As I look back over twenty-three years of practicing Pediatrics I see some dramatic changes in the health of our children. Most of the practicing clinicians I know look back at their years of training with fondness. It was during those years that our minds were absorbing all kinds of new information about the care of children. Twenty years ago during my training I was taught how to screen children and babies for serious blood infections called bacteremia and serious brain infections or meningitis. During my early years of practice, hardly a day went by without at least one spinal tap being done. Spinal taps for meningitis and blood cultures for blood infections were two relatively common procedures for practicing pediatricians. Today, thanks to new vaccines babies suffer these unpleasantries much more rarely. Two vaccines, one for pneumococcus and one for hemophilus bacteria have changed children’s health in a very real way to me. These have allowed me to keep spinal taps in my mind mostly as a memory.
Though changes in medicine have helped children’s lives there are other changes in children’s health that are not so promising. In fact, the rise of some health and mental health issues should be the concern to all of us.
Over my years of practice I have seen a dramatic growth in four types of illness. Asthma cases have risen. Childhood obesity is an epidemic. Attention Deficit Disorder with and without hyper-activity continues to rise. And mental illness particularly depression in children and teens is reaching crisis proportions. There are good reasons why we all need to be concerned about the increase in these illnesses. Let me explain my reasons with each type of illness.
Asthma is a disease where a person’s lungs become more reactive to viruses or allergens making the bronchi go into spasm. This makes it more difficult for that person to breathe. The typical symptoms include cough, night cough, difficulty breathing and coughing with exercise. Nobody knows why we have had an increase in asthma cases over time. Perhaps we have more allergens (things that cause allergies) or maybe we have more allergic people. Perhaps our air quality has something to do with it. Others say we are diagnosing it more easily than we used to. No matter what the reason, we all should have concern for this negative trend in children’s health. We could all work harder to improve air quality. We can avoid second hand smoke–producing it or receiving it! We can know the early warning signs of asthma-persistent cough, cough at night, or cough at play. And finally we should seek care early because, on the bright side, our treatments for asthma have improved as the cases have increased. We are better at taking care of asthmatics now than we were years ago.
Obesity has been in the news a lot in the past few years. Practicing pediatricians saw this trend coming long before the lay press put it on the front page. And even with the publicity given to this problem, people are not doing enough. We need to make sure our children don’t have a sedentary lifestyle. They need exercise daily. And a balanced diet eaten daily with lots of fruits and vegetables is essential. We need to model and teach good diets starting very young. If you are excusing your child’s poor eating habits, stop right now and put him on a good diet. I often shock people by telling them some stories I hear from parents about how their children eat. Yet despite obvious diet issues many parents fail to intervene and make changes. We, the parents need to take control of the choice of foods, our children will not. There is too much temptation in our society. We need to help them make the right choices. This is imperative for our future generation.
Attention Deficit disorder is a problem where children cannot sustain attention on any one subject for very long. Again it is not clear why this has risen to such a high number. Some say we are too quick to diagnose and treat. Others say schools have too high expectations for all kids to conform. Many of the practicing doctors I know feel the trend towards more ADHD is real. Many children and families are helped by treatment. Many children go from failing grades to straight A’s. Parents need to think about this diagnosis with any child who has trouble in school. Seek help from a professional. It may make a world of difference.
Depression can be a serious mental illness that can have catastrophic results. Few psychologists, psychiatrists or pediatricians doubt the rise in this illness. Parents need to know the early warning signs of depression: withdrawal from friends and activities, increased sleep, failing at school; and loss of interest to name a few. Seek professional help early. It can save a life.
The trends in ADHD and depression are extremely worrisome to me. Certainly these need to be treated and managed. But I question whether there is something cultural that we need to face to decrease these cases in the future. Are our children learning to change their focus rapidly and often while playing on the screens they watch daily? Are they failing to learn how to interact well together due to decreased interaction with people as they grow side by side with technology? These are hard questions to answer. But it is important for parents to recognize that children’s mental health development depends a lot on personal interaction. So it may stand to reason that we should be limiting screen time not just to reduce obesity but to optimize children’s personality development. If our kids are away from screens and facing each other, they learn a lot more about conflict resolution, empathy and caring then they do in front of a screen.
Suffice it to say there have been wonderful gains over the past 20 years in children’s well being. There are new vaccines against devastating illnesses. New medicines work better than old medicines against many illnesses that we are seeing larger numbers. Yet we need to continue to move forward in our children’s health and well being by looking at the new trends in pediatric illness and question why they are happening. By increasing awareness and having more minds questioning, perhaps we will find reasons for these negative trends. Once reasons are found then we hope these trends can be reversed so the health of our children can be improved once again.