Reflections on the shifting patterns of children’s health
Dr. Peter Nieman looks back on 30 years of dramatic changes at pediatric clinic
This month marks three decades for me in a community-based pediatric clinic. The location of the clinic has remained the same, but the nature of this amazing occupation has evolved in surprising ways. The saying of “the more things change the more they stay the same,” does not quite fit the shifting patterns of children’s health I have observed.
At this stage of my career, I am seeing 30-year-old parents who once were babies themselves when the clinic was launched in 1987. It does not feel that long at all, and when they remind me of this truth, it reminds both of us that our time with our children is quite limited and that the prophet Kahlil Gibran spoke the truth when he wrote, “Your children are not your children. They come through you but not from you. And though they are with you, yet they belong not to you.” We are merely stewards doing our best to raise them well, and the outcome is never certain.
Infections that were seen in the past, such as severe cases of meningitis in the children’s hospital ICU, are almost unheard of thanks to vaccines that work well. But there are no vaccines to reduce the burden on society of poor mental health. Our culture has evolved to the point where the most popular pediatricians are the ones who are the most skilled at navigating psychosocial issues for their patients and families. Caring for patients with ADHD, autism, depression, anxiety, self-harm, and addictions dominate the average day of any pediatrician in North America.
Technology has enabled babies to be born to infertile couples. More multiple pregnancies involve twins, triplets and quadruplets. Premature babies have benefited from improved care, thus reducing the risk of developmental issues later in life. Cancer treatment improved in part due to better protocols. But technology is also the root of many dysfunctional behaviours. In 1986, Neil Postman wrote a great book, Amusing Ourselves to Death, which lamented the role television plays in causing what he called “an onslaught of media.” The onslaught by smartphones, tablets, Apps and other forms of entertainment has made his book an amusing read in 2017 — simply because it is so out of touch with current reality.
The same author also wrote another bestseller, The Disappearance of Childhood, in 1982. In this book, he lamented the fact that kids are not allowed to be kids and that culture at the time is doing its best to accelerate childhood. Thirty years later, pediatricians are now seeing children get intoxicated at a young age, addicted to substances before teen years and initiating sex at earlier ages. Few endocrinologists can confidently explain all the reasons for the earlier onset of puberty. The higher rates of obesity may be a factor.
Nutrition is to the body what hinges are to doors. Although families have more options than ever to eat healthy, and although we know that the roots of healthy eating can be established while a human being is still in the womb, the reality is that obesity is still considered a major public health issue, despite efforts by government and pediatric organizations to solve this dilemma. The good news is that more and more clinicians understand that treating and preventing obesity has more to do with psychosocial issues than nutrition and exercise.
In an era where it has become harder to enter the best universities, many parents and students have become more competitive. I never heard the term “competitive parenting” in 1987. These days I see far too many parents who carry false guilt, blaming themselves for imperfect children (Recently I heard a speaker tell his audience that if you want to feel like a failure, have children)
Many high school students present to doctor’s offices with headaches, fatigue and stomach pains that often lead to extensive investigations simply to be sure that all pathology gets ruled out before stress can be “safely” diagnosed as the root issue.
When Canada wins a gold medal in ice hockey it does not surprise too many of us, but Canada also gets the gold medal when it comes to youth consuming cannabis. The current government has vowed to limit access to youth. However, it is quite unclear how they will allow families to grow four cannabis plants per home, legally, and yet limit access to a substance that negatively impact the still-developing brain.
To everything in life there is a season and how we handle change determines our own mental-health as parents, clinicians and a society. Keeping our children healthy and whole has always been both an honour and a challenge.
They are our future, and as Kahlil Gibran reminded us, “You are the bows from which your children as living arrows are sent forth.”