Asthma, Obesity, and ADHD Top the List
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Reviewed By Louise Chang, MD
June 26, 2007 -- The number of U.S. children with chronic health conditions has risen dramatically in the past four decades, according to a new report.
The new research shows that kids will become so disabled their quality of life will suffer, and their needs will tax our health care and welfare programs in the future.
"We have 80 million children in America today, and about 8%, or 6.5 million children and adolescents, have chronic conditions that interfere with regular daily activities," says James M. Perrin, MD, professor of pediatrics at Harvard Medical School and Massachusetts General Hospital, Boston. He is the lead author of the report, a commentary that appears in the June 27 issue of the Journal of the American Medical Association. The issue is devoted to the topic of pediatric chronic disease.
If children with chronic conditions not severe enough to be disabling are counted, chronic conditions affect about 18% of American teens and children in all, Perrin says.
The new numbers, Perrin says, represent a "huge increase" from previous generations. In 1960, for instance, fewer than 2% of U.S. children and teens had a chronic health condition.
Top 3 Problems
Using multiple data sources, Perrin and his co-authors found that:
- Obesity affects at least 18% of children and teens, increasing from about 5% affected in 1971-1974.
- Asthma now affects nearly 9% of children and teens, a doubling since the 1980s.
- About 6% of school-aged children have a reported diagnosis of attention deficit hyperactivity disorder (ADHD). In 1960, there was no entry for the condition in the established manual used to diagnose mental problems.
Numbers Are Worrisome
"People have been very aware of the obesity epidemic [among children] in the past decade and aware of the asthma increase, but no one has put it together the way we have," Perrin tells WebMD. "I think we are the first to look at the whole picture together."
The new commentary, he says, is meant to provide a comprehensive view of the status of the problem. "This is in many ways meant to be a wake-up call," he says.
The researchers defined a chronic health condition as one that lasts 12 months or longer or at the time of diagnosis is expected to last that long. The 1960 research finding that fewer than 2% of children and teens were noted by their parents to have a limit in activity due to a health condition that lasted more than three months.
What's Causing It?
All three conditions -- asthma, obesity, and ADHD -- have been linked to genetic influences, Perrin says, yet genetic factors can't totally explain the rise in the problems.
He points also to social, family, and environmental changes, such as a rise in working parents with less time to nurture their children, more stress on parents, increased use of television and other media and computers, and decreased opportunities for physical activity.
Another factor that may play a role, the researchers say, is the rise in very low-birth-weight babies, who have been found to be at higher risk for obesity, ADHD, and perhaps asthma.
Dietary changes -- increases in calories and portion size, as well as the abundance of sugary beverages -- also affect the rise in obesity, he says.
As today's children and teens move into young adulthood, Perrin sees a huge impact on their need for health care as well as social services if they become disabled. "I think we are going to see a doubling or tripling of health care costs," he says.
"These are people who are going to have much less of a good quality of life and good future," he says. Young people who are obese have a higher risk of getting diabetes and cardiovascular disease, he tells WebMD, and children with severe asthma can become disabled even as teens.
ADHD, he adds, is probably in large part due to genetics but may have environmental factors playing a role.
In a editorial in the same issue, Jody W. Zylke, MD, a contributing editor to the journal, and Catherine D. DeAngelis, MD, MPH, the journal's editor-in-chief, note that pediatric chronic diseases are "stealing" childhood.
Complicating the issue, they say, is that researchers don't agree on a clear definition of a chronic health condition in childhood.
In another study in the same issue, researchers from the Netherlands reviewed 64 articles that defined chronic health conditions of children. They found a large range of definitions in use. As a result, the estimates of how many children are affected ranged from 0.22% to 44%.
Despite the bleak picture, the co-authors say there are a few bright spots, such as the success with childhood cancer survival (yet there has also been a rise in treatment-related complications). And research on childhood conditions is about to take off with the expected launching this year of the National Children's Study. It will evaluate 100,000 children from before birth until age 21 to focus on the effects of environmental factors on health and development.
What Parents Can Do
Reducing childhood chronic diseases isn't just a task for researchers and health policy experts. Parents can help, says Mark Schuster, MD, PhD, director of health promotion and disease prevention at RAND Corp. in Santa Monica, Calif., a nonprofit research organization, and chief of general pediatrics and vice-chairman of the University of California at Los Angeles department of pediatrics.
"Create an environment in the household where kids can eat healthier," he suggests. "If a refrigerator is filled with high-fat snack foods, kids are more likely to eat them. A particular concern is sugar-sweetened beverages. If parents could just get their kids to drink water, that would be a good first step. Flavorings that don't add calories are OK."
Perrin tells the parents of his patients to do three things: Pay attention to your child's diet, increase physical activity, and cut down on television and other media use. "Replace it with exercise," he says.
Perrin advises limiting viewing of all media -- television, computer, and all other electronics -- to one hour a day on weekdays and two hours a day on weekends.
SOURCES: James M. Perrin, MD, professor of pediatrics, Harvard Medical School and Massachusetts General Hospital, Boston. Mark Schuster MD, PHD, director of Health Promotion and Disease Prevention, RAND Corp., Santa Monica, Calif.; chief of general pediatrics and vice-chairman, University of California department of pediatrics; and UCLA professor of pediatrics and public health. Perrin, J. Journal of the American Medical Association, June 27, 2007; vol 297: pp 2755-2759; Zylke, J. Journal of the American Medical Association, June 27, 2007; vol 297: pp 2765-2766.
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