title: The rise in chronic conditions among infants, children, and youth can be met with continued health system innovations.
abstract: Since the early twentieth century, medical and public health innovations have led to dramatic changes in the epidemiology of health conditions among infants, children, and youth. Infectious diseases have substantially diminished, and survival rates for children with cancer, congenital heart disease, leukemia, and other conditions have greatly improved. However, over the past fifty years chronic health conditions and disabilities among children and youth have steadily risen, primarily from four classes of common conditions: asthma, obesity, mental health conditions, and neurodevelopmental disorders. In this article we describe the epidemiological shift among infants, children, and youth and examine sociodemographic and other factors contributing to it. We describe how health systems are responding by reorganizing and innovating. For children with rare complex conditions, concentrating subspecialty care at regional centers has been effective. For the much larger numbers of children with common chronic conditions, primary care providers have expanded diagnosis, treatment, and management options in promising ways.
authors.affiliation: James M. Perrin (JPERRIN@mgh.harvard.edu) is a professor of pediatrics at Harvard Medical School and the John C. Robinson Professor and Associate Chair at MassGeneral Hospital for Children, in Boston, Massachusetts.
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin
authors.affiliation: L. Elizabeth Anderson is a medical student at the University of Tennessee College of Medicine, in Memphis.
authors.forename: L Elizabeth
authors.initials: LE
authors.lastname: Anderson
authors.affiliation: Jeanne Van Cleave is an assistant professor in general academic pediatrics at MassGeneral Hospital for Children.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Van Cleave
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D019988:Children with Disabilities / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D008297:Male; D009936:Organizational Innovation; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Children’s Health; Chronic Care; Epidemiology