devices out of bedrooms! but also later school start times, and considering some nutrient-related root causes of anxiety and depression.

📚 5. We Know the Solutions

The most frustrating part is that we have evidence-based interventions that work. We have successful teen pregnancy prevention programs, toxin reduction strategies, and community-based obesity interventions—successful studies have been done. The problem isn't knowledge; it's implementation at scale. 

🏠 6. Families Can Act Now

While we advocate for systemic change, families can make a start. Omega-3 supplementation reduces aggressive behavior and reduces depression, vitamin D improves mood, and simple environmental swaps reduce toxin exposure. Small actions compound into meaningful health improvements.

Favorite finds

• I Read Labels for You, my favorite site for a safe home, and safe cosmetics

• Mamavation and Moms Across America

• I’ve created a workbook to help you analyze your diet and set goals

• You can test your glyphosate level at the Detox Project

• The Environmental Working Group’s “dirty dozen” and “clean fifteen” are reasonable starting points for reducing pesticide in your food

Deep Dive Part 1/2

The Crisis in American Child Health: A Functional Medicine Informed Public Health Perspective on Trends and Solutions

Introduction

A landmark 2025 JAMA study has documented a systematic deterioration in American children's health across 172 health indicators over 16 years (Forrest et al., 2025). Using multiple data sources and international comparisons, researchers revealed that US children face dramatically worse outcomes than their peers in other wealthy nations. From 2007-2023, virtually every aspect of child health has worsened, creating what experts call a "fundamental decline in the nation's health."

The Health Crisis by the Numbers

Mortality: A Stark International Reality

• US infants: 1.78x more likely to die than OECD* peers

• US children (1-19 years): 1.8x more likely to die than OECD peers  

• 54 excess child deaths per day

• Firearms: 15x higher death rate than other wealthy nations

SIDS Rates

• Current US rate: 32.12 per 100,000 live births

• UK: 17-25 per 100,000

• Healthiest nations: 4-6 per 100,000

Rising Health Problems (2007-2023)

• Chronic conditions: 25.8% → 31.0%

• Childhood obesity: 17.0% → 20.9% 

• Early puberty (girls <12): 9.1% → 14.8%

• Sleep problems: 7.0% → 12.6%

• Depression symptoms in 9-12th graders: 26.1% → 39.7%

• Physical symptoms: 31.2% → 41.2% experiencing ≥1 symptom

When so many health indicators are declining so fast, a public health solution is very likely to be the best suited. We have a little anecdote in public health, about the guy who kept having to jump into a river to save drowning people until one day it occurred to him to ask himself how it was that they were ending up in the river in the first place?

This newsletter addresses 6 major concerns:

1. Perinatal deaths (infants in the first month of life)

2. Firearm deaths

3. Obesity

4. Early puberty

5. Sleep issues

6. Mental Health Crisis

This week’s newsletter will deal with solutions for the first 4 causes (and it’s already long enough!!)

Issue 1: Sudden Infant Death Syndrome (SIDS) and perinatal mortality (PNM)

Science-Supported Causes

Triple risk theory: Underlying vulnerability + critical developmental period + external stressors

• Underlying vulnerability: Prematurity, low birth weight, inadequate prenatal care, maternal substance use, young maternal age, infection

• External stressors: Soft bedding, overheating, tobacco exposure, prone or side sleeping

Also involved:

• Socioeconomic disparities and differences in healthcare access

• Variations in implementation of safe sleep recommendations between countries

• Higher inequality in the US and lack of health insurance, especially in non-Medicaid expansion states

• SIDS rates rose in the aftermath of the pandemic. Some argue it was due to a resurgence of RSV, which is either because of low RSV rates in 2020, and/or because COVID infections change the way our immune system responds to infections going forward. There was also much socioeconomic disruption and  increasing inequality in the aftermath of the pandemic.

Socioeconomic issues emerge as especially stark risk factors for perinatal deaths in general. Figure 1 shows that the higher the GINI coefficient (a measure of inequality) the higher the perinatal mortality. It also shows how much more unequal the US is compared to other developed countries around the world, but the relationship (see Fig. 2) holds even without the US on the graph.

Solutions

• National education campaigns for parents for newborn sleep safety

• Reduce inequality, improve access to prenatal care and infant care

• Address complicated societal forces behind teenage pregnancy and maternal drug use

I want to make it clear that we know how to do these things. It’s easy to list programs that have proved successful, the problem is finding the will to implement them. 

Programs Addressing Teenage Pregnancy

• Multidisciplinary and tailored interventions that include mentoring, skills training, and community involvement have shown effectiveness in postponing sexual initiation and increasing contraceptive use among adolescents.

• Programs focusing on skill-building, counseling, and abstinence education are generally effective at reducing adolescent pregnancy rates and improving contraceptive use.

• Home visiting programs for socially disadvantaged pregnant adolescents can increase spontaneous labor onset and reduce cesarean rates, though neonatal outcomes may not significantly change.

• Certain school-based interventions have been effective in reducing initiation of vaginal sex and teenage pregnancy rates, particularly in culturally diverse settings.

• Programs that support teen parents can improve educational attainment, increase contraceptive use, and reduce rapid repeat pregnancies.

Programs Addressing Maternal Drug Use

• Programs that combine substance use treatment with prenatal care and parenting support have demonstrated reductions in drug and alcohol use severity and frequency during pregnancy.

• Universal screening and integrated substance abuse treatment, such as the Early Start program, are associated with improved maternal and neonatal outcomes and are recommended as standard care. Punitive approaches reduce prenatal care.

Programs Improving Perinatal Outcomes

• Community-based case management for women at high risk has been shown to reduce rates of low birth weight and prematurity, bringing outcomes closer to those of low-risk populations.

• Initiatives led by nursing teams can reduce neonatal intensive care length of stay and improve overall perinatal outcomes.

• Programs targeting postpartum care, contraception use, and pregnancy spacing under Medicaid have improved maternal and infant health outcomes among at-risk women.

There are also some actions families can take. In this case, as you can see, they are few.

Individual/Family Actions

• Newborns should sleep on relatively hard surfaces, soft objects in the bed should be removed.

• Prone and side sleeping should be avoided. The official recommendation is also to avoid co-sleeping, however, a brief online search reveals that in Sweden, where the SIDS rate is very low, co-sleeping is a cultural norm. Apparently the messaging in Sweden is to avoid co-sleeping with infants younger than 3 months.

• Basic health (diet, exercise, stress reduction and sleep, toxin exposure and medical care) pre-pregnancy and during the pregnancy are also very important.

Issue 2: Firearm Deaths

Research-Supported Influences

• Gun law effectiveness: States with stronger laws related to background checks, regulation of sales/transfers, gun owner accountability, allowing firearms in public places, consumer and child safety laws, investigation of gun crimes, and local authority to regulate see lower firearm homicides and suicides.

• Community violence intervention initiatives: The only intervention that didn't show clear effectiveness

• Sociodemographic factors play a role, including unemployment, poverty, and insurance status (especially for homicides)

• Correlation with suicides: Supports the argument that guns in homes are most likely to kill the residents of the home

Public health solutions

• Gun laws, evidently

• Employment, income support, health insurance

Individual/Family Actions

Once the gun is available, there is so much less you can do to prevent its use. But it has been said that a gun offers a permanent solution to a temporary problem. One thing I suppose people could try is to reduce aggressiveness (for homicide) and depression (for suicide).

• Omega-3 supplementation: RCTs show significant reductions in externalizing (aggressive) behavior after 6 months (Raine et al., 2015)

•  Multiple vitamin supplementation: Shown to improve ADHD symptoms and emotional dysregulation (Rucklidge et al., 2021

• Vitamin D supplementation: Studies support positive influence on mental health, behavior problems, violence behaviors, anxiety, depression (Głąbska et al., 2021

• Safety around guns if in the home — lock up safely etc. Remember suicide also goes up when gun laws are lax, and almost half of high school children feel depressed almost every day 😱

• Game plan for depression: families should have game plan for what to do — don’t delay. Keep a list of phone numbers, save money for just that purpose. Don’t disbelieve your child or put off seeking care.

Issue 3: Childhood Obesity

Research-Supported Causes

• Multifactorial: Parental obesity, family environment, dietary pattern, physical inactivity and sedentary behavior, socioeconomic status, school and community environment, demographic and psychosocial factors

• First 1,000 days are especially important: Higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, accelerated infant weight gain, gestational diabetes, childcare attendance, low maternal-infant relationship strength, low SES, curtailed infant sleep, inappropriate bottle use, early solid food introduction, infant antibiotic exposure

• Environmental toxins and “obesogens” (toxins that cause obesity): Pesticides, industrial chemicals, household cleaning products, endocrine-disrupting chemicals (BPA, phthalates, POPs, organochlorinated pesticides, tributyltin, PCBs, dioxins)

• Critical exposure windows: Pregnancy and early childhood, with effects into adolescence and adulthood

• Studies and expert commentary highlight that parents are often misled by marketing and packaging, which can make ultra-processed foods appear healthy. It’s hard to find research support for this however.

Public health interventions that follow from causes above:

• Myriad! City planning, public transit, incentives for not having a car, etc.

• Effective prenatal care around weight gain; attention to insulin resistance

• Effective legislation and education around environmental toxins

• Relentless physician education against the misuse of antibiotics, 50% of which are still prescribed without a good reason

• Ongoing education of parents: “if it has a health claim, don’t eat it” — unprocessed fruits and vegetables don’t come with a stamped health claim.

Once again, we know what to do. We are just NOT doing it. Here’s another long list of interventions that have demonstrated effectiveness. One almost wonders if people want our kids more obese

• Comprehensive, community-based programs that combine policy changes, school wellness policies, improved food service, physical activity promotion, and primary care engagement have shown reductions in childhood overweight and obesity.

• Statewide and citywide interventions that address the built environment, access to healthy foods, and opportunities for physical activity have demonstrated population-level reductions in obesity prevalence.

Family-Targeted and Participatory Approaches

• Interventions that actively engage families—such as home visitation programs, parent education, and family-based behavior change—are effective

Macro- and Micro-Level Public Health Strategies

• Home visitation and changes to business practices (e.g., healthier food options in stores) are among the most effective community strategies.

• Universal community engagement interventions (e.g., citywide sports programs, cooking classes, public health campaigns) have shown small but viable improvements in weight-related and behavioral outcomes, with feasibility and scalability as major strengths.

Family approaches

As parents well know, trying to swim upstream is a challenge, but a few actions can be helpful.

• Aggressively reduce toxin exposure: websites such as “I Read Labels for You” and “Mamavation” or ”Moms Across America” list the most healthy alternatives

• Choose fresh over processed foods

• Buy in glass jars when possible

• Limit canned foods to once weekly

• Avoid microwave popcorn bags (you can make it on the stove, it will take some practice)

• Don't microwave plastic containers

• Use glass for hot foods

• Use steel or cast iron cookware; non-stick has a way of turning out to be harmful after a few years on the market

• At least let food cool before plastic storage

• Optimize your omega 3 index; also likely all the nutrients we have good ways to measure, like magnesium and vitamin D, iron, calcium, B vitamins, etc.

Issue 4: Early Puberty

An increasing percentage of girls begin puberty before the age of 9.

Literature-Supported Causes

• Multifactorial: Genetic factors, obesity and nutrition, environmental exposures

• Endocrine-disrupting chemicals: Phthalates, bisphenol A, pesticides, environmental toxins

• Psychosocial stress: Family dysfunction, low socioeconomic status, exposure to trauma

Public health interventions

• Same as Issue 3

• Awareness of trauma and reducing the stigma against family dysfunction

• Providing help to families to address trauma and family dysfunction.

• Creating policies that reduce or prevent family stress

Individual/Family Action

No published studies seem to have investigated whether we can prevent precocious puberty in siblings of affected girls. The prevailing hypothesis is that pubertal timing is largely determined during pregnancy and early infancy, suggesting that intervention may only be effective if implemented before siblings are conceived.

• Reduce endocrine disruptor chemical exposure: Same environmental toxin reduction strategies as for obesity

• Trauma therapy, family therapy; sometimes children inherit dysfunction that existed in the parents’ families, and the problem is not the present family.

(…To be Continued with last but not least: Sleep Issues and Mental Health Issues).

REFERENCES:
Detailed list next week, but for now, here’s the JAMA article (unfortunately paywalled)

Forrest CB, Koenigsberg LJ, Harvey FE, Maltenfort MG, Halfon N. Trends in US Children's Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms. JAMA. 2025