Emergency care of children in shelters.

Children living in homeless shelters often lack the health care resources usually available to other children. They are often more acutely and chronically ill than domiciled children and frequently use the emergency department (ED) as their point of entry into the health care system. To identify differences in health status, we surveyed sheltered children and domiciled controls during a nine-month period in our ED. One hundred sixty-two families completed a self-administered questionnaire during the study period: 54 homeless and 108 age-matched controls. Mean patient age was 3.4 years, mean maternal age was 27 years in both groups, and average time spent in shelters was 7.8 months. Shelter families had more children, more single mothers, and higher rates of unemployment and uninsurance than did control families. Shelter children showed greater frequencies of immunization delay, lack of TB testing, and lack of a regular health care site and higher rates of medical admissions from the ED. These data show that children in shelters have limited personal, financial, and medical resources and suggest that there are significant disparities in health status. These patients need to be identified when they present to the ED in order to meet subtle, as well as obvious, health needs.