Chronic Illness in Children—Who Is Sounding the Alarm?

Children in the United States are experiencing a serious and historically unprecedented burden of chronic illness. American children display consistently poorer health outcomes than children in other wealthy nations, notwithstanding substantially higher per capita health care spending on U.S. children.

In a 2004 report, the National Research Council and Institute of Medicine called attention to the rising tide of ill health in American children and its long-term implications, warning that “the nation cannot thrive if it has large numbers of unhealthy adults.” Ten years later, in Lancet Neurology, pediatric experts lamented the pandemic of neurodevelopmental toxicity in children that is “silently eroding intelligence, disrupting behaviors, truncating future achievements and damaging societies.” Despite these and many other admonitions, U.S. agencies and officials have paid no meaningful attention to the crisis.

Children with chronic conditions now constitute over 70% of pediatric intensive care hospital admissions.

What’s wrong with this picture?

The list of chronic afflictions beleaguering U.S. children—sometimes nearly from birth—includes neurodevelopmental conditions, autoimmune illnesses, atopic disorders, mental health problems and more. In many instances, multiple conditions overlap, or one condition increases the risk for subsequent disorders. Children with chronic conditions now constitute over 70% of pediatric intensive care hospital admissions.

In 2011, a widely cited survey found that over two-fifths (43%) of children had at least one of 20 chronic health conditions, and this proportion rose to over half (54%) when including obesity and developmental and behavioral risks. The health conditions assessed by the researchers ranged from learning disabilities to diabetes to depression. Another national study, published in the Journal of the American Medical Association (JAMA) in 2010, zeroed in on the deterioration in children’s health over time. From 1988 to 2006, there was a doubling of the prevalence of four types of chronic conditions (obesity, asthma, behavior/learning problems and “other” physical conditions), which rose from 12.8% to 26.6% of American children and youth. If researchers replicated those studies now, trends suggest that the numbers would be even higher.

Chronic illness in children accounts for significant health care expenditures, both public and private. An annual survey of outpatient care conducted by the National Center for Health Statistics showed, for example, that at least 17% of children’s visits to a doctor in 2016 were for chronic conditions (either routine or “flare-up” care). Medicaid covered a third of the visits, with the remainder mostly billed to private insurance. Research also points to a rise in the proportion of children with one or more complex chronic conditions—conditions that incur a disproportionate share of health care costs. A Minnesota study reported significantly increased five-year prevalence and incidence rates of multiple complex chronic conditions in children from 1999 to 2014. The 1990s also marked a rise in the proportion of hospitalized children who have complex chronic conditions—such children are at increased risk of lengthy hospital stays as well as mortality compared to children hospitalized for other reasons.

Autism spectrum disorders

Four diagnoses, sometimes called the “4-A” disorders, are among the most prevalent in their impact on children’s quality of life: autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), asthma and allergies. The ASD and ADHD diagnostic labels both refer to collections of behaviors and symptoms determined largely through subjective measures.

The spike in diagnosed autism has been particularly dramatic, with a rate of increase that has accelerated over time and particularly since the late 1980s. Analysis of reliable long-term data shows that there has been a 1000-fold increase in autism prevalence since the 1930s and a 25-fold increase over the past several decades. Recent work also highlights upward ASD trends among black and Hispanic children and worsening racial/ethnic disparities….

Well gee I can’t imagine what the problem could be, all I know is that we need to keep doing exactly what we’ve been doing ad infinitum until the research and medical institutions which have led us into this nightmare discover where they went wrong and announce their incompetence and culpability to the entire world.

Autism prevalence and socioeconomic status

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