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Children With Special Health Care Needs and Changing Policy

  • James M. Perrin
    Correspondence
    Address correspondence to James M. Perrin, MD, MGH Center for Child and Adolescent Health Policy, 50 Staniford Street, # 901, Boston Massachusetts 02114.
    Affiliations
    Harvard Medical School, Boston Mass; and Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, Mass
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Published:February 08, 2011DOI:https://doi.org/10.1016/j.acap.2010.08.010
      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.
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      1. The Patient Protection and Affordable Care Act, 42 USC, Public Law 111–148(2010). Available at: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590enr.txt.pdf. Accessed September 27, 2010.