Program Outcomes for Children



When considering the overall well-being of children, physical health and well-being, beginning before birth and continuing through adolescence, is an important area of concern.  Issues related to physical health may be particularly important for those children living in families at risk.  Risk factors such as poverty, poor living conditions, poor nutrition, and lack of health insurance are common in families at risk and may negatively affect the physical health of many children (Kiely & Kogan, 1994).  Indicators of physical health are included in many national reports of child well-being, including Kids Count statistics (Casey Foundation, 1998), reports from the Federal Interagency Forum on Child and Family Statistics (1997), and the 1998 Economic Report of the President.  The purpose of this discussion is to briefly describe indicators and measures of physical health and well-being that could be utilized by State Strengthening projects, 4-H programs, and other community programs for children.

NCEO Physical Health Model

Children's physical health is a comprehensive construct that includes a wide variety of developmental domains that vary with age.  The following issues are important to children’s physical health at different ages.

Infancy (prenatal through age 2): An infant’s physical health begins before birth.  Comprehensive measures of infant health should take into account prenatal and perinatal maternal health. After birth, low birth weight and infant mortality are important risk factors to assess.  Issues such as early nutrition, age-appropriate physical growth, physical safety, appropriate childhood immunization, and access to adequate health care also have important effects on the physical health of infants (e.g, American Academy of Pediatrics, 1997; Centers for Disease Control and Prevention; Fingerhut et. al, 1996;  Kids Count, 1998; Kleinman & Keily, 1991).

Early Childhood (ages 3 - 5): Good nutrition, access to adequate health care, physical safety, and immunization remain important influences on physical health during early childhood.  Preschool children may begin learning about the importance of physical activity.  Many basic eating habits are also developed and reinforced during early childhood.  As a result, measures of nutrition and age-appropriate physical development are important indicators of physical health in young children (e.g., Newachek, Halfon, & Budetti,1986). 

Elementary School (ages 5 - 12): For elementary-school children, issues such as immunization, nutrition and good eating habits, physical safety, and access to adequate health care continue to be important factors affecting physical health.  Physical fitness and physical activity level are also important factors affecting the health of school-aged children.  Elementary children are becoming aware of the dangers associated with the abuse of tobacco, alcohol, and drugs, and some late-elementary children actually may be at risk for beginning drug and tobacco use (Fingerhut et. al, 1996).

Assessment Issues

Many of the indices mentioned above — including prenatal maternal health, birth weight, physical growth, immunization history, and access to health care — can be measured using existing data from hospitals, public health records, physician and clinic records, and school records of school-age children.  Basic assessments of some indicators, such as physical fitness, nutrition, percent of body fat, and changes in height and weight, can be obtained through easily collected data such as height and weight measurements, simple parent or child checklists, teacher ratings, or systematic observation of specific behaviors (Simons-Morton & Baranowski, 1991; McKenzie, 1991).

Outcome Components

Ysseldyke & Thurlow’s (1993) conceptual model provides a useful framework for evaluating childhood outcomes in eight specific outcome domains, including physical health.  Although the model was designed with public education in mind, it can be applied to all educational efforts seeking to improve outcomes for children.  The model identifies four outcome components that may provide important indices of overall physical health.

 • Demonstrates age-appropriate physical development

 • Has access to basic health care

 • Is aware of basic safety, fitness, and health care needs

 • Is physically fit


One goal of the Children, Youth, and Families at Risk initiative is to provide children who are at risk with activities and programs that enhance their overall well-being, thus helping them to become more resilient.  Physical health is an important component of well-being for children and adolescents.  Comprehensive programs for children at risk should address the five health-related outcome components presented here in order to help children become healthier and more aware of the importance of nutrition, physical fitness, and safety.


American Academy of Pediatrics. (1997).  Recommended childhood immunization schedule - United States, January - December, 1997.  Pediatrics, 99, 136-138.

Centers for Disease Control and Prevention. (1997).  Notice to Readers Recommended Childhood Immunization Schedule -- United States, 1997.  Morbidity and Mortality Weekly Report, 46, 35 - 39.

Federal Interagency Forum on Child and Family Statistics. (1997).  America's Children: Key National Indicators of Well-Being.  Washington, DC: Author.

Fingerhut, L. A., Annest, J. L., Baker, S. P., Kochanek, K. D., & McLaughlin, E.  (1996).  Injury mortality among children and teenagers in the United States.  Injury Prevention, 2,  93-94.

Keily, J. L., & Kogan, M. D. (1994).  Prenatal care.  In L. S. Wilcox and J. S. Marks, (Eds.).  From Data to Action: CDC's public health  surveillance for women, infants, and children. Atlanta, GA: U. S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention.

Kids Count (1998).  Kids Count Data Book 1998.  Baltimore, MD: Annie E. Casey Foundation.

Kleinman, J. C., & Kiely, J. L. (1991).  Infant mortality.  HealthyPeople 2000 Statistical Notes (Vol1, No 2).  Hyattsville, MD: National Center for Health Statistics.

McKenzie, T. L. (1991).  Observational measures of children's physical activity:  Observation in the assessment of children's dietary practices.  Journal of School Health, 61, 5, 224-227.

Newacheck, P. W., Halfon, N., & Budetti, P. P. (1986).  Prevalence of activity-limiting chronic conditions among children based on household interviews.  Journal of Chronic Diseases, 39, 63-71.

Simons-Morton, B. G., and Baranowski, T. (1991).  Observation in the assessment of children's dietary practices. Journal of School Health, 61, 204-207.

Ysseldyke, J. E., & Thurlow, M. (1993, October). Developing a model of educational outcomes (NCEO Report No. 1). Minneapolis, MN: University of Minnesota, College of Education, National Center on Educational Outcomes.


Outcome Components:

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