FARGO, N.D. -- North Dakota ranks first in the U.S. when it comes to economic stability for children, according to an annual report measuring child wellbeing.

But policy experts worry the pandemic has set some families back, while other indicators don't fare as well.

The Annie E. Casey Foundation issued its annual Kids Count Data Book this week, which analyzes how states stack up in areas such as education, health, and economic factors for families with children.

The report, which mostly includes 2019 data, noted North Dakota had only 18,000 kids living in poverty.

Xanna Burg, KIDS COUNT coordinator for North Dakota, said, however, racial gaps persist.

"And unfortunately, children of color are more likely to live in poverty," Burg observed. "And so, if we base the ranking instead on the wellbeing of children of color, North Dakota would fall toward the bottom."

The report does include some post-COVID data from the Census Bureau's Household Pulse Survey. At one point during the pandemic, 16% of North Dakota households with children were unsure they could pay their next rent or mortgage payment.

As for education, the state ranked 31st, with two-thirds of fourth-graders not reading at grade level, the same as a decade ago.

And while some impact from the pandemic became less of a factor going into 2021, the report's authors pointed out it will take time to know the full weight of the crisis.

Leslie Boissiere, vice president of external affairs for the Foundation, added childhood poverty has an effect that can last for decades.

"We know that children who grow up in poverty have lower health outcomes," Boissiere explained. "They live in substandard housing that has issues like mold and lead that go untreated. Lower-income families live in poorer neighborhoods that have poorer-resourced schools, so their education outcomes tend to be worse."

She noted the expansion of the Child Tax Credit under the American Rescue Plan will boost struggling families, as it provides monthly payments starting in July.

But the expansion is only a temporary hike, and there are calls for Congress to make the expansion permanent. At the state level, the Foundation recommends North Dakota boost its minimum wage, and to make stronger investments in early childhood education.

APPLETON, Wis. - The pandemic paused many facets of life, and a new report says wellness checkups for children were among them. With school resuming this fall, Wisconsin families are urged to get caught up on preventive care.

According to the Georgetown University Center for Children and Families, new findings suggest there was a 27% decline in the United States in pediatric office visits in 2020. Dr. Sharon Rink, an Appleton-based pediatrician at ThedaCare Physicians-Darboy, said now's the time for kids to reconnect with their family physician to ensure their growth and development wasn't hindered.

"With younger children, it's just to make sure that their speech is progressing, that their gross motor is progressing," she said. "With older teens, it's just a good time to regroup: 'How is your family doing?'"

She said those conversations can help kids rid themselves of unhealthy habits they may have developed, such as too much screen time. While health experts say there are rare cases in which standard immunizations aren't called for, they urge following up on missed shots that are required for most children as they grow.

The report said 11 million routine vaccinations were missed during the pandemic. Dr. Lee Beers, president of the American Academy of Pediatrics, noted the importance of staying on track.

"If too few people in a community are vaccinated against a particular disease, it means that we might see an outbreak of that disease; we've seen this before, with measles and with pertussis," she said. "And so it's so important to make sure that your child is vaccinated, not just to protect themselves, but also to protect everyone around them."

Rink said keeping kids healthy allows them to stay in the classroom, adding that they don't want to miss any more in-person learning, as so many did during COVID lockdowns.

"The devastation from the last year-and-a-half has been terrible in terms of mental health, physical health, academic progress," she said.

For families who avoided doctor visits out of safety concerns, Rink said offices still are carrying out protocols to prevent the spread of COVID. For those who have suffered financially because of the crisis, she recommended reaching out to county human service departments to learn more about resources for wellness visits.

HELENA, Mont. - A Montana campaign is renewing its efforts to help identify developmental delays in young children.

The Centers for Disease Control and Prevention's "Learn the Signs. Act Early" program is aimed at parents and people who work with children from birth to age 5. As part of that effort, Act Early Montana has launched a website to provide free resources to help folks recognize developmental disabilities.

Marcy Hanson, a registered nurse and the Montana Act Early ambassador, said most developmental delays or disorders aren't identified until kids reach school.

"What we know is early identification and intervention is really the best for overall health outcomes," she said. "So, the goal is to get these resources in parents' hands before they hit those early school-age years, so that we can get them the resources and the tools they need."

Because of COVID-19, she said, Montana Act Early has seen a dip in referral to services and wellness visits for children. With restrictions easing, the group hopes to ramp up services and outreach again. Hanson noted that one in four kids from birth to age 5 is at moderate or high risk for developmental, behavioral or social delays.

One in six children between ages 3 and 17 has a developmental disability that can affect how they play, learn, speak, act or move, according to the CDC. Hanson shared some of the milestones they look for in young children.

"Is your child meeting eye contact when you talk with them, when you interact with them? We also look for things like hearing, and feeding themselves, and walking and babbling and rolling over," she said, "all of those fun little milestones that kiddos progress through."

Hanson said the CDC provides a milestone tracker app that can be useful for parents and folks who work with young children, such as child care, education and health-care providers.

LOUDOUN COUNTY, Va. -- Beginning last week, thousands of Virginia families with children saw more money in their bank accounts as the federal government started distributing Child Tax Credit payments to eligible families.

Vilma Hernandez-Morales is a mother of four with three children younger than 17 who qualify for the monthly payments. A legal resident of Loudoun County, originally from El Salvador, she supports her entire family by babysitting and taking on part-time jobs.

Her daughter Esmirelda said they will use the money for everyday expenses that have piled up during the pandemic.

"The way she will use it will be like, in medical situations, she has to pay for food, for clothing, for supplies," Hernandez-Morales explained.

A year and a half after the pandemic started, many Virginia families sorely need the extra cash, particularly Latino families. About 14% of Virginians with children sometimes or often didn't have enough to eat in the previous week, according to U.S. Census data from June. That number was much worse for Latino families, with almost half reporting not having enough to eat.

Jennifer Lassiter Smith, director of U.S. programs for INMED Partnerships for Children in Loudoun County, pointed out her group is educating low-income families on qualifying for and accessing payments.

She said if taxpayers received refunds deposited to their bank accounts, the payment will automatically show up. But many don't realize if they received an IRS check in the mail, they need to be sure they have registered a forwarding address if they moved since filing tax returns.

"For the people who need it the most, housing has been precarious this year," Lassiter Smith observed. "So if they don't live in the same place now as they did six months ago, then there could be a problem there. So that's another thing that we're letting them know."

The Child Tax Credit expansion is part of President Joe Biden's American Rescue Plan, and nearly 1.6 million Virginia kids are expected to benefit.

Experts say the expanded tax credit could cut child poverty in the nation almost in half if it's made permanent. About 85,000 children in Virginia alone would be elevated out of poverty.