While the economic picture across the nation has improved, children in Dallas County are still suffering, according to a recent study the Dallas Morning News reported.

According to a report released by Children's Medical Center Dallas, nearly 30 percent of those 18 and younger were living below the poverty level last year. The percentage of poverty-stricken children in the county has been practically unchanged for the last three years.

"Poverty is the common factor in substandard academic achievement, exposure to crime, domestic abuse and emotional distress," Christopher J. Durovich, Children's president and chief executive officer, told the Dallas Morning News. "Without access to preventive health care, impoverished children also suffer from needless illnesses."

According to the study "Beyond ABC: Assessing Children's Health in Dallas County", about 196,252, children in Dallas County lived in poverty. In the study, poverty for a family of four was defined as an annual income of $23,550.

The report focused on 61 health indicators drawn from federal, state and local sources. It was compiled by the Institute for Urban Policy Research at UT Dallas.

"We're expecting families to live on $64 a day or less," Durovich said.

Some children had no health insurance and many were in homes without enough food.

Based on the report, almost 27 percent of children in Dallas County lived in households without enough food to support an active, healthy lifestyle. Free school lunch and breakfast programs in the county are popular during the school year, but food supplied become scarce in the summer.

Health insurance has improved over the years for children in Dallas County.

Nearly 69 percent of the county's 2-year-olds underwent full immunization last year, compared to 62 percent in 2003. And more children enrolled in the Children's Health Insurance Program for families earning enough to afford premiums. Last year, 66,334 children enrolled, a 6 percent increase from 2011 and 65 percent increase from 2007, according to the Dallas Morning News.

The report found periodic setbacks in health indicators, though the overall trends indicate some improvement.

"There is a slow but heartening improvement in the percentage of 2-year-olds who are fully immunized," Durovich said. "But I'd like to see at least a 90 percent vaccination rate."

Still, about 13 percent of children in Dallas County lacked insurance coverage last year, compared to a national average of 7.2 percent.