Focusing on Child Health

The mapping of the human genome has the potential to revolutionize many aspects of medicine and health care, particularly childhood illnesses. Childhood cancer may be treated more effectively with far fewer short- and long-term side effects. Organ transplantation may involve genetically engineered organs that require no long-term antirejection medications. Diseases like sickle cell anemia, cystic fibrosis, and diabetes may finally be cured using gene therapies. These are, indeed, exciting times.

But these magnificent medical advances will have little impact on intentional and unintentional injury or suicide, the leading causes of death during childhood. Likewise, these discoveries will have little effect on child abuse and neglect, poverty, domestic violence, or mental health problems in children. Cures for mental retardation, learning disabilities, and developmental problems emerging from traumatic brain injury seem to be nowhere on the horizon. These social, behavioral, psychological, emotional, and developmental difficulties are likely to be the major unsolved health care problems of the next several decades.

It is estimated that 13 million children in the United States experience significant mental or behavioral health problems, yet less than one-third have access to professionals—psychiatrists, psychologists, pediatricians, nurse practitioners, or social workers—experienced in the treatment of child mental health disorders. This problem is magnified in our community, where access to mental health professionals with cultural and linguistic diversity represents a significant barrier to care. Access to general health care remains a major concern for many children, particularly those who are poor or from minority backgrounds. Preventive health care, early intervention for developmental problems, prevention of violence, and broad-based community programs for injury prevention can have the kind of impact on child health promised by the understanding of the human genome. Unfortunately, these programs are not easily available to those in the greatest need.

I recently helped the Committee on Psychosocial Aspects of Child and Family Health with an American Academy of Pediatrics policy statement titled “The New Morbidity Revisited: A Renewed Commitment to the Psychosocial Aspects of Pediatric Care.” This statement urges pediatricians to pay attention to violence, poverty, divorce, health care access, and mental health care as part of routine child health maintenance in everyday practice. Broad in scope, the policy brings these neglected but costly issues to the forefront of pediatric practice, yet it does not provide solutions.

At the University of Miami’s Mailman Center for Child Development, faculty are leading the development of innovative solutions to some of these problems. Our Pediatric Mobile Clinic provides high-quality health care to more than 2,000 children in Miami-Dade County each year who otherwise have no access to care. Our Center for Violence Prevention works with more than 50 community agencies to develop training, research, and interventions to prevent gun injury, abuse, and other consequences of societal and domestic violence. Combined, more than 15,000 children receive essential diagnostic, prevention, and early intervention services each year as part of these programs.

Through these partnerships with child care programs, schools, courts, and other community initiatives, our students learn firsthand what the “New Morbidity” really is.

Daniel Armstrong, Ph.D., is professor of pediatrics and director of the Mailman Center for Child Development.
Photography: John Zillioux
University of Miami Medicine Online
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