Research Article| Volume 67, ISSUE 4, P450-461, July 2019

Reframing child rights to effect policy change

Published:February 23, 2019DOI:


      • Many children in the United States lack access to services and care needed to improve the quality of their lives and their future adult potential; typically, these are children of color or who live in poor families.
      • Despite its wide use, a rights-based approach has limitations in advancing the well-being of children, pointing to the need for alternative framing strategies.
      • Other framing strategies, including the lifespan approach, mutualism between parent and child, cost-benefit analyses, and a capabilities approach, could augment or replace rights-based arguments for advancing children's well-being.
      • Recent education and child health policies protect some groups of children more than others and fail to ensure that all children have access to needed services, thereby contributing to inadequate outcomes.



      Much of the discourse surrounding children's advocacy in the United States relies on a rights-based approach. We argue that this approach has limitations that impede progress in advancing children's well-being.


      The purpose of this article is to explain alternatives to a rights-based approach in advocating for children, such as developmental, economic, capabilities, and mutualism frameworks.


      Our analysis is based on the independent work of two separate university-based groups studying children's rights; the authors were each members of one of the groups and subsequently integrated their findings for this article.


      US policies for children, especially in the domains of health and education, depict an unevenness that results in many children failing to receive certain critical services and benefits. Relying on a rights-based approach to correct these disparities and inequities is contentious and has yet to sufficiently change state and federal policies or improve children's health outcomes. Other approaches are needed to advance children's well-being.


      Nurses individually and collectively need to be mindful of the pitfalls of a rights-based approach and use other frameworks in advocating for children and youth.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Nursing Outlook
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Abrams D.
        • Ramsey S.
        • Mangold S.
        Children and the law in a nutshell.
        5th Ed. West Academic, St. Paul, MN2015
        • Acker J.
        $7 billion in CHIP cuts? Say Ahhh! Blog.
        Georgetown Health Policy Institute, Center for Children and Families, 2018 (Retrieved from)
        • Alstott A.
        No exit: What parents owe their children and what society owes parents.
        Oxford University Press, New York, NY2004
      1. The Annie E. Casey Foundation (2018). 2018 Kids count data book: State trends in child well-being. Retrieved from

      2. Artiga, S., & Ubri, P. (2017). Key issues in children's health coverage. Retrieved from Menlo Park, CA:

      3. Barry, P. (2016). Do you qualify for Medicare? Retrieved from

        • Baumgartner F.R.
        • Berry J.M.
        • Hojnacki M.
        • Kimball D.C.
        • Leech B.
        Lobbying and policy change: Who wins, who loses, and why.
        University of Chicago Press, Chicago2009
        • Beatty B.
        Preschool education in America.
        Yale University Press, New Haven, CT1995
      4. (1954).Brown v. Board of Education, 347 US 483, 74 S. Ct. 686, 98L. Ed. 873

        • Burke-Harris N.
        The biological effects of childhood adversity.
        Houghton Mifflin, New York2018
      5. Cannon, J. S., Kilburn, R., Karoly, L. A., Mattox, T., Muchow, A. N., & Buenaventura, M. (2017). Decades of evidence demonstrate that early childhood programs can benefit children and provide economic returns. Retrieved from

        • Caplan A.L.
        • Hotez P.J.
        Science in the fight to uphold the rights of children.
        Plos Biol. 2018; 16E3000010
        • Cohen S.S.
        Championing child care.
        Columbia University Press, New York, NY2001
      6. Congressional Research Service. (2017), History of the ESEA Title I-A formulas, R44898. Retrieved from 86370068f3561f7b1c876ec02ba0f48a1bee.pdf.

      7. Convention on the Rights of the Child. (2018). Participating countries. Retrieved from

        • Coyer C.
        • Kennedy G.
        The composition of children enrolled in Medicaid and CHIP: Variation over time and by race and ethnicity.
        The Urban Institute, Washington, D.C.2013 (Retrieved from)
        • Developments
        Developments in the law: The constitution and the family.
        Harvard Law Review. 1980; 93: 1156-1383
        • Dixon R.
        • Nussbaum M.C.
        Children's rights and a capabilities approach: The question of special priority.
        Cornell Law Review. 2012; 97: 549-593
      8. (2017).Endrew, F.v. Douglas County School District, 580 US, 137 S. Ct. 988, 197L. Ed. 2d 335.

        • Egalite A.J.
        • Wolf P.J.
        A review of the empirical research of private school choice.
        Peabody Journal of Education. 2016; 91: 441-454
        • Eidenberg E.
        • Morey R.D.
        An act of congress: The legislative process and the making of education policy.
        1969 (New York, NY: Norton)
      9. Federal Interagency Forum on Child and Family Statistics. (2018). America's children at a glance. Retrieved from

        • Feld B.
        The honest politician's guide to juvenile justice in the twenty-first century.
        Annals of the American Academy of Political and Social Sciences. 1999; 564: 10-27
        • Felitti V.J.
        • Anda R.F.
        • Nordenberg D.
        • Williamson D.F.
        • Spitz A.M.
        • Edwards V.
        • Marks J.S.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.
        American Journal of Preventive Medicine. 1998; 14: 245-258
        • Fellmeth R.C.
        Child rights and remedies.
        3rd Ed. Clarity Press, Inc, Atlanta, GA2011
      10. Findlaw. (2019). Compulsory education. Retrieved from

        • Fry-Bowers E.K.
        • Nicholas W.
        • Halfon N.
        Children's health care and the Patient Protection and Affordable Care Act: What's at stake?.
        JAMA Pediatrics. 2014; 168: 505-506
        • Halfon N.
        • Hochstein M.
        Life course health development: An integrated framework for developing health, policy, and research.
        Milbank Quarterly. 2002; 80: 433-479
        • Halfon N.
        • Larson K.
        • Lu M.
        • Tullis E.
        • Russ S.
        Life course health development: Past, present, and future.
        Maternal and Child Health Journal. 2014; 18: 344-365
        • Heckman J.
        There's more to gain by taking a comprehensive approach to early childhood education.
        The Heckman Equation. 2017; (Retrieved from)
        • Holt M.I.
        Children as topic no. 1: White House conferences focused on youths and societal changes in postwar America.
        Prologue Magazine. 2012; 42: 18-26
        • Hudson J.L.
        • Moriya A.S.
        Medicaid expansion for adults had measurable ‘welcome mat’ effects on their children.
        Health Affairs. 2017; 36: 1643-1651
        • Ilea R.
        Nussbaum's capabilities approach and nonhuman animals: Theory and public policy.
        Journal of Social Philosophy. 2008; 4 ( 547-563
        • Imig D.
        Building a social movement for America's children.
        Journal of Children and Poverty. 2006; 12: 21-37
      11. Isaacs, J. B., Lou, C., Hahn, H., Ovalle, J., & Steuerle, C. E. (2017). Kids’ share 2017: Report on federal expenditures on children through 2016 and future projections. Retrieved from

        • Lakoff G.
        Moral politics: How liberals and conservatives think.
        University of Chicago Press, Chicago2016
        • Lowrey A.
        How America treats its own children.
        The Atlantic. 2018; (Retrieved from)
        • Marmot M.G.
        • Smith G.D.
        • Stansfeld S.
        • Patel C.
        • North F.
        • Head J.
        • Feeney A.
        Health inequalities among British civil servants: The Whitehall II study.
        Lancet. 1991; 337: 1387-1393
        • Marten J.
        Children and youth during the gilded age and progressive era.
        New York University Press, New York2014
        • Melton G.B.
        Beyond balancing: Toward an integrated approach to children's rights.
        Journal of Social Issues. 2008; 64: 903-920
        • Michel S.
        Children's interests/mother's rights.
        Yale University Press, New Haven, CT1999
        • Mistry K.
        A new framework for childhood health promotion: The role of policies and programs in building capacity and foundations of early childhood health.
        American Journal of Public Health. 2012; 102: 1688-1696
        • Murray T.
        The worth of a child.
        University of California Press, Berkeley, CA1996
        • Musu-Gillette L.
        • de Brey C.
        • McFarland J.
        • Hussar W.
        • Sonnenberg W.
        • Wilkinson-Flicker S.
        Status and trends in the education of racial and ethnic groups, 2017 (NCES 2017-051). U.S. Department of Education.
        National Center for Education Statistics. 2017; (Retrieved from)
      12. National Education Association. (n.d.). Backgrounder: Understanding the gaps: Who are we leaving behind–and how far? Retrieved from

        • Noltemeyer A.L.
        • Mujic J.
        • McLoughlin C.S.
        The history of inequality in education.
        in: Noltemeyer A.L. McLoughlin C.S. Disproportionality in education and special education. Charles C. Thomas Publisher Ltd, Springfield, IL2012: 3-22
      13. Nurse-Family Partnership. (2018). Nurse-family partnership: Benefits and costs: A rigorously tested program with measurable results. Retrieved from

        • Nussbaum M.C.
        Frontiers of justice: Disability, nationality, species membership.
        Belknap Press of Harvard University Press, Cambridge, MA2006
        • Patashnik E.M.
        • Gerber A.S.
        • Dowling C.M.
        Unhealthy politics: The battle over evidence-based medicine.
        Princeton University Press, Princeton, N.J.2017
      14. Plyer v. Doe (1982).457 US 202, 102 S. Ct. 2382, 72L. Ed. 2d 786.

      15. Report to the president, White House conference on children. (1970). Retrieved from

        • Sacks V.
        • Murphy D.
        The prevalence of adverse childhood experiences, nationally, by state, by race or by ethnicity.
        Child Trends. 2018; (Retrieved from)
      16. San Antonio Independent School District v. Rodriquez, 411 US 1, 93 S. Ct. 1278; 36L. Ed. 2d 16 (1973).

        • Sardell A.
        Insuring children's health: Contentious politics and public policy.
        Lynne Rienner Publishers, Inc, Boulder, CO2014
        • Shonkoff J.P.
        • Garner A.S.
        • Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics
        The lifelong effects of early childhood adversity and toxic stress.
        Pediatrics. 2012; 129 (Epub 2011 Dec 26): e232-e246
        • Skocpol T.
        Protecting soldiers and mothers: The political origins of social policy in the United States.
        Belknap Press of Harvard University Press, Cambridge, MA1992
        • Todres J.
        The right to health under the U.N. Convention on the Rights of the Child.
        in: Todres J. Wojcik M.E. Revaz C.R. The U.N. convention on the rights of the child: An analysis of treaty provisions and implications of U.S. ratification. Transnational Publishers, Ardsley, NY2006: 221-236
      17. Trinity Lutheran Church of Columbia, Inc. v. Comer, 582 U.S.,137 S. Ct. 2012, 198L. Ed. 2d 551 (2017).

      18. U.S. Administration for Children, Youth, and Families, (n.d.). Children's Bureau Centennial, Children's Bureau timeline. Retrieved from

      19. U.S. Department of Education. (n.d.). Every Student Succeeds Act (ESSA). Retrieved from

      20. U.S. Department of Education, Office for Civil Rights. (2016) Parent and educator resource guide to section 504 in public elementary and secondary schools. Retrieved from

      21. United States Centers for Medicare and Medicaid, (December 2018). Medicaid & CHIP enrollment data highlights. Retrieved from

        • United States Senate
        Conference on the care of dependent children, proceedings. 1909 (60th Cong., 2nd sess., S. Doc 721)Retrieved from
        • Villarosa L.
        Why America's black mothers and babies are in a life-or-death crisis.
        New York Times Magazine. 2018; (Retrieved from FInfant%20 Mortality&action=click&contentCollection=timestopics&region=stream&module=stream_unit&version=latest&contentPlacement=4&pgtype=collection.)
      22. Zelman v. Simmons-Harris. (2002). 536 U.S. 639.