Tom Peterson, MD, Medical Director, Quality and Healthier Communities
Spectrum Health and Helen DeVos Children's Hospitals

If you feel like you've been seeing more kids with chronic illnesses like obesity, asthma, and behavior and learning disabilities, you probably have. A recent study published in the Journal of the American Medical Association analyzed three cohorts of children ages 2 to 8 years old whose mothers were interviewed as part of the National Longitudinal Survey of Labor Market Experience, Youth Cohort from 1988 to 2006. They found the number of kids with a chronic illness at any time increased from 27.8% in the earliest group to 51.5% in the latest (P<0.001). The good news is that the increase was not static, demonstrating that some chronic conditions resolve.

This study just reconfirms my sense that the future of pediatrics is going to be quite different from the pediatrics most of us were trained to practice. One reason is the shortage of primary care physicians. But the other is the drive from healthcare reform, patients and health plans for us to practice a more patient-centered type of care as the medical problems of our young patients begin to mimic those that adult primary care physicians see. The pediatric system was designed as a preventative system 50 years ago; we focus on immunizations and safety and education. But now we are seeing our system become one that requires we teach management skills, become health coaches, practice motivational interviewing-all skills required to get patients (and their families) to change their lifestyle and manage their chronic health problems.

Bottom line: This is not an acute-care world anymore.

This study clearly shows that we're going to have to manage chronic conditions more and more in the future and that pediatricians will need to know how to manage "adult" diseases.  To do that effectively, we need to be part of a team that includes other practitioners, whether specialists, nurses, educators, nutritionists, or physical and mental health therapists.  We will need new skills and resources.  And we will need to be more directly engaged with other areas of children's environment that directly affects their abilityto self manage their diseases, such as their school, home, and culture.

One problem is that the continuum of care is still very poorly coordinated in our system. Another is that the conditions we're seeing more and more of these days are areas in which we have had very little training: obesity, sleep apnea, hypertension, type 2 diabetes, high cholesterol. We  often lack the tools and skills in how to manage a 6-year-old who is extremely obese with two obese parents, who has high cholesterol and high blood pressure. Traditionally we simply sent them to "specialists."  This study clearly shows that we can't just keep doing that.

What are your thoughts on the growth in chronic health conditions in our kids? Click "Add Comment" below to join the conversation.