Q: You’ve been writing about children’s health problems for almost 15 years. Aren’t you running out of columns to write?
A: There are always more things to write about, even though I sometimes repeat myself on subjects that matter to me a lot. I appreciate the questions my patients ask in my office, as well as those my readers send me. The basis of my columns is always that which one of my patients or the parents of my patients has asked or might ask when in the clinic. Both types of questions bring introspection and, if I don’t know the answer, a trip to the medical literature. There’s no question that reviewing the medical literature is easier with the Internet.
I haven’t finished answering all of the questions that I have received, but I’d like to broaden the scope of what you read every other Tuesday. I have asked a young colleague and friend, Sara del Campo de Gonzalez, M.D., to write every other column for the next few months. I know that she will do it very well, as she does everything else; time will tell if this mother of two young children and full-time pediatrician will have time to take over the production of one or two columns per month.
Dr. del Campo de Gonzalez joined the practice where I work, the Young Children’s Medical Center, a little more than two and a half years ago. We sought her for her exuberant, caring approach to patient care and her ability to work with everyone – clinic staff and patients alike. Since then, she has fulfilled our expectations and has added a very important role: leading pediatricians and pediatric trainees in advocating for children in the community at all levels – local, statewide and nationally.
I suspect there will be some changes in the content of these columns: while we are similar in some ways, we write differently and have overlapping, but not matching, passions.
I have tried to restrain myself from writing too often about one of my major passions, immunizations. I do believe that those jabs, as the British call them, are one of the best ways we can protect our patients from a great many diseases that once caused untold misery and many deaths. I know that I haven’t convinced everyone; about one in every 140 children enters kindergarten with an “exemption” from immunizations, almost all of them stating that the parents believe immunizations to be a bad bargain. I disagree, strenuously, though I continue to try to work with my patients in this category.
I have written frequently about diet and exercise, obesity and diabetes, linked subjects of great importance to the future of America’s children. We have seen some leveling off of the rapid worldwide rise in obesity seen over the past several decades and have some hopes that a decline may occur. When I started writing this column in 2000, many parents came into our office saying, “My child hardly eats.” Now it is more common to hear the question, “I’m worried about my child becoming overweight. What can I do about that?” There has been a decrease in sales of sodas over the past several years and more patients seem to be limiting screen time. Both sweetened beverages, and too much TV and video games contribute to obesity. We still have much more work to do on this, but I’m hopeful. Ensuring safe places for children to play (“an hour a day of vigorous physical exercise”) and available supplies of produce (“at least five helpings of fruit and vegetables per day”) are by no means assured as of now.
I have tried to balance discussion of physical illnesses, such as ear infections, strep throats and meningitis, against the social, emotional and behavioral issues that I frankly think pose more urgent threats to children in this era of reduced threats from infectious diseases. Certainly, consideration of inability to learn, family dysfunction and uncertain parent resources fills my clinic days.
In pediatrics, we talk of toxic stress affecting the health and emotional development of children, and we try to prevent it when we can and to find ways to moderate its effects when it’s present. A small amount of stress probably strengthens a child, who learns through adversity. But constant, unremediated stress does indeed become toxic.
Toxic stress is part of what we call the “social determinants of health.” Now that immunizations and antibiotics have largely put infectious diseases in their place, it’s economic well-being vs. poverty, being well-educated vs. dropping out of school, a happy home vs. a home full of conflict, freedom from mental disorders and substance abuse vs. a home suffused by these problems that determine long-term emotional, as well as physical, health.
I have written about all of these over the course of 386 columns and 15 years, and both Dr. del Campo de Gonzalez and I will continue to write about them. Both of us will continue to respond to your questions and comments. Thanks for “listening.”