The child is father of the man: Paediatricians should be more interested in adult disease

Abstract

-We expect that most pregnancies will bear normal babies, which will grow up into healthy young adults free of the risk of serious disease. We also believe that many common diseases and causes of death in adulthood may be preventable through changes in living conditions, diet and lifestyle.The 20th century saw a massive decline in childhood mortality and morbidity as well as improvements in child health. The relations between environmental influences and genetic endowment in the genesis of disease are ever clearer, and at their 'extremes' susceptible to interventions. The burden of infectious disease has been reduced to 5% of what it was a century ago, and many chromosomal and monogenic diseases can be avoided or their effects ameliorated before or soon after birth.Nevertheless, there is strong evidence that poor environmental conditions are the principal determinants of ill health at all stages of life, and it follows that the optimal time to intervene to correct them is in early life. Moreover, we recognise the principal risk factors for chronic adult disease, and also have the tools to measure genetic susceptibility to them. There is, therefore, hope that as their natural history becomes better defined, they will be increasingly preventable or treatable.The challenge to paediatricians now is to ensure that children are not only born healthy and remain healthy, but also grow up to be healthy adults. When it is increasingly clear that the origins of many adult diseases are in childhood or before, paediatricians should strive to work closely with their colleagues in primary care, public health, clinical genetics, education, government, housing, environmental and social services, toward the common goal of promoting optimum health throughout the fullness and completeness of life.One of the forces that led to the foundation of the Royal College of Paediatrics and Child Health (RCPCH) was the belief that children are different from adults, and that the care of the sick child is based upon principles other than 'scaled down' adult medicine alone. Yet children are destined to become adults, and their health in adulthood has its roots in childhood. While paediatricians are organising themselves into a distinct professional group to promote and defend the interests of children, the links between child and adult health are becoming more apparent, and ways in which the early origins of adult disease can be investigated and modified are within closer reach. Advances in child healthPaediatricians (literally 'child healers') see themselves as doctors who care for sick children. However, they owe their position largely to advances in public health. Until the 20th century, childhood mortality was dominated by acute, usually infectious, disease. At least one in four children died before the age of four, and those that survived often died prematurely from chronic bone, heart, lung or kidney disease. From around 1750 rising standards of living led to better housing and diet; then from 1850 advances in public health great...

Dietary and Social Characteristics of Children with Severe Tooth Decay

“…1 The pattern then continues to the next generation as parents give their children what they themselves ate as children. 4 Poor diet has a number of known adverse health effects including poor dental health, overweight and underweight, and constipation. Children with a diet low in fibre are prone to disordered bowel habit 5 with functional constipation accounting for 3% of paediatric outpatient appointments.…”

Evidence‐based portion sizes for toddlers (aged 1–3 years)

“…Optimising nutrition in early life is critical for health, growth and development. Poor nutrition during the first few years can have short‐ and long‐term adverse affects on physical and mental development, as well as increasing the risk of chronic adult disease (Weaver 2001). For toddlers to be well nourished at this time, parents and carers need easily accessible practical guidance, support and information on appropriate feeding.…”

“…Weights of the midpoint of the ranges were taken as an average intake and a variety of foods in each food group were analysed to give an average nutrient and energy content from each of the five food groups. The number of daily servings from each food group according to that recommended by the paediatric group of the BDA was then combined and the overall average daily energy and nutrient content was shown to meet those recommended for this age group, as specified in the 1991 Report from the COMA panel (DH 1991), with the exception of vitamin D, for which, a dietary supplement is recommended for this age group (NICE 2008).…”

Rapid Growth in Infancy

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