Reviews the changes managed health care has brought to the delivery and use of medical services and recommends specific steps that will make the existing system more responsive to the needs of children. Systemwide health care reforms must give children stable medical care that emphasizes preventive health and developmental services. (SLD)

Recently states have increasingly turned to managed care arrangements to finance and deliver health services to Medicaid beneficiaries. As this trend continues, states should carefully monitor changes in program costs and quality and implications for delivery of pediatric services and health outcomes for children. (SLD)

Estimates the number of infants exposed to legal and illegal substances before birth, drawing on 27 published reports and National Institute on Drug Abuse data. The following are estimated exposure levels: (1) cocaine, 2-3 percent; (2) marijuana, 3-12 percent; (3) cigarettes, 38 percent; and (4) alcohol, 73 percent. (SLD)

The living arrangements of American children have been strongly affected by revolutionary social changes in the past 30 years, including a large decrease in first-marriage rates and an increase in divorce. Each year more than one million children are affected by divorce. Statistics on divorce and social trends are presented. (SLD)