Objective
Children with special health care needs (CSHCN) are at risk for decreased participation which can negatively impact their lives. The objectives of this study were to document the presence of participation restrictions for CSHCN compared to other children and to determine how personal and environmental factors are associated with participation restrictions for CSHCN.
Methods
The 2007 National Survey of Children’s Health (NSCH) was analyzed to evaluate two participation outcomes for children aged 6–17 years: school attendance and participation in organized activities, and two participation outcomes for children aged 12–17 years: working for pay and volunteering. Adjusted prevalences of participation restrictions were calculated for children with and without special health care needs. Logistic regression was used to identify factors independently associated with participation restrictions for CSHCN.
Results
After adjustment for sociodemographic characteristics, a larger proportion of CSHCN (27.9%) reported missing more than 5 days of school than other children (15.1%). In contrast, no differences were found for participation in organized activities, working for pay or volunteering. CSHCN with functional limitations were more likely to experience all four types of participation restrictions compared to other CSHCN and non-CSHCN. For CSHCN, the odds of certain participation restrictions were higher for those with functional limitations, in fair/poor health, with depressed mood, living at or near the federal poverty level and living in homes not headed by two parents.
Conclusions
CSHCN with functional limitations and those with worse health status are at elevated risk of experiencing participation restrictions than other children. Social disadvantage furthers the likelihood that CSHCN will experience participation restrictions.