Children's Health (Pediatrics)

  • Medical Author:
    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Introduction to children's health

Children's health, or pediatrics, focuses on the well-being of children from conception through adolescence. It is vitally concerned with all aspects of children's growth and development and with the unique opportunity that each child has to achieve their full potential as a healthy adult.

Children's health was once a part of adult medicine. It emerged in the 19th and early 20th century as a medical specialty because of the gradual awareness that the health problems of children are different from those of grown-ups. It was also recognized that a child's response to illness, medications, and the environment depends upon the age of the child.

There are many aspects to children's health. Any organization of these aspects of child health is necessarily arbitrary. For example, the topics could be presented in alphabetical order. However, it seems most logical to start at the beginning -- with the factors that determine a child's healthy growth and development.

Children's growth and development

A healthy child's development actually begins before conception with the parents' health and their genetic legacy. It continues on to conception and through the prenatal period. During this time, there is naturally considerable overlap between pediatric concerns for the fetus and obstetrical concerns for the mother.

Once the baby is delivered, there are new and important matters to ponder, such as breastfeeding, newborn screening tests, and sleeping safety. All too soon, there are health-care appointments to be kept, for example, for well-baby checkups and vaccinations. These are followed by other challenges, such as when to introduce solid foods and to start toilet training and when to see the dentist.

The field of pediatrics recognizes classic stages in growth and development, but these are artificial since a child's growth and development constitute a continuum. A baby changes at an astonishing rate during the newborn period and early infancy. Before you know it, the baby becomes a toddler, next a child and, after a little more than a decade, is already a teen. It is a busy, challenging period.

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Prevalence of Childhood Obesity

In the 1970s and 1980s, approximately 5% of children were obese. By 2000, over 13% were obese, and 2010 statistics indicate pediatric obesity to be leveling off at approximately 18% of the population. (In contrast, approximately 35% of adults are obese.) While the frequency of obesity appears to be leveling off, the amount of excess weight has continued to rise (for example, BMI value has risen higher per individual).

Children's illnesses

Unfortunately, even the healthiest baby can get sick. It is worth knowing the signs and symptoms of the common childhood illnesses as well as the treatment and prevention of these illnesses. There are a number of common childhood conditions such as ear infections and even tonsillitis, which may be unavoidable. But children are also subject to other preventable diseases such as the serious infectious diseases prevented by immunizations, and dental caries (tooth decay), which can be prevented by ongoing oral care and fluoride treatments.

Children may be born with health problems. For example, a cleft lip or palate is evident at birth. But some equally common birth defects, such as some heart malformations, may not be immediately apparent. Birth defects of all kinds are a consequential concern for children and their parents.

Children's injuries

It may not be possible to prevent a specific birth defect or an illness, but it should be possible to protect a child from an accident and injury, such as from common cuts and burns. Considerable progress has been made in the safety arena such as in the rapid recall of dangerous toys. The mandated uses of car seats, safety belts, and bicycle helmets are also examples of advances in child safety.

But other major areas of safety concern remain -- such as the all-too-frequent drownings of children in swimming pools, their accidental swallowing of household cleaning products, their being burned by a hot stove or heater, or being accidentally shot with a firearm. The list is endless. All of us must exercise continued vigilance and make every effort to be sure that a child's environment is made as safe as it possibly can be.

Children's behavior

In addition to a child's physical well-being, there are also concerns about a child's behavior and emotional health. Major challenges include autism spectrum disorders, including Asperger syndrome, learning disorders, and ADHD (attention deficit hyperactive disorder).

But children may also be plagued by nightmares, sleeping difficulties, and irrational fears. Many children have trouble expressing their anger in an appropriate fashion. A major area of study is the effect on children of watching violence on television and playing violent video games.

As children get older and more independent, their chances of developing eating disorders such as anorexia and bulimia increase, especially among girls who worry about being overweight. The specter of drug and substance abuse appears. Smoking also often starts in response to peer pressure. And then there are tattoos and body-piercing.

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Children's mental illness

Suicide is now the second leading cause of death during the teen years. Major depression and bipolar disease may underlie suicide attempts and suicide.

It was once thought that children were not subject to these mental illnesses because children had not yet developed the ability to feel hopeless and helpless about the future. That is clearly untrue. It is now widely acknowledged that children are susceptible not only to major depression and bipolar disease but also to anxiety disorders, phobias, and posttraumatic stress disorder. Recent studies have highlighted the acute and long-term effects of bullying on children, noting higher rates of depressive symptoms and suicide in children who have been bullied. Here again the treatment must be appropriate for use in the pediatric age range.

Family health and children

Family health looks at children's health and well-being in the context of their family unit. The health of the family as a whole plays a major role in determining the health of each child within that family. This applies not only to children's physical health but to their emotional health, as well.

Our society professes the ideal that every child should grow up in a household under the care of a pair of loving adults who possess appropriate parenting skills. The reality today is that divorce, single parenting, and step-parenting are common. Adoption and foster-parenting are also not uncommon. The historically traditional biological mother/father household is not the only type of household in which children are growing up today.

The provision of adequate child care and supervision -- and the prevention of child abuse and neglect -- need to be openly addressed. One of the most tragic situations is the physical injury, emotional damage, or even death that occurs because a caregiver has shaken, burned, hit, or sexually assaulted a child.

Community health and children

Community health goes beyond the family to the community as important to the health and well-being of children. Children need a healthy and safe environment in which to grow up.

There is a big difference between living on a farm, in a small town, in the suburbs, or in an inner city. A neighborhood plagued by crime is an unhealthy community in which to raise children. Not to mention the need for children to grow up in a healthy environment that provides clean air to breathe and clean water to drink.

Other community links that can influence the health of children include schools, sports programs, and learning resources such as libraries. To paraphrase the phrase "It takes a village to raise a child," it might be said that "It takes the community to raise a healthy child."

Health care for children

It is important to emphasize that children are not simply small adults and nor should they be treated as such. Child health care and the specialty of pediatrics are concerned with providing optimal and appropriate care to all children; and, in fact, pediatrics has expanded to include not only young children but young adults, as well, since a large portion of our 18- to 21-year-olds continue to be dependent on their parents into their 20s.

REFERENCES:

American Academy of Pediatric Dentistry. <http://www.aapd.org>.

American Academy of Pediatrics. <http://www.aap.org>.

HealthyChildren.org. <http://www.healthychildren.org>.

Last Editorial Review: 1/29/2016

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Reviewed on 1/29/2016
References
REFERENCES:

American Academy of Pediatric Dentistry. <http://www.aapd.org>.

American Academy of Pediatrics. <http://www.aap.org>.

HealthyChildren.org. <http://www.healthychildren.org>.

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