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1 | 1 PART IThe Field of Pediatrics Since the late 19th century, pediatrics has been the only discipline dedi cated to all aspects of the care and well being of infants, children, and adolescents, including their healththeir physical, mental, social, and psychologic growth and developmentand their ability to achieve full p... |
2 | people. The population growth rate continues to decline. The Pew Research Center projects the population to reach 10.9 billion people in 2100 with a growth rate of less than 0.1 at that time because of the fall in fertility rates. Africa is the only continental region that is predicted to continue to have strong popula... |
3 | age 5 than children in the developed areas of the world (see Fig. 3.1). School children (ages 5 9 years old) also experienced a large decline in mortality since the year 1990 related to lower prevalence of infectious diseases. The infant mortality rate globally (2023) is 27.4 deaths per 1,000 live births, with female i... |
4 | the timing of infectious disease control was uneven around the globe, this focus on control was accompanied by significant decreases in morbidity and mortality in all countries. Later in the 20th century, with improved control of infectious diseases through more effective prevention and treatment (including the eradica... |
5 | disease 115 Chronic lower respiratory disease 68 Heart disease 101 Congenital anomalies 354 7 Bacterial sepsis 579 Perinatal period 62 Heart disease 68 Chronic lower respiratory disease 64 Diabetes mellitus 246 8 Circulatory system disease 428 Septicemia 54 Cerebro vascular 34 Cerebro vascular 54 Influenza and pneumoni... |
6 | develop multiinflammatory syndrome (MIS C). This condition could be lethal, but most children who received timely care improved. As of spring 2023, there were over 766 million cases and nearly 6.9 million deaths from COVID 19, and the United States had the highest number of cases and deaths throughout the world. Chil d... |
7 | Suicide firearm 202 Homicide firearm 134 Unintentional drowning 86 Unintentional fireburn 52 Unintentional suffocation 43 Unintentional other land transport 37 Unintentional poisoning 23 Suicide poisoning 20 Unintentional MV traffic 6,308 Unintentional poisoning 4,245 Homicide firearm 4,107 Suicide firearm 2,995 Suicid... |
8 | normal child behavior and development, (3) health behaviors as they pertain to child health, and (4) mild, moderate, and severe behav ioral and developmental disorders. Accomplishing this would require reconceptualizing professional training, improving clinical communi cation and interviewing skills, expanding mental h... |
9 | importance of addressing the social determinants of health, as well as the increasing Table 1.4 A Development History of the New Morbidities in Child Health THE NEW MORBIDITIES (19821993) THE NEW MORBIDITIES REVISITED (2001) THE NEW NEW MORBIDITIES (2010 TO PRESENT) Behavioral disordersmental health School problems Adv... |
10 | Experiences Adverse childhood experiences (ACEs) are stressful events experi enced during childhood that can have profound health consequences both in childhood and throughout the life course into adulthood. ACEs were initially defined as abuse (physical, emotional, sexual), neglect (physical and emotional), and househ... |
11 | model of care, the evolution of the question whats wrong with you to what happened to you gets further refined to include whats right or posi tive about you. Toxic Stress and Allostatic Load The effects of stress are moderated by the intensity of the stress, the bio logic response to the stress, and the social and phys... |
12 | environmental (ecologic), biologic, and devel opmental factors into a model of health and illness. This model posits that ecology (or the social and physical environment) affects biology through physiologic disruptions and adaptations secondary to allostatic load mechanisms. The environment also influences development ... |
13 | therapeutic needs of those patients who present for care, a popula tion health approach to care refocuses efforts to emphasize the need to address health from a community or population level perspective, with emphasis on identifying and addressing the needs of individuals and families who do not seek regular care or wh... |
14 | information (lab results, consultations, educa tional plans, screeningtesting results), communicates with subspecial ists, and relays all important information to the clinical team before the patientfamily visit. After a healthcare visit, the care coordinator works with the family to address any ongoing concerns, direc... |
15 | physi cians and others to advocate for policy change. Other nonmedical health neighborhood services that could be co located in the medical center include supplemental nutrition assistance programs, parenting programs, behavioral health services, and family financial counseling. Many, if not most, other services are lo... |
16 | U.S. Department of Health and Human Services (DHHS) Healthy People 2030 report defines health disparity as a partic ular type of health difference that is closely linked with social, economic, andor environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced grea... |
17 | neigh borhoods were denied homeowner mortgages and were systematically disinvested by local, state, and federal government policies. The Federal Housing Authority (FHA), created in 1934 to be the government entity that would federally secure homeowner mortgages, created underwriting manuals for banks with rules regardi... |
18 | has other significant health consequences for Black and Latinx American chil dren, including living in food deserts (having few grocery stores in neighborhoods), digital deserts (lack of access to reliable high speed internet), having fewer green spaces, and few pharmacies. Economic disparities, racial wealth gap, and ... |
19 | and environmental policies have contributed to unequal exposure to environmental toxins. White Americans produce the majority of greenhouse gas emissions but experience less of the negative health ef fects of such emissions such as asthma, other chronic lung disease, can cer, and cardiovascular disease. Black and Latin... |
20 | an acute external stress or challenge, these systems revert to normal baseline states. However, when the stressor becomes chronic and unbuffered by social supports, dysregulation of these systems may occur, resulting in pathophysiologic alterations to these responses, such as hyperactiva tion of the allostatic systems,... |
21 | demonstrate better health than their U.S. born counterparts. Immigrant health status can be influenced by country of origin factors (e.g., war, famine), health beliefs (e.g., perceiving obesity to be a sign of wealth rather than of poor health), and racialized immigration policies in the receiving country that favor im... |
22 | Black Not Poor Poor Urban Rural No physical activity in the past week Hispanic Black, Asian White Poor Not Poor Hearing problem Poor Not Poor Vision problem Poor Not Poor Oral health problems (including caries and untreated caries) Hispanic Black White, Asian Poor Not Poor Rural Urban Attention deficithyperactivity dis... |
23 | and Hispanic Americans, increasing their risk of asthma. In addition, evidence shows a correlation between exposure to traffic pollutants and having fewer local pharmacies and healthcare providers. This triple jeopardy is more common with Black and Hispanic children. Obesity In 2018, the National Center for Health Stat... |
24 | for Health Statistics. National Health and Nutrition Ex amination Survey. https:www.childstats.govamericaschildrensurveys 2.aspnhnes.) Downloaded for mohamed ahmed (dr.mms2020gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 20, 2024. For personal use only. No other uses without ... |
25 | among Native Hawaiians was 9.4 infants per 1,000 live births, and the leading causes of infant mortality were preterm birth and low birthweight, sudden unexplained infant death, congenital anomalies, infection, and injury. Many of the causes of infant mortality disparities can be mitigated through public policy, public... |
26 | caries and treat caries before further impairment ensues. Data from the 2014 Medical Expenditure Panel Survey revealed that being poor and lacking health insurance were the main reasons for not receiving preventive dental care. Hearing Care No data suggest that the prevalence of hearing loss (either congenital or acqui... |
27 | Suicide In 2019, the CDC Youth Behavior Risk Surveillance System of 9th 12th graders reported suicide attempts by racial category, sex, and sexual ori entation. The highest rate of suicide attempts was among Indigenous NationsAlaskan Native teens (25.5), followed by Native Hawaiian Pacific Islanders (18.4), multiracial... |
28 | ADHD (17.1) compared with children with no ACEs (5.8). Children without a medical home are more likely to be diagnosed with ADHD (9.7) compared with children who have a medical home (8.0). Children diagnosed with ADHD have different treatment expe riences. After being diagnosed with ADHD, White children, when compared ... |
29 | studies have found that physicians with negative implicit racial bias are more likely to overpathologize Black child behavior and overdiagnose Black children with ODD, conduct disorder, and ADHD. The patholo gizing of Black child behavior can have severe consequences, including excessive school punishment, school expul... |
30 | healthcare delivery and patient physician communication and relationships. APPROACHES TO ERADICATING DISPARITIES: INTERVENTIONS An example of a successful intervention that closed the disparity gap is the implementation of the VFC program, which significantly decreased the disparity in immunization rates noted among ra... |
31 | Techniques such as hotspotting, cold casing (finding Downloaded for mohamed ahmed (dr.mms2020gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 20, 2024. For personal use only. No other uses without permission. Copyright 2024. Elsevier Inc. All rights reserved. 16 Part I u The Fie... |
32 | persistent Black White gap despite a substantial decline in U.S. IMR for all racialeth nic groups (see Fig. 2.5). NCHS data in 2022 showed a double digit IMR only among non Hispanic Blacks, with 10.38 deaths per 1,000 live births, compared to 4.41,000 for non Hispanic Whites. A troubling stagnation in IMR, with no rece... |
33 | public housing that is systematically underresourced to eliminate common pests, that child is more likely to encounter asthma triggers, experience asthma attacks, and require emergency department care or hospitalization. Interven tions could include remediating one apartment or home or increasing access to insurance; h... |
34 | 831 2,306 1,291 Proportion with no health insurance, age 65 yr (2018) 11.0 7.8 7.4 20.1 12.1 28.6 Infant mortality per 1,000 live births (2018) 5.7 4.6 3.9 for Asians only; 9.4 for Native Hawaiian and other Pacific Islander 4.9 10.8 8.2 Preterm Birth: proportion of singleton births before 37 wk gestation (2018) 8.2 7.2... |
35 | that those who experienced discrimination imme diately after the 911 attacks had a higher relative risk of giving birth to an LBW infant in the following 6 months than seen in births before this date. A similar association between exposures to discrimination based violence and Latina mothers giving birth to LBW infants... |
36 | those of White and Black ancestry, as another race. Starting in the late 19th century, Eastern European immigrants and Jews were considered different races. As early as 1961, the U.S. Census identified Mexicans and Puerto Ricans as White even as racial classification varied by geography. All states collected birth reco... |
37 | do not capture how broader shared social experiences shape outcomes. Racial domination or racism contributes to varia tion in the populations access to resources and exposure to disease and to the group experience of fair treatment and opportunity. Although many groups in the United States may encounter discrim ination... |
38 | the perpetrating individual is not consciously aware. The experience of unfair and prejudicial treat ment has biologic consequences, reflected in measurable increases in stress responses. Such effects of interpersonal racism are best documented for mental health, where perceived unfair treatment serves as psycho social... |
39 | inequities in the USA: Evidence and interventions. Lancet. 2017;389:14531463. Panel 2. Downloaded for mohamed ahmed (dr.mms2020gmail.com) at University of Southern California from ClinicalKey.com by Elsevier on April 20, 2024. For personal use only. No other uses without permission. Copyright 2024. Elsevier Inc. All ri... |
40 | would persist because of institutional and structural racism. Broadly, institutional racism refers to patterns of discrimination based on policy, culture, or practice and carried out by state and nonstate institutions (e.g., corporations, universi ties, legal systems, cultural institutions) within various sectors (e.g.... |
41 | ment may prevent the treatment of underlying health issues, such as mental health issues or disabilities, and cause increased stress for the entire family. 1980 1990 2000 Year USA 1980 1990 2000 Year UK 1980 1990 2000 Year Switzerland 1980 800 600 400 200 1990 2000 Year In ca rc er at io n pe r 1 00 00 0 Sweden 0 Fig. ... |
42 | institutions. Histori cally, government policies and practices have been largely responsible for the creation of these structures. De facto and de jure urban residential segregation serves as a case study for how the mechanisms of structural racism operate across mul tiple sectors and can affect child health and develo... |
43 | risk of childrens antisocial behavior. Most notably, experiences directly related to institutional and struc tural racism, operating through residential segregation (including financial hardship, parental imprisonment, and neighborhood vio lence), result in higher levels of ACEs for Blacks and Latinos than for Whites. ... |
44 | pedagogy or acquired by a pediatrician in training or clinical practice. Such an approach emphasizes respect for the expertise that caregiv ers bring to raising their child and begins with the presumption that caregivers want to do what is best for the child. By doing this, physi cians can form a collaborative relation... |
45 | discrimination standards, interaction between coworkers shapes an entire practice and can be perceived by families. Encouraging institutions to assess the impact of race among patients and staff is a first step. Healthcare delivery institutional set tings can use both data and patient accounts to examine racial effects... |
46 | and services, remediating the processes set in motion decades earlier. Clinicians play a role in advocating with the halls of medicine in linking patients to services, programming, and other resources and advocating for responsiveness in addressing gaps. Over time, concentrated efforts across sectors in targeted areas ... |
47 | slower rates, so that in 2019 the neonatal deaths made up 48 of all under 5 deaths (Fig. 3.2). Neonatal deaths account for a smaller percentage of child mor tality in low and middle income countries (LMICs) compared to HICs (Fig. 3.3), but the absolute risk of death remains significantly higher. A child in sub Saharan ... |
48 | managed through improved access to simple, low cost interventions. The most common causes of child death are pre term birth complications, intrapartum related events, pneumonia, and diarrhea (Fig. 3.4). Of all under 5 child deaths, 2.61 million were the result of infectious diseases and 21.7 of all child deaths were va... |
49 | 3.4 Neonatal and remaining under 5 cause specific mortality by region and SDI. Values presented are cause fractions: the proportion of total age specific deaths with a particular underlying cause of death. Causes are presented at Level 2 in the hierarchy, with other noncommunicable dis eases disaggregated to include co... |
50 | resources are devoted to their well being compared to their earlier years of growth. The paucity of support during this time of transition into adulthood diminishes the impact that child survival can have on their lives. Adolescents made up 18 of the worlds population, approximately 1.8 billion individuals, in 2010, an... |
51 | in the economic and political environments in which the child is born (see Figs. 3.4 and 3.5). Growth of economies during the first half of the 20th century was associated with dramatic health improvements, with falling mortality rates and rising life expectancy across all regions. However, the second half of the 20th ... |
52 | such as HIVAIDS and the growing prevalence of noncommunicable diseases. The COVID 19 Pandemic The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) leading to the global pandemic of coronavirus disease 2019 (COVID 19) resulted in over 6 million deaths from COVID 19 and over 499 million cases... |
53 | for Federal Programs and Policy Responses. Washington, DC: National Academies Press;2015.) Indirect impact: Social determinants of health and adverse childhood events Overall health impact Excess mortality and morbidity COVID19 pandemic impact on child health Impact over time Increased inequities Undernutrition Infecti... |
54 | 19 pan demic for parents and their children; as the pandemic has progressed, the prevalence of depression and anxiety symptoms among adolescents has escalated. The impact on mental health is not surprising because of the extraordinary disruption of routines, recreation, family income, peer interaction, and school suppo... |
55 | development, environmental sustainability, and social inclusion for all. The Global Strategy for Womens, Childrens and Adolescents Health 20162030 maps out the strategies to achieve the SDGs by cen tering on the goal of health for all women, children, and adolescents using evidence based approaches, backed by innovativ... |
56 | treated bed nets) Pneumonia Diarrhea (rotavirus immunization) Meningitis (meningococcalHibpneumococcal vaccine) Measles (vaccine) Prevention of mother to child transmission Case management of severe acute malnutrition Management of childhood diseases Malaria (antimalarials) Pneumonia (case management, antibiotics) Diar... |
57 | declines in immunization coverage caused by the COVID 19 pandemic have increased the risk for a resurgence of these vaccine preventable infections amidst weakened healthcare systems. Reaching Every Child, Everywhere Global vaccine organizations aim for universal coverage of immu nizations but face challenges within cou... |
58 | ab ies Ear ly ini tia tio n of b re as tfe ed ing Pos tn at al vis it f or m ot he rs Skil led b irt h at te nd an ce Neo na ta l te ta nu s p ro te cti on Ant ire tro vir al tre at m en t o f p re gn an t w om en liv ing w ith H IV Ant en at al ca re (a t le as t f ou r v isi ts) Dem an d fo r f am ily p lan nin g am ... |
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