title: Children with special health care needs: acknowledging the dilemma of difference in policy responses to obesity.
abstract: Children with special health care needs (SHCN) account for part of the increasing prevalence of childhood obesity in the general population and can face an elevated risk for obesity. The federal government, in partnership with states, has assumed the role of steward for this vulnerable population and supports a network of services designed to promote their health through increased access to quality health services. Addressing obesity-related health risks among children with SHCN requires policies that support family- and community-based initiatives in addition to health services. We discuss the ethics of child obesity policy from the perspective of children with SHCN and their families, and identify salient issues to optimize benefits for children and families. We refer to the dilemma of difference to identify policy concerns that are specific to children with SHCN and ethically may require different approaches. Determining the appropriate mix of inclusive and special obesity prevention initiatives for children with SHCN and identifying approaches to ensure their full participation in community-based obesity prevention activities present challenges. Children with SHCN from low-income and minority communities are particularly vulnerable and warrant special attention.
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111, USA. paula.minihan@tufts.edu
authors.forename: Paula M
authors.initials: PM
authors.lastname: Minihan
authors.forename: Aviva
authors.initials: A
authors.lastname: Must
authors.forename: Betsy
authors.initials: B
authors.lastname: Anderson
authors.forename: Barbara
authors.initials: B
authors.lastname: Popper
authors.forename: Beth
authors.initials: B
authors.lastname: Dworetzky
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005006:Ethnicity; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D007223:Infant; D009765:Obesity / Q000453:epidemiology* / Q000517:prevention & control*; D044469:Racial Groups; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology