In the latest issue of the New England Journal of Medicine, researchers from Harvard and Harvard Medical School report that, even when the age of childbearing is still very much a work in progress, children with a history of poor health have a better chance of attending their doctor’s appointments when they are younger than adults.
The researchers, led by Dr. Robert C. Wittenmyer, PhD, analyzed data from the National Health Interview Survey and the National Center for Health Statistics.
The survey, which began in 1997, has tracked children’s health for more than 3.2 million people aged 1 to 59 for more 10 years.
Their analysis found that children with an average of 1.6 missed days of school each year had a lower chance of going to a doctor’s appointment with a doctor than those who went to school every day.
Their study also found that the odds of getting a doctor appointment increased by about a quarter for children with mild-to-moderate-to severe asthma and by about half for children who had an average age of 11 or more.
The authors of the study caution that this is just one study and that more research is needed.
The study does not prove causation, Wittenmayer says, but it does provide some evidence that a child who has a history the child is at increased risk of health problems.
“This does suggest a very real, important role for pediatricians and pediatric nurses in making sure their patients have the health and physical environment to make the most of their lives,” he says.
“If the children are healthy, they will be healthy.
If they are unhealthy, they are going to be unhealthy.”
A study from the same group published in the same journal also found a stronger relationship between asthma and children who were younger than age 10.
However, both studies used the same questionnaire and used similar measures of asthma, so they could not be used to extrapolate to other age groups.
Children who had a history are more likely to have asthma if they have it more frequently, and that risk is greater for children younger than 10, says lead author Dr. Daniel A. Katz, PhD. The link between childhood asthma and later asthma risk is more than just a relationship with older age, Katz says.
Children in families with asthma have a much higher risk of asthma in adulthood.
Children with asthma are also more likely than those without to get bronchitis or bronchiolitis.
The studies were conducted in a small sample of children aged 1 through 19 years old, but Katz says more work is needed to determine whether there is any connection between asthma in early life and subsequent asthma later in life.
Children aged 1 year and older have a 50% higher risk than children aged 10 years and younger of developing asthma, he says, and children in families who have asthma are more than twice as likely as children in non-affluent families to have it in adulthood, according to the study.
Katz says there are several reasons why this might be so.
Children tend to be more vulnerable to developing asthma in the first place.
Children are more susceptible to early symptoms of asthma if their parents are more sensitive to asthma, or if they are exposed to the symptoms early in life, he notes.
This is because the immune system is more sensitive and develops early, and the immune response can start at an earlier age.
The children in the study were older and had fewer asthma symptoms at ages 4 to 9 years, when their parents were more sensitive.
Children also tended to have lower levels of lung function tests, such as C-reactive protein, as well as fewer asthma-related tests at ages 10 to 12 years, Katz notes.
Children may also have a stronger immune system than older children.
Children have fewer receptors in their lungs that are able to respond to chemicals that are released by the immune cells in their bodies, such that a stronger response is generated, says Katz.
The stronger the response, the more likely the immune reaction is to produce a stronger reaction.
“So if the children have the immune systems that are stronger and are responding more readily to these chemicals, they might be more likely in later life to develop asthma,” he notes, “so it could be a protective mechanism.”
The study authors also found there was a link between children who have been diagnosed with asthma and less well-being.
In this case, children who experienced symptoms of chronic bronchitic inflammation were more likely not to attend school as adults.
However a strong immune response to a disease or an inflammatory condition in early childhood may have other protective effects that can persist even into adulthood.
The next step is to look at how children who are diagnosed with chronic bronachitis and who have had more severe asthma episodes have fared compared with those who are not.
For example, the study authors suggest this may be one of the most important questions to answer: How much better do children in these families fare?
Katz says further research is warranted