Chronic Conditions Not Necessarily Chronic for Children, Study Shows

The term “chronic condition”—by definition—implies a permanent problem.

But dictionaries may need to change the definition of that catchall medical term, according to a study that appeared in the February 17 edition of the Journal of the American Medical Association.

Chronic conditions such as obesity, asthma, diabetes or attention-deficit hyperactivity disorder tend to be permanent among adults but are not necessarily so in children, according to the study. It was funded in part by the Investigator Awards in Health Policy Research program, which is supported by the Robert Wood Johnson Foundation (RWJF) and provides health researchers with up to $335,000 to investigate innovative solutions to health problems and policy issues.

“The number of children with chronic conditions is on the rise, but some children and adolescents get rid of chronic diseases,” said James Perrin, M.D., one of the study’s co-authors. “These findings present a strong opportunity to institute preventative programs to keep kids from getting these conditions and also to find ways to help children get rid of those conditions, where possible.”

Perrin, a professor of pediatrics at Harvard Medical School and director of the Division of General Pediatrics and the Center for Child and Adolescent Health Policy at the MassGeneral Hospital for Children, co-authored the report with lead author Jeanne Van Cleave, M.D., a pediatrician, researcher and instructor in pediatrics at Harvard Medical School and the MassGeneral Hospital for Children, and Steven Gortmaker, Ph.D., a professor of health sociology at Harvard School of Public Health.

Perrin and Gortmaker received the Investigator Award in Health Policy Research in 1997. This new study results from their collaboration as Investigator Award winners.

Children’s Health Programs Should Focus on Prevention, Recovery, Study Suggests

Their findings have significant implications for government programs that provide health care and income support for children such as the Social Security Administration, the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Maternal and Child Health Bureau, Perrin said.

These programs, he added, should put a greater emphasis on prevention and intervention rather than continuity of care for children with so-called chronic conditions. That will help more children recover from chronic conditions and grow up to be healthier, more successful adults.

“Many public programs have an unspoken motto: Once disabled, always disabled,” Perrin said. “But that motto just doesn’t apply to kids.”

Researchers followed more than 5,000 children with chronic conditions for periods of six years at various intervals between 1988 and 2000.

The longitudinal approach marked a departure from previous reports that studied children with chronic conditions for shorter periods of time. Researchers found that fewer than half of children who reported chronic conditions experienced the same conditions by the end of study period, suggesting that prevention programs and health interventions among children have the potential for great success and enormous cost savings to society.

Overall, the study found that about half of children will have a chronic health condition at some point during their childhood, indicating that the number of children with obesity and other chronic conditions is on the rise. The increase can be explained in part by increasing maternal age of parents of children studied in later cohorts. Likely more important explanations include food choices, less physical activity, increased media use and changing adult supervision of young people.

Even though many children outgrow chronic conditions, the growing number of children with chronic conditions will still take a tremendous toll on society, Perrin said. “We are going to have huge numbers of young adults with major disabilities in the next decade,” Perrin said. “These conditions will affect people’s ability to get a job, enjoy interpersonal relationships and live independently. Frankly, we as a society are not prepared for that.”