Poor health among children confounds parents, doctors

Sunday, July 30, 2000

In doctors' offices across Western Massachusetts, a national paradox is playing out.

At a time of unprecedented national prosperity, more and more children are suffering from a range of health problems, some once believed to be the exclusive province of adults.

Asthma. Obesity. Mental illness. Diabetes. Autism.

Both statistically and anecdotally, all appear to have increased among children. And, in many cases, experts can't conclusively say why.

Are certain illnesses and disorders increasing, or are the increases linked to advanced tests and wider screening?

The answer depends on the illness or disorder.

Studies have shown that asthma, allergies, obesity and diabetes are increasing. When it comes to learning disorders, the empirical data on causes may not abound, but individual health practitioners say changing values, poor interaction in families, inadequate mental health screening and treatment are all factors.

And some parents have raised questions about the long-term impact of childhood vaccinations.

At the same time, the federal government reports that other childhood diseases are at an all-time low. And childhood vaccination rates are at an all-time high, except for pockets in some inner cities.

Disease and death from diphtheria, pertussis, tetanus, measles, mumps, rubella and hepatitis B are at or near record lows, according to the federal Department of Health and Human Services.

But doctors and public health experts are alarmed by increases in chronic illnesses among children, like asthma and obesity, that can be controlled by lifestyle changes.

"Asthma is just out of control," said Dr. Edward Bailey, medical director of the Springfield school system and a Baystate Medical Center pediatrician.

A federal review done in 1998 showed staggering increases, 160 percent among children from birth to age 5 from 1980 to 1994.

"The mystery is why. We have no idea whether this is related to much more tightly controlled home environments so that we keep re-breathing noxious materials. Or, something new in the environment with new products and fabrics.

"Or, are we living in a different society where people have fewer infections because of immunizations and we have somehow changed our immune systems?"

Bailey said the highest rates for asthma in children in the state are in the Brightwood and Hill-McKnight neighborhoods in Springfield.

School nurses are swamped with youngsters needing inhalers, and they report increases in numbers of children with asthma and other allergies.

There is also an apparent increase in the numbers of children with learning disorders, what is called attention-deficit and hyperactivity disorder and autism. While some therapists, counselors, educators and parent-advocates say the numbers are increasing, federal epidemiologists can't confirm those statements because comparative data are hard to come by.

But one study by the U.S. Department of Education found an increase of more than 500 percent of autistic children in special-education programs.

And a 1998 California study found 287 percent more people seeking assistance for autism.

Studies on both attention-deficit disorder and autism are under way by the National Institutes of Mental Health.

Obesity also has become a cause of national concern for children, putting them at risk for heart disease and diabetes. Some pediatricians and diabetes specialists are reporting a growing number of children with Type II diabetes, a disease that is related to weight, diet and lifestyle.

Among illnesses being targeted by public health officials:

Asthma has become a target for intervention and control, especially in urban environments where children in inner cities suffer disproportionately.