Concepts of Altered Health in Children

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hildren are not miniature adults. Physical and psycho­logical maturation and development strongly influ­ence the type of illnesses children experience and their responses to these illnesses. Although many signs and symptoms are the same in persons of all ages, some diseases and complications are more likely to occur in the child. This chapter provides an overview of the develop­mental stages of childhood and the related health care needs of children. Specific diseases are presented through­out other sections of the book.

At the beginning of the 20th century, a child in the United States had little chance of reaching adulthood: the infant mortality rate was 200 deaths per 1000 live births.¹ Infectious diseases were rampant, and children, with their

immature and inexperienced immune systems and their frequent exposure to other infected children, were espe­cially vulnerable. With the introduction of antimicrobial agents, infectious disease control, and nutritional and tech­nologic advances, infant mortality decreased dramatically. Although infant mortality has declined over past decades, the record low of 6.9 infant deaths per 1000 live births in 2000 placed the United States only 28th in relation to other industrialized nations.²,³ Also of great concern is the difference in mortality rates for white and nonwhite in­fants. Infant death rates among African Americans, Native Americans, Alaska Natives, and Hispanics/Latinos in 2000 were all above the national average of 6.9 deaths per 1000 live births. The greatest disparity exists for African Ameri­cans, whose infant death rate (14.1 per 1000 in 2000) is nearly 2.5 times that of white infants (5.7 per 1000 in 2000). Recent data indicate that the racial disparities be­tween white and African-American infant mortality rates are increasing.¹-⁴

One of the more perplexing causes of infant mortality is the incidence of preterm birth among women of all races and classes. Despite continued, gradual declines in the overall infant mortality rate during the latter part of the 20th century, the incidence of premature births continues as a challenge to reducing the racial disparities as well as the overall incidence. Prematurity and consequent low birth weight is the leading cause of death in African-American infants. For white infants, the leading cause of death is congenital anomalies.¹-³ Sudden infant death syndrome (SIDS) is the third leading cause of overall infant mortality among all races in the United States, accounting for ap­proximately 9% of infant deaths.⁴

Congenital anomalies (birth defects) account for the most infant deaths, causing approximately one in five in­fant deaths overall. Efforts to decrease mortality rates are aimed at improving access to prenatal care and under­standing the underlying causes of neonatal (i.e., infants younger than 28 days of age) mortality, congenital anom­alies, and preterm delivery, which are still poorly under­stood despite continuing research. Many of the major causes of death during the post-neonatal period (i.e., age 28 days to 1 year)—SIDS, death from infectious diseases

(e.g., pneumonia, influenza), and accidents—may be pre­ventable through health promotion efforts such as routine infant care instruction, immunizations, and teaching of parenting skills.