Children With Special Health Care Needs and Changing Policy

  • James M. Perrin
    Address correspondence to James M. Perrin, MD, MGH Center for Child and Adolescent Health Policy, 50 Staniford Street, # 901, Boston Massachusetts 02114.
    Harvard Medical School, Boston Mass; and Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, Mass
    Search for articles by this author
Published:February 08, 2011DOI:
      The growth of chronic health conditions and special needs among children has been dramatic over the past few decades. Where parents reported fewer than 2% of children in the 1960s as having a chronic health condition that interfered on a regular basis with daily activities, this number had risen to almost 8% by the late 1990s. Some growth reflects real improvement in medical and surgical care, with better survival of many children (eg, with leukemia, cystic fibrosis, and congenital heart disease) who would have died in childhood in earlier years. Much change over the decades, however, reflects major growth in rates of common conditions that have little mortality but cause great morbidity: obesity, asthma, and mental health conditions. Over 11 million children and youth are obese today (at least 1 in 7), over 5 million have asthma, and large numbers have attention-deficit/hyperactivity disorder, autism spectrum disorders, and depression. These rates contrast with relatively stable numbers among less common conditions, such as 60 000 with spina bifida, 37 500 with sickle cell disease, 22 500 with cystic fibrosis, or 7500 with hemophilia.
      • Perrin J.M.
      • Bloom S.R.
      • Gortmaker S.L.
      The increase of childhood chronic conditions in the United States.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Perrin J.M.
        • Bloom S.R.
        • Gortmaker S.L.
        The increase of childhood chronic conditions in the United States.
        JAMA. 2007; 297: 2755-2759
        • Mathers M.
        • Canterford L.
        • Olds T.
        • et al.
        Electronic media use and adolescent health and well-being: cross-sectional community study.
        Acad Pediatr. 2009; 9: 307-314
        • Oreskovic N.M.
        • Kuhlthau K.A.
        • Romm D.
        • Perrin J.M.
        Built environment and weight disparities among children in high and low income towns.
        Acad Pediatr. 2009; 9: 315-321
        • Institute of Medicine (IOM)
        The Future of Disability in America.
        The National Academies Press, Washington, DC2007
        • Guyer B.
        • Ma S.
        • Grason H.
        • et al.
        Early childhood health promotion and its life course consequences.
        Acad Pediatr. 2009; 9: 142-149
        • Stille C.
        • Turchi R.M.
        • Antonelli R.
        • et al.
        • for the Academic Pediatric Association Task Force on the Family-Centered Medical Home
        The family-centered medical home: specific considerations for child health research and policy.
        Acad Pediatr. 2010; 10: 211-217
        • Homer C.J.
        • Klatka K.
        • Romm D.
        • et al.
        A review of the evidence for the medical home for children with special health care needs.
        Pediatrics. 2008; 122: e922-e937
      1. The Patient Protection and Affordable Care Act, 42 USC, Public Law 111–148(2010). Available at: Accessed September 27, 2010.