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As pediatrics and the delivery of children’s health
care enter the 21st century, the role of the pediatrician continues
to evolve and change. Guided by the knowledge, skills, and tools
that the profession has accumulated over many decades, pediatricians
must strategically respond to changing conditions, health determinants,
and epidemiology of childhood as well as to shifting social and
cultural norms of what constitutes healthy child development. Our
knowledge of the pathophysiology of many diseases has evolved from
simple causal models based on germ theory to more complex notions
of gene-environment interactions. As pediatric care has triumphed
over many infectious diseases and made significant strides in the
management of chronic disease, newer morbidities have emerged, including
a growing prevalence of developmental, behavioral, and mental health
conditions. To impact child health, 21st-century pediatricians must provide
care with an expanded concept of healthy child development and must
acquire skills to effectively practice in collaboration with other
individuals and entities involved in promoting and supporting that
development.
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Societal expectations for healthy child development are a reflection
of our collective hopes for what our children should achieve and
what challenges they must successfully face in their transition
to adulthood. These expectations are being transformed by an expanded
understanding of what constitutes a healthy child as well as by
a globalized economy that places a higher value on cognitive and
emotional performance in the workplace, especially within developed
nations.
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The 2004 Institute of Medicine’s landmark report, Children’s
Health, The Nation’s Wealth,1 presents
a new definition of child health and three associated, measurable
domains:
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“Children’s health should be defined as the extent
to which individual children or groups of children are able or enabled
to (a) develop and realize their potential, (b) satisfy their needs,
and (c) develop the capacities to allow them to interact successfully
with their biological, physical, and social environments.”
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The domains include health conditions, capturing
the traditional notions of health measured by disorders or illnesses
of body systems; functioning, assessing how health
affects an individual’s daily life; and health
potential, identifying the assets and positive aspects
of health, such as competence, capacity, and developmental potential.
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The new definition and domains help establish the goals of child
health care, which go beyond diagnosing and treating disease and preventing
and managing chronic health conditions. They include promoting the
health capacities of each child and optimizing the health potential
of all children. Underlying this definition and these goals is a
new and more dynamic conceptual model of how health develops; the
model can be represented by a health trajectory that is influenced
by a range of biopsychosocial and environmental risks, as well as
by protective and promoting factors (Fig. 1-1).2
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Pediatricians play an important, collaborative role in influencing ...