Summing up 1998 for children

EDITORIAL

Summing up 1998 for children

The past year was a pretty good one for children in the United States.

• Plans to take advantage of the $24 billion federal matching funds to provide health care for uninsured children (State Children's Health Insurance Program, or SCHIP) have been implemented in about half the states.
  In Maryland, 60,000 previously uninsured children and pregnant women have been enrolled.
• The results of a large trial of a conjugated pneumococcal vaccine show remarkable efficacy in preventing invasive pneumococcal disease. The vaccine will probably be licensed within the next year.
• The number of infants who acquire HIV perinatally has dropped by 42%
  as a result of improved screening of pregnant women and treatment with zidovudine (AZT).
• Data released this year demonstrate that teenage birth rates dropped 21% between 1991 and 1996.
• Rotavirus vaccine was licensed. This vaccine has been shown to be 50% effective in preventing infection and 70% to 80% effective in preventing serious diarrheal disease in infants.
• The number of infants dying of SIDS has been reduced by 30% in the US in association with the Back to Sleep Campaign.

In some ways, however, the hardest work to improve the health of pediatricpatients is yet to be done. As threats from disease are reduced by improvedhygiene, immunizations, and medications, conditions that require behavioralchanges for their remedy become more difficult to ignore. Smoking amongteenagers has increased again, 19% of them don't wear seat belts, and 50%have consumed an alcoholic beverage in the past month. Depression is fartoo common and often unrecognized, and suicide remains near the top of thelist of killers of adolescents and young adults. Children also suffer whentheir parents smoke, abuse drugs, and get depressed, and we have not yetfound effective ways to address those problems. Obesity is increasing amongchildren of all ages. Behavior problems, discipline, and learning disabilitiesare among the most common concerns parents bring to pediatricians, but pediatriciansneed time at each visit and longitudinal involvement with the family toaddress these problems.

There's lots more to do.

Julia A. McMillan, MD, Editor-in-chief of ContemporaryPediatrics, is Vice Chair, Pediatric Education, and Director, ResidencyTraining, Johns Hopkins University School of Medicine, Baltimore.