Poor health among children confounds parents (original) (raw)

Poor health among children confounds parents, doctors

Sunday, July 30, 2000
By SUSAN FENELON KERR

In doctors' offices across Western Massachusetts, a national paradox is playing out.

At a time of unprecedented national prosperity, more and more children are suffering from a range of health problems, some once believed to be the exclusive province of adults.

Asthma. Obesity. Mental illness. Diabetes. Autism.

Both statistically and anecdotally, all appear to have increased among children. And, in many cases, experts can't conclusively say why.

Are certain illnesses and disorders increasing, or are the increases linked to advanced tests and wider screening?

The answer depends on the illness or disorder.

Studies have shown that asthma, allergies, obesity and diabetes are increasing. When it comes to learning disorders, the empirical data on causes may not abound, but individual health practitioners say changing values, poor interaction in families, inadequate mental health screening and treatment are all factors.

And some parents have raised questions about the long-term impact of childhood vaccinations.

At the same time, the federal government reports that other childhood diseases are at an all-time low. And childhood vaccination rates are at an all-time high, except for pockets in some inner cities.

Disease and death from diphtheria, pertussis, tetanus, measles, mumps, rubella and hepatitis B are at or near record lows, according to the federal Department of Health and Human Services.

But doctors and public health experts are alarmed by increases in chronic illnesses among children, like asthma and obesity, that can be controlled by lifestyle changes.

"Asthma is just out of control," said Dr. Edward Bailey, medical director of the Springfield school system and a Baystate Medical Center pediatrician.

A federal review done in 1998 showed staggering increases, 160 percent among children from birth to age 5 from 1980 to 1994.

"The mystery is why. We have no idea whether this is related to much more tightly controlled home environments so that we keep re-breathing noxious materials. Or, something new in the environment with new products and fabrics.

"Or, are we living in a different society where people have fewer infections because of immunizations and we have somehow changed our immune systems?"

Bailey said the highest rates for asthma in children in the state are in the Brightwood and Hill-McKnight neighborhoods in Springfield.

School nurses are swamped with youngsters needing inhalers, and they report increases in numbers of children with asthma and other allergies.

There is also an apparent increase in the numbers of children with learning disorders, what is called attention-deficit and hyperactivity disorder and autism. While some therapists, counselors, educators and parent-advocates say the numbers are increasing, federal epidemiologists can't confirm those statements because comparative data are hard to come by.

But one study by the U.S. Department of Education found an increase of more than 500 percent of autistic children in special-education programs.

And a 1998 California study found 287 percent more people seeking assistance for autism.

Studies on both attention-deficit disorder and autism are under way by the National Institutes of Mental Health.

Obesity also has become a cause of national concern for children, putting them at risk for heart disease and diabetes. Some pediatricians and diabetes specialists are reporting a growing number of children with Type II diabetes, a disease that is related to weight, diet and lifestyle.

Among illnesses being targeted by public health officials:

Asthma has become a target for intervention and control, especially in urban environments where children in inner cities suffer disproportionately.

• Attention-deficit and hyperactivity disorder is found in as many as one in 20 children, or 3 to 5 percent. Some estimates indicate cases among boys outnumber those of girls 3-1. The National Institute of Mental Health is now engaged in a nationwide study to determine the prevalence of mental disorders among children and adolescents. Other studies now under way are seeking causes.
• Autism cases appear to be increasing, but it is not known how many children in the United States currently have autism disorders, according to the Centers for Disease Control. Estimates based on studies done in Europe and Asia since 1985 indicate there may be as many as 2 in 1,000 children, while studies being done in Georgia indicate 2 to 5 per 10,000 children. Genetic and environmental factors to vaccinations have been suspected in the increase, but some physicians say the vaccination scare is related to the fact that autism is often diagnosed at about the same age children receive their first vaccinations.
• The number of obese children has almost tripled, with the federal government estimating 14 percent of children are now considered obese, up from 5 percent in the mid-1960s. About 6 million children are obese, putting them at risk for heart disease and diabetes.
• Some doctors who specialize in pediatric diabetes say patients with the so-called "lifestyle" diabetes, which can be controlled by exercise and nutrition, now make up 15 percent of their patient load compared to 1 or 2 percent in years past.
  To combat perceived environmental causes for high asthma rates, the New York State Association of School nurses is pushing for laws that would require schools to buy fewer toxic and polluting materials and buy the least toxic pesticide for "pest" control.
  Other theories for an increase in some conditions range from long-term effects of the increasing number of vaccines required by the time a child enters school, (20, with new vaccines being added,) to air pollution. Violence in the media has been blamed for increases in psychological problems.
  "The levels of inattention, impulsive behavior, learning problems and violence children encounter is quite impressive," Bailey said. "There is an increase both in terms of rates of kids who are in severe trouble and the absolute lack of resources. It is shameful."
  A 1997 survey by the Centers for Disease Control reported that more than 20 percent of youths surveyed had seriously considered attempting suicide, more than 15 percent had made a specific plan and 7 percent had attempted suicide.
  The conclusions drawn were that physicians and pediatricians should routinely discuss depression and other mental health issues during routine examinations with adolescents.
  Bailey cites poor relationships within the family, too much exposure to media and television and a change in the value systems of this culture for what he says is a crisis of children's mental health.
  And he says there are not enough resources to evaluate children and get them into treatment.
  "When I look and I hear that the average vocabulary of a 12-year-old today is a third to one-half of what is was a decade ago, when I see that the average child is spending 24 hours a week in front of the television instead of reading or going out with peers to play, or being involved with the family, I can get despondent over that," said Bailey.
  "It's not as if they are watching classics. They are watching violent, assaultive behavior. Hour after hour. They learn that power and control and weapons are the way to relate to people," he said.
  Bailey said Springfield adults have the highest rate of illiteracy in the state — 30 percent — but he sees the behavior problems in children across economic and social status lines.
  His prescription for every parent who brings a child in to his pediatric practice is to read 20 minutes a day.
  "We tell every parent to hold that baby, talk to it, sit and look at picture books to give them language. Twenty minutes a night. Twenty minutes of reading out loud. We hammer that home," Bailey said.
  At Dr. Rubina A. Heptulla's childhood obesity program at Baystate Medical Center in Springfield, there is a three-month waiting list.
  Her program tries to teach the children about good nutrition and get them into a regular exercise program. Obesity can lead to diabetes and heart disease.
  "These kids are extremely overweight, three times normal," she said. "And there is a lot of moderate obesity that doesn't make it to my clinic."
  Other families are turning to personal trainers like Mark D. Shumway, whose Springfield fitness business helps to motivate children to shed excess weight.
  Many studies are showing an increase in diabetes Type II in children, an illness that usually appears in adults but is related to being overweight.
  Tracking increases in conditions and illnesses is not an exact science because comparative data are not always available.
  For example, Oona Powell, a spokeswoman at the federal Centers for Disease Control and Prevention, said CDC studied a town in New Jersey for autism. But because there is no comparative data, it is difficult to determine whether the rates are higher than elsewhere, or higher than in years past.
  Thus it is difficult to determine whether high rates of autism are caused by something in that environment, she said.
  Many sources for health-care information are available to parents. Information can be found in local libraries, through various national organizations and associations for each disease or condition, and on the Internet.
  "Support groups are very important," for parents whose children have difficult, complex and chronic illnesses, said Dr. Beata J. Tyminska, a Mercy Hospital pediatrician.
  How a parent copes depends on the diagnosis, but they need to remember they are the role models and they are the bosses of their children.
  For example, for a child with a weight problem, the parent should stock the house and cook only with nutritious, healthy food.
  For a child with attention deficit disorder, be specific with instructions and give short, simple tasks. Work on one behavior at a time, and consider family therapy to cope.
  For asthma, be aware of the allergens that trigger an attack. Treat viral infections aggressively and control the children's exposure to animals or trigger foods. Make sure the child takes medications appropriately.
  Chronic illnesses and conditions usually require a multi-disciplinary approach and these children should see specialists, Tyminska said.
  "Parents are sometimes too tired and exhausted to make it to all the visits. They must make sure they follow up with all the specialists," she said. "And they should enjoy each day."
  � 2000 UNION-NEWS. Used with permission