From Randall Flick, MD, MPH on Mother’s support group
The Value of Children
Today’s PAAD is an important reminder of the challenges faced by women in medicine and in American society. Women in medicine have and continue to struggle to achieve their professional goals whether they are in academic or private practice. I am proud that the SPA has actively addressed many of these challenges through our DEI committee, the work of WELI, early efforts to ensure the availability of lactation facilities and childcare at our meetings and more. A moments glance at the composition of the SPA leadership when compared to the ASA leadership demonstrates that our efforts have been, in part, successful. The work continues…
I wonder if we look more broadly at the challenges outlined in today’s PAAD, we might see a more profound, and disturbing problem nearly unique to American society among Western countries. The problem I am referring to is the low value we place on our children. Specialty care for children is disappearing across the country especially in rural areas, hospital beds for children are likewise disappearing and there is a growing crisis in mental health among adolescents. Children in the U.S. are the group most likely to be poor, least likely (among those under 65 years) to be covered by private insurance and disproportionately likely to be victimized by violence. Sadly, the most common cause of death for children is now firearm related (NEJM 2022).
The value we place on children is reflected by the investment; We the People, make through government. All government (state, local, federal) spending in the U. S. for the elderly is nearly two and one half times that spent on children. Incredibly, the federal government spends seven times as much on the elderly as on children. Compared to EU countries support for pregnant women, parents of new infants and children in the U.S. is abysmal with Norway spending sixty times as much as we do. (See below; NYT 10/21).
Women and their families in medicine struggle with the challenges related to pregnancy, lactation, and child-care. But these struggles are not unique to medicine, this is a burden shared by families across all aspects of American society. We are fortunate, in medicine, to have the resources to provide high quality childcare and education for our children. Others are not so fortunate. Imagine for a moment how the professional lives of our colleagues would be different if we as a nation prioritized the care of pregnant women and the health, welfare, safety, and education of young children. Imagine too, how the lives of all children would be improved.
If we wish for a bright future for our specialty, we must first recognize and address the plight of all children in the U.S. The future rests with them.
Alan Jay Schwartz, MD, MSEd on loss of pediatric beds: Change Requires Dogged Years of Persistence
In the October 17, 2023 PAAD, "The loss of pediatric beds and expertise in community hospitals", Yaster, Heitmeier, and Deshpande point out the need for pediatric medical expertise in settings where sick children may receive care.
This is nothing new under the sun. In 2001, McGillivray, Nijssen-Jordan, Kramer, Yang, and Platt published,
"Critical Pediatric Equipment Availability in Canadian Hospital Emergency Departments" in ANNALS OF EMERGENCY MEDICINE 37:371-374.
These Authors summarized their assessment of the availability of pediatric resuscitation equipment items in Canadian hospital EDs to identify risk factors for the unavailability of these items. The Authors concluded that their "...study has demonstrated that essential pediatric resuscitation equipment is unavailable in a disturbingly high number of EDs across Canada.”
To address the need for focused care of pediatric patients, the American College of Emergency Physicians and the American Academy of Pediatrics crafted
"Care of children in the emergency department: guidelines for preparedness". (Ann Emerg Med. April 2001; 37:423-427)
Gausche-Hill and Wiebe in their accompanying Editorial,
"Guidelines for preparedness of emergency departments that care for children: a call to action". (Ann Emerg Med. April 2001; 37:389-391)
answered 2 key questions that are still quite relevant today.
1. Why is there a need for this policy statement? More than 20 years have passed. Have the recommended changes been implemented. Perhaps not! The October 17, 2023 PAAD emphasizes that specifically specialized pediatric care is not always readily available.
Whyte LE and Evans M: Children Are Dying in Ill-Prepared Emergency Rooms Across America. Hospitals and regulators have done little to ensure E.R.s are ready to treat children in emergencies, while researchers prove taking basic steps can save lives.
2. Who should implement this policy statement? Everyone caring for pediatric patients can answer this question. We all need to assure the implementation of the highest standard of pediatric care. Consider visiting you own hospital's emergency room. Comb the facility. Look for the essential ingredients for "best" pediatric care. See if in 2023, your facility is up to snuff.