Timing and duration of pre- and postnatal homelessness and the health of young children

Objectives: Prenatal homelessness is associated with elevated risks of adverse neonatal outcomes. How the timing and duration of homelessness during pregnancy and/or a child's early life relate to postnatal child health is unclear.

Methods: We interviewed 20 571 low-income caregivers of children 4 years old in urban pediatric clinics and/or emergency departments in 5 US cities. Categories of homelessness timing were prenatal, postnatal, both, or never; postnatal duration was >6 months or 6 months.

Results: After controlling for birth outcomes and other potential confounders, compared with never-homeless children, children who were homeless both pre- and postnatally were at the highest risk of the following: postneonatal hospitalizations (adjusted odds ratio [aOR] 1.41; confidence interval [CI] 1.18-1.69), fair or poor child health (aOR 1.97; CI 1.58-2.47), and developmental delays (aOR 1.48; CI 1.16-1.89). There was no significant association with risk of underweight (aOR 0.95; CI 0.76-1.18) or overweight status (aOR 1.07; CI 0.84-1.37). Children 1 year old with >6 months of homelessness versus those who were never homeless had high risks of fair or poor health (aOR 3.13; CI 2.05-4.79); children 1 to 4 years old who were homeless for >6 months were at risk for fair or poor health (aOR 1.89; CI 1.38-2.58).

Conclusions: After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.