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According to the Tennessee Commission on Children and Youth, out of the 95 Tennessee counties, Shelby County ranks 93rd in Economic Wellbeing, 91st in Education, 93rd in Health, and 74th in Family and Community. The leading causes of death in children, teens, and young adults in Tennessee and Shelby County are accidental injuries, homicides, cancer and suicide.

According to the State of Tennessee 2023 Child Fatality Report, firearm deaths were the leading external cause of death among Tennessee children. While the rate of child deaths has remained the same across Tennessee, the rate in Shelby County has increased over the same 5-year period. The greatest health issues Tennessee children face include poverty, community violence, lead poisoning, mental health, inadequate prenatal care, nutrition, obesity and unintentional injury.

Poverty. Poverty and health-related social needs negatively impact many aspects of physical, mental, social and emotional health, as well as educational attainment and more. A quarter of the residents of Shelby County are children under age 18, and a quarter of those children are living in poverty. Of the children living in Shelby County, 60% are African American. There is a significant racial disparity with a 38% of all African American children and 34% of Hispanic children living in poverty compared to 7% of White children in Shelby County.

Prenatal Care. Pregnant women living in poverty are less likely to get adequate prenatal care (regularly beginning in the first trimester). In Shelby County, just over half (58%) of African American women get adequate prenatal care compared to 66% of White women. Inadequate prenatal care can lead to poor infant health outcomes such as prematurity, low birth weight, infant mortality and negative outcomes for mothers. African American babies are two times more likely to be born with low birth weight and 1.5 times more likely to be born premature compared to White babies. Since 2017, the percentage of women getting prenatal care has increased noticeably from 54%, to 61 % in 2021. During this same time, the infant mortality rate has decreased from 10 per 1,000 live births in 2017, to 8.8 per 1,000 live births in 2021. While we celebrate a decrease, a significant racial disparity persists between African American and White infant mortality. African American babies die in infancy at a rate more than two times that of White babies.

Nutrition and Obesity. In 2021, 22% of children under 18 years of age face food insecurity in Shelby County. Although Shelby County has typically had comparable rates to the state average, in 2020 (year of the COVID-19 pandemic), the rate of food insecurity in children under 18 increased dramatically to 27% compared to the state average of 20%. In 2022, supplemental nutrition assistance was provided to 34% of all children under 18, while a quarter of all children under age 5 received WIC services. WIC and the Supplemental Assistance program provide nutritional education and support to their clients. The 2021 CDC’s Youth Risk Behavior Surveillance Survey (YRBSS) found that in Shelby County, 18.5% of surveyed high school students were overweight and 23.5% were obese. (1)

Community Violence. Homicide and violent crime rates are indicators of poor community safety, which leads to premature deaths. According to the State of Tennessee 2023 Child Fatality Report, firearm deaths were the leading external cause of death among Tennessee children. The rate of firearm death was 5.5 deaths per 100,000 children. Between 2017 and 2021, the rate of homicide among Tennessee children increased by 18.9%.2 Shelby County has a violent crime rate that is double that of Tennessee and triple that of the United States. Since 2016, the homicide rate for Shelby County has more than doubled. The rate of aggravated assaults has increased by 46% and the rate of gun related incidents has increased by 42%. Unfortunately, our children are not immune to this violence. In 2021, Tennessee had among the highest rates of all states in both under 18 homicide victims (10th) and under-18 homicides using a firearm (7th).

As a Level 1 Trauma Center, Le Bonheur treats children and teens with gunshot wounds. The number of children treated at Le Bonheur for gunshot wounds has nearly tripled from 68 in 2018 to 180 in 2023. Across the county, nearly 20% of assaults in which a firearm was used to perpetrate the crime involved children under the age of 18. The racial disparity between victims of assault is great. African American children are 10 times more likely to be a victim than White children are.

Lead Poisoning: Childhood lead exposure impacts early development by damaging the brain and nervous system and can result in lifelong health, behavioral, social, and economic challenges. Childhood lead exposure is associated with attention deficit problems and increased incidence of problematic behavior or justice system involvement. The focus of lead poisoning prevention efforts should be on reducing the most common sources of lead exposure which are lead-based paint and dust in the home, water service lines and lead in the soil. There is no safe level of lead in a child’s blood. Even a slightly elevated lead level can lead to problems in the future – which is why protective measures like cleaning to remove lead dust from floors or using filtered water to make baby formula if a home has lead water lines are vitally important to reduce the risk of exposure.

In the past decade, Tennessee has seen a significant increase in lead screening and reduction in the burden of lead poisoning among children under six years of age. The aggregate screening rate (the number of children who had at least one blood lead test prior to age six divided by the under six population estimate for the last year in the aggregate time interval) increased from 59% in 2011–2015 to 66% in 2016–2020. The annual rate of elevated blood lead levels above ≥ 5 micrograms per deciliter dropped from 4% in 2011 to 1.1% in 2020, the lowest in a decade.3 However, from 2019 to 2020, the annual screening rate (the number of children screened for blood lead in a year divided by the under six population) across Tennessee decreased by nearly 10% from 2019 to 2020. This could be a function of the COVID-19 pandemic, decreased well-child visits, incomplete reporting and changing screening recommendations.

Early intervention programs and nutritional support can help mitigate the behavioral and developmental impacts of lead exposure if identified by proper screening and referred to services. Lead levels higher than 3.5 micrograms per deciliter automatically qualify a child for TN Early Intervention services, which provides support for children with or at risk for developmental delays. Families also quality for services from Shelby County Health Department and the City of Memphis.

Teen Sexual Health. Shelby County’s five-year annual average birth rate for females ages 15-19 is 34.8 per 1,000 females, which is greater than the rate for both Tennessee (27.2 per 1,000 females) and the United States (19.3 per 1,000 females).4 There is great racial disparity among teen births. The birth rate for African American teens is four times greater than that for White teens. The birth rate for Hispanics is six times greater than the rate for Whites. The rate of males and females ages 15-17 with sexually transmitted infections (STIs) is two times greater than the state rate. Shelby County ranks 74th of all Tennessee Counties for teens with STDs.

Unintentional Injuries. Unintentional injuries is a broad category and encompasses injuries such as motor vehicle crashes, falls, and sport accidents. Motor vehicle crashes are the leading cause of unintentional injury death in children. Shelby County ranks 95th in the state’s counties for teen drivers who were involved in a vehicle crash. Teens ages 16-17 are involved in 17% of all motor vehicle crashes. The rate of teen and young adult drivers involved in crashes has increased every year and is much greater than the rate for Tennessee. The percentage of restraint and seat belt use for children involved in motor vehicle crashes has increased dramatically since 2018. Of children aged 0-12 involved in crashes, 97% were restrained.

In 2021, Tennessee saw the highest number and rate of unintentional infant deaths due to suffocation since before 1999, according to the Tennessee Commission on Children and Youth (TCCY) State of the Child report.

According to the TCCY State of Child Report, from 2018 - 2021 in Tennessee there were 502 unintentional deaths among children ages 1-17:

• 47 percent (237 deaths) were from Motor Vehicle Traffic Accidents
• 15 percent were from Drowning (75 deaths)
• Eight percent were from Poisoning (41 deaths)
• Six percent were from Fire/Flame (28 deaths)
• Four percent were from Suffocation (19 deaths)

In 2021, Tennessee had the 13th-highest rate of unintentional deaths. Tennessee had the 11th-highest rate of Unintentional Motor Vehicle Deaths. Children in Tennessee are at the greatest risk for unintentional motor vehicle deaths between age 15 to 17 and age 2 to 4. The unintentional death rate among children ages 1 to 17 between 2018 and 2021 increased from 3.7 to 4.8 per 100,000, with an increase of 1.0 per 100,000 just between 2020 and 2021. (5)

Mental Health. In 2021, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, Children’s Hospital Association, and more than 130 health organizations called for a national emergency declaration in children’s mental health citing “soaring rates of depression, anxiety, trauma, loneliness and suicidality.”6 According to the Tennessee Department of Health, for Tennessee children ages 1 to 14, suicide is the fifth leading cause of death and the second leading cause of death for teens and young adults ages 15 to 24. (2022).

These issues impact children across the entire state. Rural communities often have fewer resources to adequately address mental health concerns, though there are extreme strains in urban areas as well. Tennessee’s children’s hospitals are at the front line of helping all of Tennessee’s children – rural and urban – who are dealing with the most severe medical and behavioral health issues. In Tennessee, 50.7% of children, ages 3 to 17, with a diagnosed mental/behavioral condition are not receiving treatment (2020-21).

Throughout the report, all rates are age adjusted. Age adjusted death rates facilitate the comparison of death rates in populations with different age structures. These rates are calculated with statistical methods of standardizing rates to U.S. population datasets. For example, most diseases or illnesses occur at different rates within each age group. Older people get cancer and heart disease more often than younger people. A community with a very large number of older citizens may have more cases of cancer or heart disease and therefore a larger rate of these diseases. To be able to compare the rate of diseases with other communities such as ones with smaller populations of older citizens, adjustments of the rates are done based on statistical calculations within each age grouping and disease or illness. The authors of this Community Health Needs Assessment reported rates that were already calculated and reported in source material as referenced.

It is important to acknowledge the assistance many families were able to receive during the COVID-19 pandemic. Support like pandemic assistance programs, tax credits and TennCare deadline extensions lifted many families with children out of poverty and provided them very necessary resources during a time of extraordinary crisis. Although the impact made on families should not be overlooked, it is also important to note that these assistance measures have expired. Families now face losing health insurance coverage and historically high rates of homelessness in communities that have still not recovered from the COVID-19 pandemic.

The goal of this document is to highlight the greatest health issues and burdens faced by our community’s children. These issues include poverty, community violence, lead poisoning, mental health and inadequate prenatal care. Since its establishment, Le Bonheur Children’s Hospital has worked diligently to meet families and children and provide resources and programs that help address these identified health issues and more. Collaboration with like-minded community partners has allowed our community programs to reach every zip code in Shelby County and expand outward into Arkansas, Mississippi and Tennessee.

In addition to building awareness of the issues our children face, this report serves as a vehicle for Le Bonheur, UTHSC and other community partners to showcase the work currently underway to improve the health of children and families. Le Bonheur Children’s and UTHSC want to educate the community about these issues to bring about action and facilitate advocacy for expanded focus and funding on issues that directly impact our communities.

The expert team assembled this data report from existing data reports and available information. They acknowledge the need for and call for more streamlined and readily accessible data and information with consistency in age ranges and definitions around the health and safety of children and young people. Once we as a community understand the issues facing our children, we can work together on proven and effective interventions to improve children’s lives.

In this inaugural report, we have learned a lot about what information is readily available and what gaps we have. We are committed to showcasing this information in the years to come and continuing to share what Le Bonheur and other key community stakeholders are doing to help our children grow up healthy, safe and well.

Learn more about the work Le Bonheur, UTHSC and their partners are doing in the community:

Request information or medical expert interviews:

lchai@lebonheur.org

This report is a publication of Le Bonheur and UTHSC’s Child Health Advocacy Institute. The goal of the Institute is to define and understand the issues impacting children in the community and collaborate with community partners to work together on issues that impact children’s health and well-being.

Visit or more information.

Special thanks to:

Le Bonheur President and Surgeon-In-Chief Trey Eubanks, MD, FACS

Christina M. Underhill, Ph.D.

Evan Wilson, MA

Rowland Yancey, MA

Cynthia Cross, MD, FAAP

Jason Yaun, MD

Sara Burnett

Cheyenne Plesofsky, MPH

Le Bonheur Advocacy Advisory Council

Kristen Bland

Cynthia Cross, MD, FAAP

Robin Crutchfield, MEd, MS

Trey Eubanks, MD, FACS

LaPrecious Harrold, MD

Nellann Mettee

Maureen O'Connor

Cheyenne Plesofsky, MPH

Kathryn Ramsey Mason

Katy Spurlock

Jennilyn Utkov

Regan Williams, MD

Jason Yaun, MD

Le Bonheur Data Report Medical Advisory Committee

Ariss Arena

Sandra Arnold, MD

Michelle Bowden, MD

Desiree Burroughs-Ray, MD

Cynthia Cross, MD, FAAP

Emilee Dobish, MD

Alexander Feliz, MD

Tanjala Gipson, MD

Cindy Hogg, RN, BSN

Claudette Jones-Shephard, MD

Nellann Mettee

Adebowale Odulana, MD, MPH

Pediatric Chief Residents

Cheyenne Plesofsky, MPH

Tracee Ridley-Pryor, DNP, PMHNP-BC

Webb Smith, PhD

Christina Underhill, PhD

Jennilyn Utkov

Rush Waller, MD

Nick Watkins, MD

Toni Whitaker, MD

Regan Williams, MD

Evan Wilson, MA

Jason Yaun, MD

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