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Child health research lags behind adults, with long-term societal consequences

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Holly Korschun

Barbara J. Stoll, MD, the George W. Brumley, Jr. Professor and Chair, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta; President, American Pediatric Society.

In a Viewpoint article in JAMA, pediatric leaders call for a renewed commitment to child health research through innovative strategies, unique partnerships, creative use of emerging technologies, enhanced training of child health researchers, a culture of participation in clinical trials, and advocacy for children and child health research.

The Viewpoint, "The Transformation of Child Health Research: Innovation, Market Failure, and the Public Good" is written by Barbara J. Stoll, MD, the George W. Brumley, Jr. Professor and Chair of the Department of Pediatrics in Emory University School of Medicine and Children’s Healthcare of Atlanta, and David K. Stevenson, MD, and Paul H. Wise, MD, MPH, from Stanford University School of Medicine.

This essay is a response to an editorial published in JAMA in 2012: "Challenges to Excellence in Child Health Research," by Zylke et al. which summarized a series of articles suggesting that the quality and number of pediatric research studies lag behind research focused on adults.

Improving positive outcomes in child health is a necessary step for advancing public health generally, say the authors, but this will depend on elevating the status of children in society and on having the political will to provide adequate financial support.

Over the past few decades pediatric medicine has realized a remarkable record of accomplishments, including prevention and successful treatment of acute infectious diseases and transforming previously fatal diseases into more manageable chronic conditions, but long-term outcomes are still less than optimal, the authors assert.

"The impressive increase in survival from childhood disease and injury has pushed us to look beyond survival to consider long-term outcomes and the consequences of pediatric health and disease on society as a whole," says Stoll. "Research has shown that adult chronic diseases may begin in childhood, and also that societal factors play a large role in health and disease in children and adults."

The increased survival of preterm infants has created a new set of challenges for long-term child health and development, and injuries are now the leading cause of death for children in the United States, suggesting a crucial need for increased attention to prevention.

"New perspectives about pediatric origins of adult disease, social determinants of health, and long-term effects of early exposures and interactions suggest that the poor health of children (reflected in rates of prematurity, obesity, behavioral and developmental problems, etc.) can be a harbinger of poor adult health," say the authors.

 The authors recommend several key steps to transforming child health, including:

  • Pediatric research should be informed by the changing epidemiology of childhood illness, the need to monitor both survival and long term outcomes, and the increasing recognition of pediatric origins of adult chronic disease.
  • Expansion of clinical sites for pediatric research networks, including the Neonatal Research Network funded by the National Institute of Child Health and Human Development.
  • Creative use of new technologies, including new genetics, imaging, and bioinformatics tools and expanded electronic health records to integrate health information and create new multi-institutional research opportunities.
  • Increased financial support for trainees and young faculty to create a continual pipeline of clinical and laboratory scientists focused on advancing child health.
  • Financial and regulatory incentives and investment opportunities to help confront powerful market forces that skew research priorities and drug/device development away from pediatrics.
  •  Development of innovative partnerships that include traditional academia, industry and government funders to jointly promote an agenda for children that includes child health research.
  • Continued advocacy on behalf of children to promote an agenda that includes attention to child health research.

Note: Barbara J. Stoll, MD, president of the American Pediatric Society (APS) will deliver the keynote address at the APS 125th anniversary meeting on Sunday, May 5 in Washington, D.C.

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