Child and Adolescent Health

Newborn Screening

In the past 50 years, developed nations have successfully implemented population-wide newborn laboratory screening programs that detect conditions such as phenylketonuria, sickle cell disease, and hypothyroidism early enough that treatment can prevent or ameliorate many of the consequences of the disease. Dozens of conditions can now be identified within days of birth using a few drops of blood; the large scale of the programs allows ultimate savings of money and human life for recognition of even very rare metabolic, hormonal, and other disorders.

Growth Surveillance

Monitoring child growth parameters of height, weight, and head circumference allows early warning and intervention in problems such as malnutrition, congenital malformations, chronic infection, and other chronic diseases. Such monitoring can be done easily and with minimal cost; it provides invaluable information to guide further care. Optimal maternal nutrition and prenatal care are foundations for infant growth; prevention of premature birth is one of the most important challenges in health care today. Human milk is the optimal food for newborns.

Poor growth is evaluated based on deviations from the expected growth curve or trajectory. For example, infants with poor weight gain, but normal height and head circumference growth, may not be receiving adequate caloric intake. They may suffer starvation in cases of dire poverty or maternal neglect, or they may not absorb the nutrition that is provided (infectious diarrhea)—this is often called ‘failure to thrive.’ Children with suboptimal weight and height, but relatively normal head circumference, may have had [Page 172]prolonged protein calorie deprivation or a chronic medical condition such as chronic renal failure. In the United States, the incidence of overweight and obesity now exceeds failure to thrive and undernutrition.

Immunizations

Prevention of infectious disease by childhood immunization is one of the triumphs of medical science. Smallpox has been eradicated. Poliomyelitis may be near worldwide eradication. At present, effective immunization against tetanus, diphtheria, pertussis, hepatitis A and B, influenza, measles, mumps, rubella, varicella, hemophilus influenza B, and pneumococcus have reduced or nearly eliminated these conditions in many geographic areas. Newer immunizations against rotavirus, meningococcus, and human papillomavirus have recently begun widespread use. In the near future, other infections will also be targeted. Unfortunately, vaccination programs worldwide are often hindered by political, economic, and cultural barriers as well as practical issues such as requirements for vaccine refrigeration during storage.

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