On one morning, about a year ago, I walked into a room to see two brothers whom I have seen in my clinic for several years, 3-year-old Ari and 4-year-old Ryan. (I’ve changed their names to protect their privacy.) Their mom was worried about their behavior. She said that they had a hard time listening, couldn’t sit still, and fought with each other constantly. The two boys were running and jumping all around and ended up fighting several times during their appointment.
Their family had been moving around for as long as I had known them, staying with family members and friends, in their car, or in a hotel room. Even though their mother had a steady job, she had not yet been able to make enough to get her own home, which was something she talked about wanting every time I saw them. On this morning, their mom talked about how tired and stressed she felt from her full-time job, taking care of her boys under someone else’s house rules, and knowing she would eventually have to move yet again.
While their mom’s concerns at this visit were not new, Ari and Ryan did seem more agitated than in the past: full of nervous energy and more emotionally fragile than I would expect children their age to be. It was clear that both boys were feeling their mother’s mounting anxiety and were struggling with the stress.
As a pediatrician in the San Francisco Bay area for over 20 years, I have focused on working with families who experience unstable housing. Families like the ones I work with are often left out of conversations about the housing crisis. However, the best data we have, collected by the US Department of Education, suggests that millions of children in the United States are homeless every year; in the 2018-19 academic year, nearly 1.4 million, or one in 30, school-age children met the federal McKinney-Vento Act’s definition of homelessness. And this unfathomable number is actually an undercount, since it does not include young children ages 0–5 who have not yet enrolled in school, which is helped of all homeless children. In fact, the age at which a person is most likely to stay in a shelter is between birth and 1 year old. It also does not include children who experienced homelessness during the summer when school was out, and children who did not inform anyone in the school about their housing challenges. Ari and Ryan, who are not yet enrolled in school, are not on any housing agency or school’s radar.
Homelessness can damage kids’ physical health and hinder their ability to do well in school. But one of the most profound and long-lasting impacts I’ve observed is on children’s mental health. Ari and Ryan should be focusing on their development: learning how to interact with other children, negotiate conflicts, share, and foster their creativity. They should not have to worry about where they will sleep, if they will have food to eat, or how to manage the stress they see in their parents. But nearly every patient I see who has experienced homelessness or unstable housing is burdened by significant mental health repercussions.
