COMMENTARY

Pediatrics by the Numbers: Putting Our Time Where It Works Best

L. Gregory Lawton, MD

Disclosures

June 04, 2018

Where Should We Direct Our Efforts?

#1: Drug overdoses. A day cannot pass without a reminder concerning the scale or scope of the opioid epidemic, the leading killer of children in the United States.[1] Perhaps it comes in the form of a newspaper article about a single mom who died in her children's bedroom after a failed stint in rehab. Maybe it was the local news story about the funeral of a hometown twenty-something, as told by tearful parents.

More Americans die from accidental drug overdoses or drug-related complications such as infections or cardiovascular events than from firearms or motor vehicle accidents.[2] In fact, the persistent decline in the life expectancy of Americans is attributed to the fact that the trend in these deaths continues to increase: nearly 55,000 in 2016.[3] For adolescents and young adults 15-24 years of age, the number is 4825. Factor in the parents of our patients, those 24-44 years of age, and over 26,600 lives have been claimed.

In total, the opioid and heroin epidemic is having a staggering effect on the lives of the families, patients, and parents for whom we provide care.

#2: Motor vehicle accidents. According to the Insurance Institute for Highway Safety, over 700 children younger than age 13 years died in a car in 2016.[4] Deaths in teens (up to 20 years of age) were reported at 2000 in 2013.[5] Together, this totals approximately 2700 children who die in a car annually. There are a number of reasons for the decline in these numbers compared with prior decades, but there is little doubt that child restraint systems and overall seatbelt design (as well as laws) have had a significant impact on this decline. It helps that car seats are not controversial. Nonetheless, it is still the wise move to emphasize this point with "invincible" teens.

#3: Cancer. This is one risk for our kids that we likely can't mitigate with anticipatory guidance. Cancer, while relatively rare in children, is the leading cause of death by disease past infancy among children in the United States. Almost 15,000 children from birth to age 19 years are diagnosed each year, and over 1700 will die of the disease.[6] This sobering reminder underscores the importance of continued funding of research into the causes and treatments of childhood cancers.

#4: Firearms. A June 2017 study in Pediatrics[7] concluded that nearly 1300 children die and 5790 are treated annually because a bullet was fired into their body. This could be accidental (a toddler found the loaded, unlocked family Glock), a result of suicide (teens can be very impulsive, a fatal propensity when combined with relative ease of access to a firearm), or intimate partner or family violence. The American Academy of Pediatrics, an organization dedicated to the health of kids, has a very clear policy statement regarding firearm safety in the home.[8] A home without a gun is safer than a home with a gun, even when the gun is safely stored. That's something to mention at a well-child visit.

#5: Poisonings. The accidental ingestion of medication, chemicals, or cleaning products still accounts for a significant number of child injuries and deaths. According to the CDC, over 700 children die each year due to an accidental ingestion.[9] Undoubtedly, the number of deaths would be much higher were it not for the avocation of pediatricians for the safe storage of medications and household chemicals. We talk about placing medications out of reach of children and installing hardware devices in our kitchens and laundry rooms to safeguard cleaning products. Childproof pill bottles have been ubiquitous for years. And the results are in. Since 1972, fatal poisonings in children under the age of 5 years have decreased by 87%.[10] Each year, thousands of lives are saved because parents listen to their pediatrician.

#6: SUID. While not included in my pop quiz, which references children older than 1 year of age, no discussion of childhood safety would be complete without including SUID. The "Back to Sleep" (now "Safe to Sleep") campaign was launched in 1994 as a result of research that showed a decline of over 50% in the incidence of "crib death" in infants who were placed on their backs to go to sleep.[11] However, in January 2018, the US Centers for Disease Control and Prevention (CDC) reported that approximately 3500 sleep-related infant deaths still occur annually in the United States.[12] As an anticipatory guidance point with new, often sleep-deprived parents, it's tough to argue with 50%. This bit of advice also has a very limited window of applicability. It makes a lot of sense to emphasize at a time when only a handful of external issues (such as proper car seat usage) threaten a child's life. And it's particularly important in light of recent research that found that less than half of parents consistently follow Back to Sleep advice.[13]

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....