The prevalence of chronic diseases in children has increased since the 1980s and will likely increase further, according to the Journal of the American Medical Association, which devoted its entire June 27, 2007, issue to the subject of pediatric chronic illness.

For children with chronic illness, life can be complicated and difficult, the Journal points out. “A child with asthma may need to take daily medication, an obese youngster may endure taunts or stares, a child with cancer may be hospitalized for extended periods of time, and concern about bills and time and health are very real, at least for their parents.”

The implications of childhood chronic illness for institutions that serve children, including schools, are immense and growing, the Journal says in an accompanying editorial. Journal editor Catherine DeAngelis cites conditions for which prevalence has increased in the last two decades, including the three that have grown most—obesity, asthma, and attention deficit disorder. It also appears that physician-diagnosed diabetes mellitus among children and adolescents has increased, with type 2 diabetes becoming common especially among minority adolescents. Added to these are other illnesses of childhood, including cancer, cerebral palsy, juvenile rheumatoid arthritis, cystic fibrosis, and cardiovascular disease, for which we still do not fully understand the effects of treatment on children’s physical and psychological development.

The Journal examines in detail two of the chronic diseases that are commanding new attention—diabetes and childhood obesity.

Diabetes
Diabetes occurring early in life has devastating effects on the ability of young patients to live full lives, researcher Rebecca Lipton points out. But diagnosing the condition is changing. “Before 1997, virtually all diabetes in young individuals was thought to be autoimmune type 1 diabetes mellitus (DM). Now there is widespread recognition that insulin-resistant type 2 DM can occur in childhood. Furthermore, evidence is accumulating that type 2 DM in young individuals is qualitatively different from that in older adults, often resulting from an interplay of insulin resistance and autoimmunity.”

A World Health Organization-sponsored study that began in the 1980s has found major increases in diabetes in children in all areas of the world, and the Centers for Disease Control and Prevention (CDC) estimates that the risk of diabetes before age 20 in the United States is 24.3 per 100,000 per year, overall.

Almost simultaneous with the increase in diabetes, there has been an unprecedented increase in childhood obesity during the past two decades, and it’s tempting to assign the growing incidence of diabetes to obesity alone, but that may miss important contributing factors such as genetic susceptibility that are not yet clearly identified, the research report notes.

Obesity
An epidemic of childhood obesity and overweight threatens long-term medical, psychosocial, and financial consequences beyond U.S. society’s current capacity to respond, according to researcher Rita Lavizzo-Mourey.

“Current evidence indicates a worst-case trend. In just over a generation, rates of overweight have approximately tripled among children aged 6 to 11 years, and in 2004 17.1 percent of children and adolescents in the United States were overweight.” The researcher notes that children in certain demographic subsets, including African American adolescents, are particularly vulnerable to overweight and its adverse health effects, “adding to the burden of populations that are already disproportionately uninsured and experiencing disparities in health care.”

Programs to change the food and physical activity environment of children exist in some schools, including a Healthy Schools Program created by the Alliance for a Healthier Generation, a joint project of American Heart Association and the William J. Clinton Foundation that aims to help schools set and implement standards for nutrition, physical activity, and staff wellness. “The program started with 230 pilot schools in 13 states, and more than 900 schools signed up to use the programs online tools, In its first year, the program reached approximately 750,000 students and is providing further evidence that school-based interventions are a powerful tool for reaching large numbers of at-risk youth.”

School-based interventions alone may not be enough to reverse the upward trend in obesity rates, however. Recent research has suggested that to succeed, school-based programs must be accompanied by family and community interventions.

Defining ‘Chronic Illness’

Understanding the true scope and impact of childhood chronic illness on schools, physicans, and the public health system requires agreement on what, exactly, the term means, and such agreement is currently lacking, the Journal says. Various programs and services for children use differing ways of identifying those who are chronically ill, based on factors such as a patient’s ability to function normally in life or school, the need for supportive medical service on a part- or full-time basis, and the need for accommodation to a disability.

A comprehensive review of medical literature came up with a range of concepts, from “medically fragile” to “children with special health care needs.” The Journal researchers do not mention the definitions used by federal agencies, which differ, for example, between the Individuals with Disabilities Education Act (IDEA) and Social Security Supplemental Income (SSI), but they make clear that some kind of international consensus is needed if we are ever to know how many children are “chronically ill,” and what the term means for their care and treatment.

What everyone can agree on, says Journal editor DeAngelis, is that chronic illness steals childhood, and that stemming the growth of chronic illness in children calls for major efforts to understand causation and means of prevention.