Children's Health

Definition

Children's health encompasses the physical, mental, emotional, and social well-being of children from infancy through adolescence.

Description

All children should have regular well-child check ups according to the schedule recommended by their physician or pediatrician. The American Academy of Pediatrics (AAP) advises that children be seen for well-baby check ups at two weeks, two months, four months, six months, nine months, twelve months, fifteen months, and eighteen months. Well-child visits are recommended at ages two, three, four, five, six, eight, 10, and annually thereafter through age 21.

In addition, an immunization schedule should be followed to protect against disease and infection. As of 2004, the AAP and the U.S. Centers for Disease Control (CDC) recommended that the following childhood immunizations be administered by age two:

• Hepatitis B. Three doses.
• Diphtheria, Tetanus, and Pertussis (DTaP). Four doses.
• H. influenzae type b (Hib). Four doses.
• Inactivated Polio. Three doses.
• Pneumococcal Conjugate. Three doses.
• Measles, Mumps, Rubella (MMR). One dose.
• Varicella (chickenpox ). One dose.
• Hepatitis A. (In certain geographical areas and with certain high risk groups.)

The flu vaccine has been added in recent years and has been recommended for childhood caregivers. It is not recommended for children younger than six months of age. A combined vaccine called the Hexavac includes the vaccine for diphtheria, tetanus, pertussis, poliomyelitis, H. influenza B, and hepatitis B in one dose. In clinical trials in 2004, it was shown to be safe and effective in young children.

Some immunizations may cause mild side effects, or more rarely, serious adverse reactions. However, the benefits of immunization greatly outweigh the incidence of health problems arising from them.

There are serious chronic diseases and health problems that are frequently diagnosed in childhood and cannot be vaccinated against. These include, but are not limited to, asthma, type I diabetes (juvenile diabetes), leukemia, hemophilia, and cystic fibrosis.

Mental health

Children who have difficulty in areas of language acquisition, cognitive development, and behavior control may be suffering from mental illness. Mental health problems that may afflict children include:

• Attention Deficit Hyperactivity Disorder (ADHD ). According to the AAP, 4-12% of school-aged children have ADHD, a condition characterized by poor impulse control and excessive motor activity.
• Learning disorders. Learning disabilities affect one in 10 school children.
• Depression, anxiety, and bipolar disorder. Affective, or mood, disorders can affect kids as well as adults.
• Eating disorders. Anorexia nervosa, bulimia nervosa, and binge eating disorder (BED) frequently occur in adolescent girls.
• Schizophrenia. A disorder characterized by bizarre thoughts and behaviors, paranoia, impaired sense of reality, and psychosis may be diagnosed in childhood.
• Obsessive-compulsive disorder. Also called OCD, this anxiety disorder afflicts one in 200 children.
• Autism and pervasive developmental disorder. Severe developmental disabilities that cause a child to become withdrawn and unresponsive.

• Mental retardation. Children under age 18 with an IQ of 70 or below and impairments in adaptive functioning are considered mentally retarded.

Emotional and social health

Children take their first significant steps toward socialization and peer interaction when they begin to engage in cooperative play at around age four. Their social development will progress throughout childhood and adolescence as they develop friendships, start to be influenced by their peers, and begin to show interest in the opposite sex.

DR. BENJAMIN SPOCK (1903–1998)

Benjamin Spock, pediatrician and political activist, was most noted for his authorship of Baby and Child Care, which significantly changed predominant attitudes toward the raising of infants and children. He began medical school at Yale University in 1925, and transferred to Columbia University's College of Physicians and Surgeons in 1927. Spock had decided well before starting his medical studies that he would "work with children, who have their whole lives ahead of them" and so, upon taking his M.D. degree in 1929 and serving his general internship at the prestigious Presbyterian Hospital, he specialized in pediatrics at a small hospital crowded with children in New York's Hell's Kitchen area.

On a summer vacation in 1943 he began to write his most famous book and he continued to work on it from 1944 to 1946 while serving as a medical officer in the Navy. The book sharply broke with the authoritarian tone and rigorous instructions found in earlier generations of baby-care books, most of which said to feed infants on a strict schedule and not to pick them up when they cried. Spock, who spent ten years trying to reconcile his psychoanalytic training with what mothers were telling him about their children, told his readers, "You know more than you think you do…. Don't be afraid to trust your own common sense…. Take it easy, trust your own instincts, and follow the directions that your doctor gives you." The response was overwhelming. Baby and Child Care rapidly became America's all-time best-seller except for Shakespeare and the Bible; by 1976 it had also eclipsed Shakespeare.

Leading Causes Of Death In Adolescents

Motor vehicle crashes

Suicide (numbers 2 and 3 are approximately equal)

Homicide

Poisoning (which includes accidental poisonings due to alcohol or other drug overdose)

Drowning

Factors which can have a negative impact on the emotional and social well-being of children include:

• Violence. Bullying can cause serious damage to a child's sense of self-esteem and personal safety, as can experiences with school violence.
• Family turmoil. Divorce, death, and other life-changing events that alter the family dynamic can have a serious impact on a child. Even a positive event such as the birth of a sibling or a move to a new city and school can put emotional strain on a child.
• Stress. The pressure to perform well academically and in extracurricular activities such as sports can be overwhelming to some children.
• Peer pressure. Although it can have a positive impact, peer pressure is often a source of significant stress for children. This is particularly true in adolescence when "fitting in" seems all-important.
• Drugs and alcohol. Curiosity is intrinsic to childhood, and more than 30% of children have experimented with alcohol by age 13. Open communication with children that sets forth parental expectations about drug and alcohol use is essential.
• Negative sexual experiences. Sexual abuse and assault can emotionally scar a child and instill negative feelings about sexuality and relationships.

Causes and symptoms

Childhood health problems may be congenital (i.e., present at birth) or acquired through infection, immune system deficiency, or another disease process. They may also be caused by physical trauma (e.g., a car accident or a playground fall) or a toxic substance (e.g., an allergen, drug, or poisonous chemical), or triggered by genetic or environmental factors.

Physical and mental health problems in childhood can cause a wide spectrum of symptoms. However, the following behaviors frequently signify a larger emotional, social, or mental disturbance:

• signs of alcohol and drug use
• falling grades
• lack of interest in activities that were previously enjoyable to the child
• excessive anxiety
• persistent, prolonged depression
• withdrawal from friends and family
• violence
• temper tantrums or inappropriate displays of anger
• self-inflicted injury
• bizarre behavior and/or speech
• trouble with the police
• sexual promiscuity
• suicide attempts

The causes of developmental disorders and delays and learning disabilities are not always fully understood. Pervasive developmental disorder (PDD) and autistic spectrum disorder (more commonly known as autism) are characterized by unresponsiveness and severe impairments in one or more of the following areas:

• Social interaction. Autistic children are often unaware of acceptable social behavior and are withdrawn and socially isolated. They frequently do not like physical contact.
• Communication and language. A child with autism or PDD may not speak or may display limited or immature language skills.
• Behavior. Autistic or PDD children may have difficulty dealing with anger, can be self-injurious, and may display obsessive behavior.

Autism is associated with brain abnormalities, but the exact mechanisms that trigger the disorder are yet to be determined. It has been linked to certain congenital conditions such as neurofibromatosis, fragile X syndrome, and phenylketonuria (PKU).

Diagnosis

Physical, intellectual, emotional, and social maturation are all important markers of a child's overall health and well-being. When evaluating children, pediatricians and child-care specialists assess related skill sets, such as a child's acquisition and use of language, fine and gross motor skills, cognitive growth, and socialization, and achievement of certain milestones in these areas. A developmental milestone is a task or skill set that a child is expected to reach at a certain age or stage of life. For example, by age one, most children have achieved the physical milestone of walking with the assistance of an adult. Developmental disorders may be identified and/or diagnosed by physicians, teachers, child psychologists, therapists, counselors, and other professionals who interact with children on a regular basis.

It is important to remember that all children are unique, and develop at different paces within this broad framework. Reaching a milestone early or late does not necessarily indicate a developmental problem. However, if a child is consistently lagging on achieving milestones, or has a significant deficit in one developmental area, he or she may be experiencing developmental delays.

Leading Causes Of Illness/Injury In Adolescents

Trauma (this could be anything from sports-related injuries to gunshot wounds; alcohol or other drug abuse is frequently a factor)

Mental health issues (substance abuse, depression, etc.)

Sexually transmitted infections

Acquired immunodeficiency syndrome (AIDS)

Eating disorders

Pediatricians and other medical professionals typically diagnose physical illness and disease in children. In cases of illness and injury, children will undergo a thorough physical examination and patient history. Diagnostic tests may be performed as appropriate. In cases of mental or emotional disorders, a psychologist or other mental healthcare professional will meet with the patient to conduct an interview and take a detailed social and medical history. Interviews with a parent or guardian may also be part of the diagnostic process. The physician may also administer one or more psychological tests (also called clinical inventories, scales, or assessments).

Treatment

Medications may be prescribed to treat certain childhood illnesses. Proper dosage is particularly important with infants and children, as medications such as acetaminophen can be toxic in excessive amounts. Parents and caregivers should always follow the instructions for use that accompany medications, and inform the child's pediatrician if the child is taking any other drugs or vitamins to prevent potentially negative drug interactions. Any side effects or adverse reactions to medication should be reported to the child's physician. If antibiotics are prescribed, the full course should always be taken.

Other treatments for childhood illness and/or injuries include, but are not limited to, nutritional therapy, physical therapy, respiratory therapy, medical devices (e.g., hearing aids, glasses, braces), and in some cases, surgery.

Counseling is typically a front-line treatment for psychological disorders. Therapy approaches include psychotherapy, cognitive therapy, behavioral therapy, family counseling, and group therapy. Therapy or counseling may be administered by social workers, nurses, licensed counselors and therapists, psychologists, or psychiatrists. Psychoactive medication may also be prescribed for symptom relief in children and adolescents with mental disorders.

Support groups may also provide emotional support for children with chronic illnesses or mental disorders. This approach, which allows individuals to seek advice and counsel from others in similar circumstances, can be extremely effective, especially in older children who look toward their peers for guidance and support.

Speech therapy may be helpful to children with developmental delays in language acquisition. Children with learning disorders can benefit from special education therapy.

Alternative treatment

Therapeutic approaches that encourage self-discovery and empowerment may be useful in treating some childhood emotional traumas and mental disorders. Art therapy, the use of the creative process to express and understand emotion, encompasses a broad range of humanistic disciplines, including visual arts, dance, drama, music, film, writing, literature, and other artistic genres. It can be particularly effective in children who may have difficulty gaining insight to emotions and thoughts they are otherwise incapable of expressing.

Certain mild herbal remedies may also be safely used with children, such as ginger (Zingiber officinale ) tea for nausea and aloe vera salve for burns. Parents and caregivers should always consult their healthcare provider before administering herbs to children.

Prognosis

The prognosis for childhood health problems varies widely. In general, early detection and proper treatment can greatly improve the odds of recovery from many childhood ailments.

Some learning disabilities and mild developmental disorders can be overcome or greatly improved through the therapies discussed above. However, as of early 2001, there was no known medical treatment or pharmacological therapy that is capable of completely eliminating all of the symptoms associated with pervasive developmental disorder (PDD), autism spectrum disorder, and mental retardation. Mental illnesses such as schizophrenia and bipolar disorder are also chronic, lifelong disorders, although their symptoms can often be well-controlled with medication.

Prevention

Parents can take some precautions to ensure the safety of their children. Childproofing the home, following a recommended immunization schedule, educating kids on safety, learning CPR, and taking kids for regular well-child check-ups can help to protect against physical harm. In addition, encouraging open communication with children can help them grow both emotionally and socially. Providing a loving and supportive home environment can help to nurture an emotionally healthy child who is independent, self-confident, socially skilled, insightful, and empathetic towards others.

Because they are still developing motor skills, kids can be particularly accident prone. Observing the following safety rules can help protect children from injury:

• Helmets and padding. Children should always wear a properly fitted helmet and appropriate protective gear when riding a bike, scooter, or similar equipment or participating in sports. They should also ride on designated bike paths whenever possible, and learn bicycle safety rules (i.e., ride with traffic, use hand signals).
• Playground safety. Swing sets and other outdoor play equipment should be well-maintained have at least 12 in (30 cm) of loose fill materials (e.g., sand, wood chips) underneath to cushion falls, and children should always be properly supervised at play.
• Staying apprised of recalls. Children's toys, play equipment, and care products are frequently involved in product recalls. The U.S. Consumer Safety Products Commission (CSPC) is the agency responsible for tracking these recalls (see Resources below).
• Staying safe in the car. Up to 85% of children's car seats are improperly installed and/or used. Infants should always be in a rear-facing car seat until they are over 12 months of age and weigh more than 20 lb (9 kg). An infant or car seat should never be put in a front passenger seat that has an air bag. Once they outgrow their forward facing car seats, children between the ages of four and eight who weigh between 40-80 lb (18-36 kg) should ride in a booster seat. Every child who rides in a car over this age and weight should buckle up with a properly fitted lap and shoulder belt.
• Teaching children pedestrian safety. Younger children should never be allowed to cross the street by themselves, and older kids should know to follow traffic signs and signals, cross the street at the corner, and look both ways before stepping off the curb.
• Teaching children about personal safety. Kids should know what to do in case they get lost or are approached by a stranger. It is also imperative that parents talk openly with their children about their body and sexuality, and what behavior is inappropriate, to protect them against sexual predators.

KEY TERMS

Bipolar disorder— Manic depressive disorder. A mood disorder characterized by manic highs and depressive lows.

Child development— The process of physical, intellectual, emotional, and social growth that occurs from infancy through adolescence. Erik Erikson, Margaret Mahler, Sigmund Freud, and Jean Piaget are among the most well-known child development theorists.

CPR— Cardiopulmonary resuscitation. A first aid technique designed to stimulate breathing and blood flow through a combination of chest compressions and rescue breathing.

Immunization— Creating immunity to a disease through a vaccine injection that stimulates the production of antibodies.

Learning disabilities— An impairment of the cognitive processes of understanding and using spoken and written language that results in difficulties with one or more academic skill sets (e.g., reading, writing, mathematics).

Motor skills— Controlled movement of muscle groups. Fine motor skills involve tasks that require dexterity of small muscles, such as buttoning a shirt. Tasks such as walking or throwing a ball involve the use of gross motor skills.

Obsessive-compulsive disorder— Also known as OCD; a disorder characterized by obsessive thoughts (e.g., fear of contamination) and compulsive behaviors (e.g., repetitive hand washing) that cause distress and/or functional impairment.

Psychological tests— Written, verbal, or visual tasks that assess psychological functioning, intelligence, and/or personality traits.

Type 1 diabetes— A chronic immune system disorder in which the pancreas does not produce sufficient amounts of insulin, a hormone that enables cells to use glucose for energy. Also called juvenile diabetes, it must be treated with insulin injections.

Child-proofing the household is also an important step toward keeping kids healthy. To make a house a safe home, parents and caregivers should:

• Ban guns. Accidental shootings in the home injure an estimated 1,500 children under age 14 each year. If a gun must be in the home, it should be securely locked in a tamper proof box or safe.
• Keep all matches, lighters, and flammable materials properly stored and out of the reach of children.
• Make sure hot water heaters are set to 120 degrees or below to prevent scalding injuries.
• Equip the home with working fire extinguishers and smoke alarms, and teach children what to do in case of fire.
• Secure all medications (including vitamins, herbs, and supplements), hazardous chemicals, and poisonous substances (including alcohol and tobacco).

• Don't smoke. Aside from causing cancer and other health problems in smokers, second-hand smoke is hazardous to a child's health.
• Keep small children away from poisonous plants outdoors, and remove any indoor plants that are toxic.
• Post the phone numbers of poison control and the pediatrician near the phone, and teach children about dialing 9-1-1 for emergencies.
• Children under age five should never be left alone in the bathtub, wading pool, or near any standing water source (including an open toilet). Drowning is the leading cause of death by injury for children between the ages of one and four.
• Remove lead paint. Lead is a serious health hazard for children, and houses built before 1978 should be tested for lead paint. If lead is found, the paint should be removed using the appropriate safety precautions.

These safety guidelines are not all-inclusive, and there are many age-specific safety precautions that parents and guardians of children should observe. For example, infants should never be left with a propped-up bottle in their mouths or given small play items because of the choking hazards involved.

Resources

BOOKS

Holtzman, Debra Smiley. The Panic Proof Parent. Chicago: NTC/Contemporary, 2000.

Pasquariello, Patrick S., Jr., editor. The Children's Hospital of Philadelphia: Book of Pregnancy and Child Care. New York: John Wiley & Sons, Inc., 1999.

PERIODICALS

"Immunization Practices Group Recommends Flu Vaccine for Young Children." Medical Letter on the CDC & FDA May 30, 2004: 68.

"Vaccine Against Six Diseases is Safe and Effective in Children." Obesity, Fitness & Wellness Week June 26, 2004: 76.

ORGANIZATIONS

National Institute of Mental Health. 6001 Executive Boulevard, Rm. 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513.

National SAFE KIDS Campaign. Children's National Medical Center. (202) 662-0600. 〈http://www.safekids.org〉.

U.S. Consumer Products Safety Commission (CPSC). 4330 East-West Highway, Bethesda, MD 20814-4408. Consumer Hotline: (800) 638-2772. 〈http://www.cpsc.gov〉.