CHILD HEALTH SERVICES

Ensuring children's health is critical not only for reducing child morbidity and mortality, but also for increasing the likelihood of a healthier adult life. The primary goal of child health services, however, is to prevent the major causes of death, difficulties, and disease during childhood: accidental injuries, infections, education problems, and behavioral problems.

Child health services address environmental risks, problems related to low family income, sociopsychological stress, and traditional medical services. Early detection and treatment of disease and disability requires screening, counseling, and, for high-risk populations, interventions. For children from birth to age ten, screening includes measurements of height and weight, blood pressure, hearing, and vision. Counseling, or anticipatory guidance, relates to injury prevention, diet and exercise, substance use, and dental health. Immunizations for children generally include diphtheria-tetanus-pertussis (DTaP), oral poliovirus, measles-mumps-rubella, H. influenza type B, hepatitis B, and varicella. Interventions for high-risk populations are dependent on the population, but range from HIV (human immunodeficiency virus) testing for infants of mothers at risk for HIV to hepatitus A vaccine for children traveling to developing countries.

For children older than age ten, additional screening recommendations include a Pap smear and chlamydia screening for sexually active females and assessment of problem drinking for all adolescents. Counseling with this age group covers sexual behaviors, smoking, drinking, and other drug use. Immunizations should include a tetanus-diphtheria booster for those aged eleven to sixteen. Hepatitus B and varicella vaccines should be given to those who did not receive them at earlier ages. High-risk populations include those who engage in high-risk sexual behavior or drug use and those with certain medical conditions. Interventions specific to each of these populations are needed.

The U.S. government's Healthy People 2010 objectives provide guidance to those planning for or providing child health services. Central among these is access to care. Unfortunately, certain economic, educational, racial, and ethnic factors, as well as disability status, affect such access. To be of benefit, health care must not only be available, it must also be accessible in an ongoing and routine fashion. The American Academy of Pediatrics recommends six well-child visits during infancy. An additional three such visits are recommended during a child's second year, annual visits are recommended through age six, and visits every other year through the remainder of childhood. Access to care is essential in order to accomplish the screening and preventive care previously noted, as well as to ensure that children receive treatment for both acute and chronic illnesses.

In addition to access to care, Healthy People 2010 addresses levels and severity of child health-related issues and conditions. Pediatric asthma and diabetes; accidents, violence, and suicide; mental health; tobacco use; and nutrition and physical activity are areas in which little or no improvement has been seen. Equally important aspects of child health include dental exams and oral health; school nursing and health education; environmental hazards (particularly lead); food-borne pathogens; sexuality; alcohol and other drug use; and vision and hearing. Developmental disabilities, the reduction of specific diseases, and access to a medical home for children with special health care needs are also addressed by Healthy People 2010. Each of these constitutes an aspect of child health and can serve as a touchstone for individuals and communities in both the provision and monitoring of child health services.

Iris J. Meltzer

(see also: Alcohol Use and Abuse; Child Care, Daycare; Childhood Injury; Child Mortality; Child Welfare; Congenital Anomalies; Healthy People 2010; Immunizations; Lead; Maternal and Child Health; Oral Health; Well-Baby Clinics )

Bibliography

Last, John M., ed. (1986). Maxcy-Rosenau Public Health and Preventive Medicine, 12th edition. Norwalk, CT: Appleton-Century-Crofts.

U.S. Department of Health and Human Services (2000). Healthy People 2010, Conference edition. 2 vols. Washington, DC: Author.

U.S. Preventive Services Task Force (1996). Guide to Clinical Preventive Services, 2nd edition. Baltimore, MD: Williams & Wilkins.