Christine directs a childcare program that serves many low income families, some of whom are homeless or are at risk for losing their current housing. Christine realizes that young children in homeless families often have undiagnosed or untreated health needs. She wants to find community resources to provide support for the health needs of homeless children and families.

Homelessness occurs when an individual has inadequate housing; these families often live in shelters, motels, vehicles, campgrounds, or with relatives or friends. Some live on the street in whatever shelter they can find or create. The common theme is that they lack a permanent place to call home.

The economic crisis, rising unemployment, and challenges such as addiction, domestic violence and mental health issues, have increased the number of homeless people in the U.S.

About half of the yearly homeless population is made up of families with children, and those children occupy about 40 percent of the beds in homeless shelters each night. Many homeless children are very young, with at least half under the age of 5.

Homelessness occurs in rural, suburban, and urban areas. Recent studies show children are homeless for an average of 10 months at a time, and one-quarter of homeless children are homeless more than once. Homeless children often have working parents who rely on childcare programs to provide daytime food and shelter.

Homelessness and Young Children’s Health

Homelessness can have a profoundly negative impact on young children’s well-being, and many children who are homeless have multiple health problems. Young children who are homeless are more vulnerable to infectious diseases, injuries, mental health issues, nutritional deficiencies and hunger, poor dental health, hearing and vision problems, asthma, anemia, lice and scabies, exposure to lead, and child abuse and neglect.

In some cases, living conditions contribute to health problems. For example, the crowding in some shelters and transitional housing increases children’s risk of contracting upper respiratory infections, ear infections, diarrhea, and other communicable disease.

Dust mites, cockroaches, rodents, and molds aggravate asthma and allergies; these factors are commonly found in dilapidated buildings that may serve as temporary housing. Many homeless families struggle with emotional difficulties, mental illness, domestic violence, and substance abuse. These in turn can contribute to anxiety, depression, and behavioral issues for children.

Children and families may not have a medical home or consistent health care provider. Consequently, they may not be properly immunized, which increases the risk for infectious disease. Sanitation, hygiene, nutrition, and basic first aid often are not available, which further compromises health status.

The daily struggle for survival faced by homeless families often takes priority over the developmental needs of their children. Therefore, a variety of developmental delays, along with social, emotional, and behavioral problems, are associated with homelessness.

Homeless Children and Childcare

One difficult and frightening aspect for children is the lack of stability that is associated with permanent housing. Young children who are homeless have four times the rate of developmental delays as their peers. Infants who are homeless may cry more often and have slower motor development than other children. Toddlers also may have delayed motor development and language skills.

Childcare can help provide stability by offering a warm, consistent, and nurturing environment to support the young child’s health and development. The meals and snacks, health screenings and services, immunizations, parent education, outdoor play, and naptimes included in the childcare programs have positive benefits for all children; for homeless children, these can make a profound difference in their lives.

Childcare programs typically have relationships and contacts with community service providers who can assist homeless children and their families. Appropriate referrals to and resources from community-based services can meet needs ranging from children’s nutritional status to immunizations and vision and hearing screenings.

For example, research indicates homeless children are hungry twice as often as other children, and nearly one-third of homeless families do not have financial resources or a consistent place to prepare daily meals. Childcare programs that serve nutritious meals and snacks will immediately improve a hungry child’s health and dietary status.

In addition, the childcare program may link the family with the WIC (Women, Infants, and Children) nutrition program and community food pantries to improve nutrition for the entire family.

Many homeless families are affected by substance abuse and mental health issues. Childcare providers can facilitate links to community-based services to help families struggling with these problems.

Many children who are homeless have few opportunities for outdoor play. Childcare programs that offer access to nature, exploration, and exercise through outdoor learning environments are helping to fill that void for homeless children.

Naptime and rest is essential for homeless children. Transitional housing often is not conducive to sleep, so naptime during childcare helps children catch-up on rest. Childcare also gives preschoolers who are homeless a chance to practice their self-help skills. The handwashing and tooth brushing rituals that are part of the daily schedule teach children who are homeless about personal hygiene and health practices that will serve them throughout life. 

Parent Education

Parent education programs can support families who may have difficulty understanding appropriate expectations, guidance, and discipline for children. Parent training can provide information and promote skills to safeguard children’s health and safety.

Temporary housing and shelters may not offer children adequate room for movement and exploration, and there is often noise and crowding that makes conversations difficult. Childcare providers can work with parents to offer simple activities to encourage children’s motor, language and social-emotional development. They may also make referrals to Early Intervention programs and to therapists who can provide support for children’s health and development.

Working with homeless children and their families can be challenging. The instability that defines homelessness often means that children may only attend childcare sporadically and for a short period of time. However, the services, routines, and activities that childcare can offer homeless children can make a tremendous difference in their health and development.

Marna Holland
Parent Educator, Asheville City Schools Preschool, Asheville, NC

Internet Resources

America’s youngest outcasts: State report card on child homelessness, Campaign to
End Child Homelessness, www.homelesschildrenamerica.org

Helping Homeless Families Meet Childcare Needs, Head Start Bureau, www.hrsa.gov/homeless/pa_materials/pa8/0807.pdf 

Homeless children: What every health care provider should know, National Health Care for the Homeless Council,
www.nhchc.org/Children/index.htm