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OBJECTIVES

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Objectives

  • Review emerging definitions of children’s health and changing epidemiology.

  • Define health development and discuss the impact of the social environment on health outcomes.

  • Identify protective factors for child health development.

  • Define health promotion and describe the Life Course Health Development Model.

  • Describe the unique vulnerability of children.

  • Identify strategies to transform the clinical practice to serve vulnerable children.

  • Summarize strategies to tailor clinic-based assessment, education, intervention, and care coordination to vulnerable children.

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Xavier is a 2-year-old boy with delayed language development. His parents are immigrants from Mexico and speak to him in Spanish. He watches television 3 hours a day and reads with his parents two to three times per week. His parents describe him as a normal, healthy boy.

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INTRODUCTION

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Childhood is a critical and dynamic period of health development that has lifelong effects on health and well-being.1 Preventing chronic illness and promoting optimal long-term health require a special focus on optimizing health and overall functional capacity in childhood, investing in a child’s health potential and lifelong health reserves.

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This chapter discusses emerging concepts of children’s health and highlights the relationships among health, health development, and health promotion. It proposes a framework for understanding health development over an individual’s lifetime2 and how pediatric health-care providers can promote health and prevent chronic illness in the child and the future adult.

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EMERGING CONCEPTS IN CHILDREN’S HEALTH

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The 2004 Institute of Medicine (IOM) report, Children’s Health, the Nation’s Wealth, defines children’s health as “the extent to which an individual child or groups of children are able to or enabled to (a) develop and realize their potential; (b) satisfy their needs; and (c) develop the capacities that allow them to interact successfully with their biological, physical, and social environments.”3 This definition of children’s health highlights the intimate relationship between health and human development and expands it to include not only physical but also social and mental well-being. Furthermore, this definition focuses not only on the individual child but also on groups or populations of children.

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US child health ranks at the bottom among wealthy nations in the Organization for Economic Co-operation and Development (OECD)/UNICEF rankings, partially explaining why the United States is the sickest of wealthy nations as measured by adult health outcomes.4,5 This is not surprising given that in just one generation, we have witnessed remarkable increases in child health problems, with over 30% of all children having chronic health conditions. Nearly 10% of all children report disabilities caused by health problems (up from 2% in 1960) and 22% of adolescents report diagnosable mental health conditions with impairments.6,7

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CHANGING EPIDEMIOLOGY

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The shifting epidemiology of child health has profound implications for how children’s health care should be organized and delivered. Prior to the 1970s, ...

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