Winston-Salem, U.S.A. – With nearly one-third of American children being overweight or obese, doctors agree that there is an acute need for more effective treatments. In many weight management programs, the dropout rate can be as high as 73%, and even in successful programs, the benefits are usually short term.

Although family-based approaches to pediatric obesity are considered the gold standard of treatment, theories of the family and how it functions have not been incorporated into effective interventions, according to a study published in the May issue of the International Journal of Obesity by researchers at Wake Forest Baptist Medical Center.

“The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment,” said Joseph Skelton, M.D., assistant professor of pediatrics and director of the Brenner FIT (Families in Training) Program at Wake Forest Baptist, and lead author of the study.

Skelton and his research team reviewed medical literature published between 1990 and 2011 to identify the use of prominent family theories in pediatric obesity research. Of the 76 manuscripts found, 13 were selected for the study.

Wake Forest Baptist researchers found limited use of family theories in the study of pediatric obesity, particularly in weight management treatments. Family behavioral theories can provide valuable insight into the complexities of families, and increased use of these theories in both research and practice may help in the development of more effective treatments for childhood obesity, the study found.

“Traditionally doctors looked at the patient as the one in the family to focus on, but now we have to look at the entire family as the patient,” Skelton said.

“One of the problems we found was that there wasn’t even a clear definition of family in the literature. A two-parent household with a stay-at-home mother and working father is no longer the norm. Inability to define the family makes it difficult to apply a straightforward model of family function to child health and weight management.”

In the clinic setting, families are often represented by a child and a parent, typically the mother. However, this often does not accurately reflect family complexity and it doesn’t define which family members should be included in treatment, Skelton said.

A common theme in the field of family studies is that families are a system, made up of interdependent units. Intervening with one unit, such as a mother and a child, will influence other units. These interpersonal relationships influence the health behaviors of the child and the family as a whole, according to the study.

“The challenge is to find ways to incorporate the entire family in the process, while allowing for different schedules and different age kids with different health needs,” Skelton said. “If we don’t find more effective treatments and this epidemic continues, these children will likely go on to become obese adults, resulting in an entire generation with lower life expectancies than their parents’ generation.”

Skelton and his team at Brenner FIT have begun incorporating theories of the family into their research and in their treatment approach, and are finding ways to engage more members of the family in treatment.

Funding for the study was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Duke Endowment and the Kate B. Reynolds Charitable Foundation.

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The total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse and neglect) is approximately $124 billion, according to a report released by the Centers for Disease Control and Prevention, published in Child Abuse and Neglect, The International Journal.

This study looked at confirmed child maltreatment cases, 1,740 fatal and 579,000 non-fatal, for a 12-month period. The lifetime cost for each victim of child maltreatment who lived was $210,012, which is comparable to other costly health conditions, such as stroke with a lifetime cost per person estimated at$159,846 or type 2 diabetes, which is estimated between $181,000 and $253,000.  The costs of each death due to child maltreatment are even higher.

“No child should ever be the victim of abuse or neglect – nor do they have to be.  The human and financial costs can be prevented through prevention of child maltreatment,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC′s National Center for Injury Prevention and Control.

Child maltreatment has been shown to have many negative effects on survivors, including poorer health, social and emotional difficulties, and decreased economic productivity.  This CDC study found these negative effects over a survivor’s lifetime generate many costs that impact the nation’s health care, education, criminal justice and welfare systems.

Key findings:

• The estimated average lifetime cost per victim of nonfatal child maltreatment includes:
• $32,648 in childhood health care costs
• $10,530 in adult medical costs
• $144,360 in productivity losses
• $7,728 in child welfare costs
• $6,747 in criminal justice costs
• $7,999 in special education costs
• The estimated average lifetime cost per death includes:
• $14,100 in medical costs
• $1,258,800 in productivity losses

Child maltreatment can also be linked to many emotional, behavioral, and physical health problems. Associated emotional and behavioral problems include aggression, conduct disorder, delinquency, antisocial behavior, substance abuse, intimate partner violence, teenage pregnancy, anxiety, depression, and suicide.

Past research suggests that child maltreatment is a complicated problem, and so its solutions cannot be simple. An individual parent or caregiver’s behavior is influenced by a range inter-related factors such as how they were raised, their parenting skills, the level of stress in their life, and the living conditions in their community.  Because of this complexity, it is critical to invest in effective strategies that touch on all sectors of society.

“Federal, state, and local public health agencies as well as policymakers must advance the awareness of the lifetime economic impact of child maltreatment and take immediate action with the same momentum and intensity dedicated to other high profile public health problems –in order to save lives, protect the public’s health, and save money,” said Dr. Degutis.

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Because of care advances, more infants and children with previously lethal health problems are surviving. Many, however, are left with lifelong neurologic impairment.

A Children’s Hospital Boston study of more than 25 million pediatric hospitalizations in the U.S. now shows that neurologically impaired children, though still a relatively small part of the overall population, account for increasing hospital resources, particularly within children’s hospitals.

Their analysis, based on data from the Agency for Healthcare Research and Quality Kids’ Inpatient Database, was published online January 17 in PLoS Medicine. The researchers analyzed KID data from 1997, 2000, 2003, and 2006, encompassing 25.7 million hospitalizations of children age 0 to 18. Of these, 1.3 million hospitalizations were for children with neurologic conditions, primarily cerebral palsy and epilepsy.

During the 10-year period, children with neurologic diagnoses were admitted more to children’s hospitals and less to community hospitals. At non-children’s hospitals, they made up a falling share of admissions (from 3 percent in 1997 to 2.5 percent in 2006); at children’s hospitals, they made up a rising share (from 11.7 percent of admissions in 1997 to 13.5 percent in 2006).

Within children’s hospitals, neurologically impaired children accounted for an increasing proportion of resources: In 2006, they accounted for 25 percent of all bed days (up from 21.8 percent in 1997) and 29 percent of hospital charges ($12 billion, up from 27 percent in 1997).

“Our findings suggest that children’s and non-children’s hospitals are caring for increasingly different populations of children,” says first author, Jay Berry, MD, MPH, an attending physician in the Complex Care Service at Children’s Hospital Boston.  “Children with neurologic impairment tend to require expensive, lengthy hospitalizations. As policymakers increasingly focus on healthcare costs, we must be careful to not jeopardize the care these children receive as health reforms are considered.”

The researchers note that improved care delivery and coordination could lead to reduced hospital utilization and better patient outcomes. Children with severe neurologic conditions commonly have additional health problems, such as respiratory and feeding problems, that make their care needs more complex. Yet studies indicate that pediatric providers often feel unprepared to assess and treat them.

The result, the researchers write, is uncoordinated, crisis-driven care that can lead to a disproportionate share of emergency care and frequent re-hospitalizations that drive up costs. “We’re nervous that many children with neurologic impairment are without a healthcare provider who is taking charge of their care and making sure that all of their healthcare needs are adequately addressed,” says Berry.

In the study, inpatient utilization increased most markedly among neurologically impaired adolescents. Across all hospitals, this group of children had a 28 percent increase in hospitalizations from 1997 to 2006, while children of the same age without neurologic diagnoses had an 8.4 percent decrease in hospitalizations.

“Children with severe neurologic impairment tend to have more health problems as they reach adolescence and young adulthood,” says Berry. “This coincides with a difficult period where they begin to outgrow their pediatric providers, but have trouble transferring their care to adult providers.”

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Ending the federal budgeting process recently, Congress dealt a devastating blow to the fight against childhood lead poisoning. The Omnibus Appropriations Bill cut funding for the CDC’s Healthy Homes Lead Poisoning Prevention Program to $2 million—a 94% reduction from FY11.

Lead poisoning still remains a significant environmental public health threat that affects over 30 million homes and nearly a half-million children annually. Today, parents of lead poisoned children can rely on their state or local health departments for help. A nurse or trained professional will come to their house and find the source of lead poisoning.

The program may connect parents to resources to remove hazards and can compel rental property owners to fix hazards. The program also prevents the disease through policies, community education, and outreach. ”Congress gave our children a lump of lead this holiday season,” said Rebecca Morley, Executive Director of the National Center for Healthy Housing.

“Studies show that educating a child with lead poisoning costs an extra $38,000. If even half of the children with lead poisoning incur these costs, that’s a $10 billion price tag,” continued Morley. “The cost of eliminating this program is staggering.”

The decision will result in the near-elimination of the program and massive job loss at the state and local levels. The move follows an advisory committee’s recommendation to CDC to lower the threshold for when a child is considered to have enough lead in his or her blood that follow-up action is needed. This change in the “action level” will more than double the caseload of poisoned kids that need the health department’s help.

“The burden on the most vulnerable families just got heavier. Too many children with lead poisoning already go undiagnosed. Without this program, we will return to the era of children being hospitalized for lead. Why is Congress treating our children like canaries in a coal mine?” said Liz Colon, parent and organizer for the Childhood Lead Action Project in Rhode Island.

The impact of these proposed cuts will also fall directly on the backs of low-income families and communities of color that are disproportionately impacted by environmental health hazards. Nationally, African American children are three times more likely to suffer from lead poisoning.

In some locales, African American and Latino children are eight to nine times more likely to enter school with a history of lead poisoning. Children poisoned by lead are seven times more likely to drop out of school and six times more likely to end up in the juvenile justice system.

“Lead poisoning is preventable. We are taking a huge step back in protecting our children’s health, safety, and future by eliminating the resources communities need to prevent and address lead exposures,” said Nsedu Witherspoon, Executive Director of the Children’s Environmental Health Network.

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