Author: Judy Palfrey

Judy Palfrey, MD, FAAP, has been a pediatrician at Children’s Hospital Boston since 1974. She is a general pediatrician and child advocate. She was chief of Children’s General Pediatrics Division from 1986 to 2008 and currently directs the Children’s International Pediatric Center.

Dr. Palfrey is the new president of the American Academy of Pediatrics (AAP), which is the nation’s largest pediatric organization, with a membership of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists.

A week or so ago, I heard the story of a mother who was incredibly grateful to her pediatrician. She described her fairly typical family: 2 full-time working parents with 2 children.

Each day, she said, was crammed with rushing here and there with work and school commitments and little time at the end of the day for meal preparation. She described how with all the 21^st century pressures, she and her husband were relying increasingly on pizza deliveries and drive-through hamburger stores for their family dinner.

When her pediatrician sat down and alerted her that her little girls’ BMI measurements were creeping up, she put into place several small adjustments: decreasing the size of meal portions, adding fruits and vegetables to meals and snacks, putting water instead of juice in their lunches and watching TV only on the weekends. She said that these changes were really very easy to do.

The next time, this mother brought her children to the pediatrician, he was delighted. The BMI measurements had fallen back to where they were before he had raised the concern. In a family-centered way, he told her how great this was. He wanted her to let him know what she did so he could share the ideas with other families.

The fact that this fairly typical mother is now the nation’s First Lady, Michelle Obama, is a wonderful twist of events. As a public figure, she has studied the current public health data and is alarmed by what is happening to our children and our nation.

She sees that 20-30 percent of children are overweight or obese. She sees the toll that overweight and obesity are taking on adults with the high rates of diabetes, hypertension, heart disease and cancer.

She is taking her public role seriously and doing everything in her power to harness the strengths in our nation to attack the obesity problem. She is calling on business, government, health care and all citizens to tackle this because the causes are rooted in all aspects of our 21^st century lives.

Perhaps as fortunate for us all is that Michelle Obama is also the First Mom. She understands the constraints that everyday families face when they try to live healthy, active lifestyles.

She knows that children often don’t have the choice to run and jump and play. She knows that it is hard to find fresh fruits and vegetables and to keep them handy for lunch and snacks. She knows that we are all bombarded with too much food, too many commercials, too much to do….to much busy-ness.

For the first time in our history, many of our child health problems are coming not from want, but from excess. Modern parenting is finding that delicate balance between too little activity and too much, too little food and too much, too little exposure to the realities of the outside world and too much bombardment with the news and the facts of the day.

Over the coming weeks and months, the First Lady will be leading a major initiative to combat childhood obesity. I had the honor to be on a panel with her and she graciously said, “You in pediatrics have been working on this for a long time.” This is absolutely true.

At Children’s we have been working hard to call attention to these problems and to develop solutions for them. The weeks and months ahead will be truly exciting as our pediatric efforts are bolstered and reinforced by the First Lady and all the partners she will bring to bear to improve the lives of children and families.

Learn more about the First Lady’s initiative – Let’s Move!

Read what Children’s David Ludwig, MD,PhD, thinks about the First Lady’s initiative in this New York Times article.

Children’s Judith Palfrey, MD, FAAP, president of the American Academy of Pediatrics writes about the most urgent children’s health stories that were neglected by the media last year:

This past year, the newspapers and blogs were full of stories about H1N1, obesity, autism and health care reform. These are all important and newsworthy topics, but there are other stories that are perhaps less flashy, but nonetheless have worth on their own merit.

As far as I am concerned, one of the biggest of these is the story of our adolescents and young adults with chronic conditions and disabilities. Quietly and without fanfare, as a result of the great innovations of medicine and surgery, the numbers of adolescents and young adults with significant health problems has been rising in the United States. Young people with cardiac disease, cystic fibrosis, sickle cell anemia, Down Syndrome, congenital anomalies, HIV and neurodisabilities are living longer and fuller lives than youngsters with these conditions ever did in the past. That’s the good news and certainly a big part of the story.

But the bad part, the part of the story filled with complexity, drama and nuance, is the fact that society has not woken up to recognize the change that has occurred. As a result, there are challenges all around for these young people and their families. There aren’t enough programs to help young people with chronic illness and disability finish high school, prepare for college and careers. There are too few physicians and nurses trained to deal with their unique needs. And, when there are services and programs, they are in limited supply.

Young people from traditionally under-served communities experience the double whammy of having a disability and then having nowhere to turn for health care, mental health services, vocational and career planning and recreation. There are major disparities in health care and health outcomes for young people with chronic conditions. Two striking examples are that black boys with asthma have four times the mortality rate as white boys and that whites with Down Syndrome live on average twice as long as blacks (age 50 versus age 28).

Over the past three and a half years, my colleagues at the Institute on Community Inclusion and I have been working on a large project entitled Opening Doors for Children and Youth with Disabilities and Chronic Health Conditions. We’re partnering with community based organizations in Boston to learn how to improve access to community services for children with disabilities from under-served communities.

Opening Doors has three embedded research projects. Project Solutions is a study of early screening for disabilities. For a long time, we’ve been aware that many children from minority and poverty communities have later identification of their disabilities….by as much as a year or two.  This puts these children at a huge disadvantage since they are late getting started with the health and developmental interventions that we know can be so meaningful. Project Solutions has already been able to document that we can integrate early screening into primary care practice for our patients who face many financial, cultural and linguistic challenges. We’re currently designing a multi-lingual brochure to encourage parents to seek help if they are concerned that their child is very ‘different’ from other children. This brochure has now been translated into five languages.

Project Adventure pairs students 8 to 12 years old who have disabilities and/or chronic illness with a mentor who goes with them on a weekly basis to the YMCA to participate in inclusionary recreation. This program has multiple goals, including enhancing the disability services at local area Ys, improving awareness of the developmental benefits of regular exercise, and establishing a corps of community mentors with the hope that some of these mentors will choose a career in working with children with disabilities. If you are interested in learning more about Project Adventure please contact [email protected].

Opt4College is our research project geared most directly to transition-age students from traditionally under-served communities. We’re studying whether a computer-based training program can engage youth with disabilities and chronic illnesses from traditionally under-served communities and provide them with the knowledge and skills they need to apply to and enter college. We’ve recruited many students from the Boston public schools for the program and are eager to involve students who attend Children’s clinics. Anyone interested in learning more about Opt4College should contact [email protected].