By Elizabeth Goodman, M.D.
Children today face many risks to their health and safety; some were nonexistent just a decade ago, others have persisted for decades. To assess the public’s perception of children’s health risks, the C.S. Mott Children’s Hospital in Michigan conducts an annual web-based survey of about 2,000 adults with and without children asking them to rank the “big problems” in child health from a list of 26 problems.
The Mott survey captures national attention, and it’s useful to track trends in adult perceptions, as well as stimulate a national discussion. So the poll is worth a close look.
In 2015, the top 10 “big problems” adults ranked were: childhood obesity (60 percent); bullying (58 percent); drug abuse (53 percent); Internet safety (51 percent); child abuse and neglect (49 percent); sexting, school violence, and smoking and tobacco use (each 45 percent); teen pregnancy (42 percent); and stress (41 percent).
What is on this list is not surprising, nor is how close the percentage of adults ranking each problem are to each other. Many of these topics are constantly in the public eye; childhood obesity trends are frequently the subject of news media reports, as are school shootings, the nation’s opioid epidemic and child abuse and neglect. Other topics, such as internet safety and sexting, point to the soaring rates of social media use and the degree to which new technologies now permeate what has become a “24/7” world. Negotiating screen use and safety have become major issues facing parents today.
While physicians agree the “top 10” list in this year’s poll reflects important issues, they tend to have wider perspective. Here are some of the top risks facing children from the pediatrician’s viewpoint that, while on the list of choices, didn’t make the “top 10” this year.
Unintentional injury, particularly from motor vehicle accidents, is the number one cause of death for children of all ages and is foremost on the minds of pediatricians. Other unintentional injuries of concern include drowning, burns, poisoning and injuries due to firearms in the home.
Mental health is a hugely important issue for children of all ages. The Centers for Disease Control estimates that 13-20 percent of American children experience a mental disorder in a given year, some leading to suicide. Behavioral and conduct disorders, such as attention deficit/hyperactivity disorder (ADHD) or autism, can be apparent in younger school-age children, while mood disorders, including anxiety and depression, can be more prevalent with adolescents.
Vaccination is another priority of pediatricians, especially with the return of outbreaks of measles, whooping cough, and other infectious diseases. Both illnesses that can be prevented by vaccines and vaccine safety were possible choices in the poll, but neither made the “top 10.”
Below are two major concerns for pediatricians that were not included as choices in this year’s survey, so never had the chance to make the “top 10.”
Sleep is now recognized as a critical element to children’s health. Poor sleep habits can affect physiological functions and moods, raise the risk of obesity, and influence a child’s growth and development. The American Academy of Pediatrics has called chronic sleep loss in children and adolescents one of the most common – and fixable – public health issues in the country.
Poverty affects more than 21 percent of children under 18 according to the U.S. Census Bureau and is one of the most difficult challenges families face. Poverty’s effects on children can be all-inclusive, seen in deteriorating physical and mental health and overall well-being.
Additionally, some threats, while constant over the years, are taking new directions. Smoking and tobacco use, consistently in the top 10 in the poll, now includes the concerns of flavored electronic cigarettes and “vaping,” the use of smokeless tobacco, and the rise of “hookah bars.”
Whether voted by adults in a poll or cited by pediatricians, the health risks to children are many, widespread, evolving and require vigilance. Adults also need to remember that health is a mix of positive and negative outcomes affected by both risk and protective factors. It is just as important to promote positive health outcomes that buffer and protect children, such as self-esteem, as it is to focus on risk reduction.
Overall, to thrive, children need three things: nurturing relationships; healthy nutrition; and a safe, supportive environment. When one or more of those three are missing, child health and development suffer.
For more information on child health, visit the American Academy of Pediatrics at www.healthychildren.org. For a video discussion, visit www.physicianfocus.org/childhealth.
Elizabeth Goodman, M.D., is Associate Chief for Community-Based Research at MassGeneral Hospital for Children, a Professor of Pediatrics at Harvard Medical School, and a Board Member of the Mass. Chapter of the American Academy of Pediatrics. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.