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'Policymakers need to do their job too': Pediatrician's view on child poverty rate


It's unusual for child poverty to double in a year, and equally unusual, we can pretty clearly say why it happened. The expanded child tax credit that started two years ago came to an end. The extra help made a huge difference for Jennifer Bereskin (ph), who lives in Bothell, Wash. She and her 11-year-old son are on disability.

JENNIFER BERESKIN: I needed car repairs. I needed to replenish our food, you know, being able to have dry goods and things because during that COVID and everything, you know, grocery stores were running out of food quite quickly.

SHAPIRO: The money allowed her to catch her breath.

BERESKIN: I could, like, breathe for a moment and be able to be like, all right, I can - I don't have to sacrifice, you know, something here to get something else. I could get everything I needed.

SHAPIRO: Across the country, child poverty fell dramatically. And then less than a year after the expanded child tax credit was enacted, Congress let it expire. New census data show that child poverty rose last year from 5.2% to 12.4%. Pediatrician and researcher Megan Sandel sees the impact this has on kids she treats at Boston Medical Center. Welcome back to ALL THINGS CONSIDERED, Dr. Sandel.

MEGAN SANDEL: Thanks for having me, Ari.

SHAPIRO: A couple of years ago, you were on the program after the child tax credit expansion took effect. And here's what you told us.


SANDEL: I really have to call out the child tax credit. We have seen in the last six months families starting to get back on their feet. We have started to graduate kids from our Grow Clinic finally. And a lot of that has to do with being able to have that consistent check every month that they know they're getting.

SHAPIRO: So now that the credit is gone and child poverty is way up, what are you seeing?

SANDEL: You know, we're seeing families just under that enormous stress again. They are having to make really tough decisions. They have kids going back to school, and they don't know if they can afford a backpack and that school uniform, and needing to make really difficult choices about whether or not they're going to be able to actually be able to afford the food that their kids need to grow.

SHAPIRO: I think everybody understands that poverty affects health. But as a doctor, can you tell us specifically what you tend to see more of when families struggle to meet kids' basic needs?

SANDEL: Yeah. I think, you know, many of us who are parents remember taking our kids to the doctor. And one of the things we do is we measure your weight and your height, and we put you on a growth curve. What are you expected to grow? What's the rate you're expected to grow for different ages? And what we're starting to see is kids flatlining, kids who should be growing, should be gaining weight, should be, frankly, growing the brain that they need for the rest of their lives. And we're seeing kids not grow. We're seeing kids lose weight, which when you're 3 or 4 years old, that is a medical emergency. What's going on? And a lot of times when we really dig deeper, it's simply because people can't afford enough food and are stretching beyond what they can deal with.

SHAPIRO: Is there a family or a kid you can tell us about who kind of puts a face to this trend?

SANDEL: Yeah. One of my favorite families, their child was getting ready for kindergarten. And, you know, this was a kid who I was ready to graduate in August because he was going to kindergarten. We had gotten him back to his weight. He didn't need special shakes anymore like PediaSure or things to grow. And he showed up, and his weight had - he had lost 2 pounds, like not even gained, not even flatlined, he had lost weight. And what ended up coming out was that, you know, they were really, really stretched, and they no longer had the child tax credit.

SHAPIRO: These expanded benefits ended during a time of record inflation. How does that overlay on these other trends you're talking about?

SANDEL: I do think that it is important to name both food inflation, and honestly, housing costs as two of the biggest bills that families have to face every day. That being said, what you were able to see is even in those rising costs, there was effective ways in which to reduce child poverty. And so what I don't want people to walk away from is to say, oh, well, inflation. It doesn't matter if you give people more money, it's just going to be spent and it won't travel as far. I do think that in many ways, it really is about the positive effects of putting money in people's pockets.

I think that what it underlines is that we also need to start thinking about ways in which to help people out of poverty and to be more financially stable, to not just improve their income, but to help them be able to save money. A lot of programs disincentivize people saving. And you gain more money, but you actually lose a benefit. And I also think that this is a moment where we need to invest in housing. A lot of the infrastructure and Build Back Better had housing in the original plan, and it went away. And I think that - if I were to tell you, you know, food insecurity and housing insecurity are the twin demons that face my families that I serve every day. And so we need to be able to talk about them together.

SHAPIRO: As a medical provider, how does it feel to see a government program that you could see helping your patients effectively be eliminated despite the fact that it was making a visible difference?

SANDEL: It's so interesting. We talk about evidence-based government and always wanting to say we're investing in things that work. And so this is really where we need to look ourselves in the mirror. We have something that worked really, really well. And so I want to ask, what are the ways in which, you know, we can say to ourselves, this is worthy of investment? Because what I like to say is I can do my best role as a physician to help kids grow. But what I need is policymakers to do their job to be able to help kids grow, too. And that is really in their hands.

And so I'm not going to give up the fight. Like, I'm not going to say, you know, it's over. I think that these are the wake-up call that we can do better. And this is - I'd love to be able to come on in a year and be able to talk about that we got the number back down to 5% and beyond.

SHAPIRO: What does it do to somebody's prospects as an adult when they grow up without the kind of growth, weight gain and development that you were seeing when this child tax credit was in place?

SANDEL: Yeah. I think, you know, there are really important metrics around how kids are going to thrive in the economy. So one is, are they showing up to kindergarten ready to learn? Are they in third grade reading at grade level? Because after third grade is where you read to learn. And if you're not reading on grade level, you're missing out. And then are you able to thrive in high school, graduate and be able to move into the economy?

And I think that when we start thinking about these ripple effects, you know, being able to see translated in literally kids' body weight how they're doing well and how their families are thriving or not, I do think that that can make a difference in terms of what that child's going to be able to accomplish. Now, I don't ever want to give up on kids and families. And, you know, whether or not you missed out on a critical time period of growth, I'm going to try and catch you back up to that curve. And it's meant we've had to, you know, institute programs like special education, you know, consultation programs to help those kids get back on track. But it is avoidable. It was preventable. And that's the thing that I think is important is that we can do better. We saw it work. Now we have to get back to doing it regularly and making it a permanent fix.

SHAPIRO: That's Dr. Megan Sandel, pediatrician at Boston Medical Center. Thank you so much.

SANDEL: Thank you so much, Ari, for bringing light to this really important issue. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Brianna Scott is currently a producer at the Consider This podcast.
Christopher Intagliata is an editor at All Things Considered, where he writes news and edits interviews with politicians, musicians, restaurant owners, scientists and many of the other voices heard on the air.
Ari Shapiro has been one of the hosts of All Things Considered, NPR's award-winning afternoon newsmagazine, since 2015. During his first two years on the program, listenership to All Things Considered grew at an unprecedented rate, with more people tuning in during a typical quarter-hour than any other program on the radio.