Chronic Health Conditions

Chronic Health Conditions in Childhood

A chronic condition is an umbrella term that refers to a health problem that lasts over three months, affects normal activities, and requires ongoing health care to manage. About 15–18% of U.S. children are affected.
Children with chronic conditions may not appear ill, but they do have special needs. The most common chronic conditions are:

• Allergies
• Asthma
• Cerebral palsy
• Childhood cancer
• Congenital heart problems
• Cystic fibrosis
• Diabetes
• Epilepsy
• HIV/AIDS
• Sickle cell anemia
• Spina bifida

Asthma, the most common childhood chronic illness, is caused by the constriction of the airway, resulting in difficulty with breathing. This inflammation and increased mucus production compromises the ability to carry air in and out of the lungs

• A variety of things can trigger an asthma attack, including allergies, stress, exertion, air pollution, and viruses. Colds are the most common cause of attacks for both children and adults.
• An attack is usually characterized by shortness of breath, wheezing, and coughing. Symptoms can range from slight to life-threatening.
• Bronchodilators (inhalers), which relieve airway constriction, are often used along with other drugs to manage the disease. Drugs, along with environmental precautions, can usually be used to manage this incurable condition.
• Rates have been increasing for decades, but now 10% of all children have asthma (National Center for Environmental Health, 2011). 
•  Poor, urban and non-white children are most at risk, because of exposure to air pollution, stress, secondhand smoke, and inadequate health care (Federio & Liu, 2003).
• Researchers don’t really know the cause of asthma—only that it results from a complicated interplay between genetic predisposition and environmental influences.

Allergies are overreactions to a substance (allergen) from a hypersensitive immune system. Allergens, which are commonly foods, dust, dander, molds, or pollen, cause no response in non-allergic people. Risk factors include early exposure to allergens, genetic predisposition, and industrialization.

Food allergies

• Food allergies have become increasingly common, with an estimated 6–8% of children and 4% of adults affected. The most common food triggers for children are milk, eggs, peanuts, tree nuts, soy, and wheat. These, along with seafood, are the allergens for 90% of U.S. food allergy sufferers (AAP, 2013).
• Symptoms first affect the lips, mouth, throat, and digestive tract. Later skin rashes and other bodily immune reactions may occur.
• Anaphylaxis, a severe and life-threatening allergic reaction, must be treated immediately. This shock can be triggered by food allergies (especially fish, nuts, and eggs), as well as by medications and insect stings. This is rare but more severe in younger children. Many who are at risk carry an EpiPen, prescribed by their doctor.
• Recent studies have shown hope for peanut allergy sufferers: Early exposure to peanuts actually lowers the chance for developing the allergy (doctors used to claim the opposite). New guidelines have been released by the National Institute of Allergy and Infectious Diseases (Togias et al., 2017)

In the U.S., approximately 3% of children and 2 million people total are allergic to bee stings (Children’s Hospital Boston, 2005). Anaphylactic shock occurs in only 1% of bee stings and rarely happens to children because of their limited exposure (the more stings, the more severe the reaction).

Diabetes is a group of metabolic disorders where sugars cannot be properly used by the body.
Type 1 diabetes (T1D) I or Juvenile Diabetes is an autoimmune disease where the pancreas doesn’t make insulin, the hormone that controls blood-sugar levels. So, glucose builds up in the bloodstream, where it can cause life-threatening complications.

• T1D can affect children or adults.
• Typically, it has very quick onset (symptoms include increased thirst and hunger, frequent urination, etc.).
• T1D must be managed with the use of insulin—either via injection or insulin pump. 
• T1D is the leading cause of diabetes in children and teenagers.

Type 2 diabetes (T2D) is more common in adults and develops over time when the body becomes unable to respond to the insulin made by the pancreas. Fewer than 4% of children have this type (Scott, 2013).

Cerebral palsy (CP) refers to is a brain-based chronic condition that affects movement and body coordination. Most CP develops as a result of brain injury during the prenatal period (70%, according to United Cerebral Palsy, 2007) or within 3 years of birth.

• Risk factors include prematurity, low birth weight, teratogen exposure, and lack of oxygen during birth.
• Impairment varies from severe to mild.
• There is no cure, but early intervention can help children learn to control their bodies and communicate.

Sickle cell anemia is an inherited form of anemia—a condition where a lack of healthy red blood cells leads to inadequate oxygen through the body. Instead of round red blood cells, the cells become misshapen into rigid sickles or crescents, so they become stuck in small blood vessels, which slows or blocks blood flow and oxygen. In the United States, it is most common among African-Americans, and both parents must be carriers of the sickle cell gene.

Cystic Fibrosis (CF) is an inherited disease characterized by an abnormality in the body's salt, water- and mucus-making cells. It is a chronic and progressive disease and results in thickened mucus that may affect the organs and more. There is now a longer life expectancy because of improved treatments, so most people with CF live into their late thirties or longer. 

Childhood Cancer has been increasing for many years, but mortality has decreased (U.S. Environmental Protection Agency, 2011). 

• Most common childhood types are leukemia (about 30%) and brain and central nervous system cancers (26%) (American Cancer Society, 2016).
• The highest incidence of these two occurs between ages 1 and 4 years.
• 80% of children with cancer survive 5 or more years because of treatment advances in recent decades (ACS, 2016).
• Causes are still not fully understood, but evidence points to environmental toxin exposure as a reason for the increase (US EPA, 2013).

Human Immunodeficiency Virus (HIV) can cause Acquired Immunodeficiency Syndrome (AIDS) in children when it is transmitted during pregnancy, birth, or breastfeeding. Sexual contact or other exposure to bodily fluids can also pass the virus.

• Without treatment, HIV continues to replicate itself within the body, eventually leading to severe immunodeficiency, chronic illness, and death.
• In 2016, approximately 2.1 million people infected with HIV are children under 15 years of age. New HIV infections among children declined by 47% between 2010 to 2016. But 400 children are newly infected with HIV every day (UNAIDS, World AIDS Day Factsheet, 2017).
• Although there is no cure, early diagnosis is critical since ART should be given as soon as possible to help children living with HIV lead longer, healthier lives.  

Epilepsy is a neurological disorder of the CNS where brain activity is abnormal, causing seizures or periods of unusual behavior, sensations, and/or loss of awareness.

• Seizure symptoms can vary from mild (simply staring) to severe, where the arms and legs twitch or spasm repeatedly. 
• A single seizure can be caused by many things, so a diagnosis of epilepsy requires at least two unprovoked seizures.
• Medication treatment or surgery can control seizures for most. Some will need long- term seizure controlling treatment, whereas others will outgrow epilepsy with age.

Spina bifida is a type of neural tube defect where the spine doesn’t close all the way by birth. It can occur anywhere on the spine when the backbone doesn’t close to protect the spinal column, resulting in damage to the spinal cord and nerves. How disabled a child is depends on the size and placement of the spinal opening and what nerves are affected.