Component 1: Medical Record Review

Children’s HealthWatch collects detailed medical and sociodemographic data through medical record review. We conduct repeated cross-sectional surveillance of the population of children under four years of age accessing emergency departments and acute clinics in inner-city medical centers.


  • Daily entry of data from medical records into a secure Children’s HealthWatch research web site maintained and managed by the Boston University School of Public Health’s Data Coordinating Center (DCC).
  • Weekly reporting of surveillance data to all participating medical centers by the DCC.
  • Continuous monitoring of children in surveillance population by each Children’s HealthWatch for growth and nutrition problems.
  • Notification of primary care providers for children presenting possible growth or nutrition problems.

Component 2: Caregiver Interviews

Cross-sectional sampling of English- and Spanish-speaking caregivers (and Somali-speaking in Minneapolis only) of children under four years of age accessing emergency departments (ED) and clinics in Children’s HealthWatch medical centers. The household survey instrument is administered during waiting periods in the ED or clinic with detailed information collected about demographics, child health and development, parental health, housing, household food security, federal assistance program utilization and income.

Caregivers of children under 48 months of age seeking medical care for their children are interviewed during their medical visit. Study research assistants:

  • Obtain consent and determine eligibility.
  • Ask caregivers the questions included in the Children’s HealthWatch interview.
  • Weigh and measure the children. Click to learn more about anthropometric assessment.
  • Connect families that are in need with pertinent resource and referral information that can assist them, either on-site or in their neighborhood.
  • Children with significant growth delays are assessed to see if they are receiving medical follow-up. If not, they are referred back to their primary care provider for follow-up.

Interviews are coded and cleaned by the medical centers, and mailed monthly to the Boston University School of Public Health Data Coordinating Center to be entered into the database and analyzed.

Study Hypothesis

Children’s HealthWatch interview data are used to continually monitor the following hypothesis: Changes in public assistance policies and spending and the fluctuations of the economy impact the nutrition, health and development of young, low-income children. It is anticipated that the impact of policy and economic changes will be detected in:

  • food insecurity and hunger rates
  • weight-for-age and weight-for-height measurements
  • child health status
  • hospitalization rates, and;
  • developmental risk.

Since Children’s HealthWatch began collecting data during the economic boom and has been continuously monitoring data and public policy changes, its ongoing data collection is uniquely positioned to demonstrate these effects.

Learn more about food insecurity.

Study Location

Why monitor children in acute centers and emergency departments?

The Children’s HealthWatch sample comprises a vulnerable sentinel group (like “canaries in a coal mine”). Emergency Departments and acute care clinics serve a disproportionate share of medically uninsured and underinsured young children. Additionally, working poor parents are likely to have less work flexibility to take children for routine health care visits, making greater use of off-hour acute care centers and emergency departments instead. Health and social problems come to the attention of emergency department medical providers that otherwise would be missed.