Theme Issue on Chronic Diseases in Infants, Children, and Young Adults: Call for Papers

Abstract

PEDIATRICS HAS TRADITIONALLY BEEN DEFINED BY ACUTE illnesses, but with the aid of public health measures, modern medications, vaccines, and product safety advances, acute illnesses are more preventable and treatable than ever. The major challenge for health care professionals who care for infants, children, and young adults and for those who will treat them as they age into adulthood has become the management of chronic diseases. Chronic illnesses in children include a wide range of maladies. Some, such as obesity, malnutrition, and cardiovascular disease, begin in childhood and can continue into adulthood. Others, such as congenital heart disease, are very different from adult-onset disease and require different management. Illnesses such as sickle cell disease and certain cancers that manifest in childhood have had gradual advances in treatment, and these diseases and others, such as neonatal prematurity, present new challenges as children live longer. While all children require general pediatric care (attention to immunization, proper nutrition, development, etc), some problems, such as cancer, congenital heart disease, and autism, are treated primarily by subspecialists. Others, such as cerebral palsy, require the teamwork of multiple disciplines. The prevalence of chronic conditions in childhood varies depending on the condition and how it is defined in terms of severity and functional impact. The Maternal and Child Health Bureau proposed an encompassing view of chronic illness, defining children with special health care needs as “those children who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health care-related services of a type or amount beyond that required by children generally.” In 2001, an estimated 12.8% or 9.3 million US children younger than 18 years had special health care needs. Prevalence was higher in boys, older children, and those from low-income families. A national survey in 20022003 found similar results. The leading chronic health conditions causing activity limitation in children differed by age and sex, but included speech problems, asthma, mental retardation, learning disability, and attention-deficit/ hyperactivity disorder. The impact of chronic diseases in childhood is enormous, whether measured economically or in terms of mortality and morbidity. Children with special health care needs accounted for 42.1% of total medical care costs for US children in 2000. In 2003, 5 of the 10 leading causes of death in childhood were chronic diseases: malignant neoplasms; congenital malformations, deformations, and chromosomal abnormalities; diseases of the heart; chronic lower respiratory tract diseases; and cerebrovascular diseases. Chronic conditions resulted in 66 million restricted-activity days and 27 million days lost from school. The impact on families of having a child with a chronic illness should not be overlooked. Having a child with poor health has been associated with higher rates of marital stress, divorce, and paternal unemployment, and one fifth of families report financial problems caused by their child’s health care needs. Because the burden of chronic diseases on children, their families, and the health care systems throughout the world is sogreat, JAMAwilldevoteanissuetochronicdiseasesof infants, children, and young adults in June 2007. Research in the realm of chronic diseases of children has the potential to influence notonlyhealth inchildhoodbuthealthandwell-beingthroughout the child’s life and, as such, is of utmost importance. We wish to increase awareness of the variety of chronic diseases that can afflict children, encourage research on treatment and outcomes, and promote attention at the health policy level for patients who cannot advocate for themselves. Because the development and impact of chronic conditions are influenced by genetics, behavior, and environment, we encourage studies that consider the multidimensionality of these disorders and their management. Authors are invited to submit manuscripts on topics related to chronic diseases in infants, children, and young adults. High-quality original research, especially randomized clinical trials, systematic reviews, and commentaries, are welcome. Manuscripts received by January 8, 2007, will have the best chance of consideration for this theme issue. Please consult the JAMA Instructions for Authors for guidelines on manuscript preparation and submission.