Redefining pediatric care: Improving the critical early years of life

To steer away from the traditional conveyor belt of medicine in children’s early years, modern insights into gut microbiota enable precision medicine.

Some of the world’s most intellectually curious minds, from Aristotle to John Locke to Sigmund Freud, have contemplated the theory of tabula rasa – the idea that every human being is born a “blank slate,” that all the ways in which we think and behave are influenced by our experiences as we age. This has been somewhat debunked by modern genetic and neurobiology research.

We’ve also come to learn that the real tabula rasa is not so much the minds of our children. Rather, it’s their guts.

The trillions of microorganisms that make up our gut microbiota – all of the bacterial cells that affect key bodily functions and influence our overall health – begin to develop as early as the womb. From the moment we leave the birth canal, when our gut microbiota is exposed to new foods, bacteria and environments, its composition begins to diversify. That composition, recent studies have reported, plays a role in everything from brain development, metabolic pathways and immune function to the manifestation of chronic disease.

By age three, our unique gut microbiome has taken shape. It’s a short window of time to influence long-term health and wellness, and most parents – and importantly, their pediatricians – are not equipped to take advantage of it.

Science and medicine have made incredible advancements over the past century, especially in preventing communicable diseases, and developing cures and treatments. These are all innovations that continue to drastically reduce the mortality rate among children. That doesn’t mean our children are living healthier lives. Rather, they’re getting sicker.

Conditions like childhood obesity, asthma and behavioral health disorders are on the rise. Children today have more food allergies, more diagnosed developmental disabilities and more autoimmune diseases than those of generations past, and it's not getting any better. Epipens and menu diversity have become must-haves at childrens’ birthday parties.

We can do so much more for our kids. Modern science and medicine have already provided us with the information we need to help them prevent disease and live longer, healthier lives – nutrition and environment being chief among them. However, very little of this knowledge is applied to the practice of pediatric medicine.

In fact, as researchers noted in a 2020 study on child development, the basic structure of the specialty has “remained largely unchanged” since the 1960s.

The conveyor belt of care

The practice of medicine is supposed to evolve in tandem with the latest medical research, and for the most part, it does. Medicine is a science, after all; inherently, it’s in a constant state of change.

For years, the standard treatment for most cancers was a combination of surgery, chemotherapy and radiation. Despite the fact that no two cancer patients experience the disease in exactly the same ways, medicine took a “one-size-fits-all” approach. Today, oncology has become much less invasive, much more personalized and far more effective with the introduction of advanced precision technologies and genetic research. As a result, now no two cancer patients receive the same exact treatment.

Pediatric care exists on the other side of the spectrum. It’s a conveyor belt of care, where every child receives uniform treatment, and it begins before birth. Every pregnant mother, for example, is given a pamphlet that tells them what to expect when their child reaches every new month of their life. When the baby is born, they’ll see the pediatrician more often in the first two years than they will in the next 16. They’ll get their measurements and their shots, completing the checklist of first year care, and they’ll go home.

There is no analysis of nutrition, of their environment, or of any of the social or economic factors that influence the health of children. And because there is no regimented discussion or assessment of these determinants, there is no opportunity for intervention. Unless a child is failing to thrive, there is no deviation from the routine. If there is an issue, the case will be referred to a specialist.

This isn’t a problem created by the local pediatrician, nor is it a problem they’ve exacerbated intentionally. Pediatricians are bound into a systemic tangle that prevents them from implementing anything novel into the way they practice. The healthcare system is not set up to incentivize the dynamic, personalized care children require.

The government’s social safety net measures are just as ineffective. The Supplemental Nutrition Program for Women, Infants and Children (WIC), for example, was expanded in 2021 to provide healthy produce to mothers in need of nutrition assistance. Nearly 40 percent of all infants in the U.S. have come to rely on the program in the past year for access to healthy foods – an absolute necessity for good childhood health. The program is likely to lose its extension by the end of the year.

During the past decade or more, as the nation’s population has aged and chronic disease burden has become unmanageable, the healthcare system has become hyper-focused on supercharging preventive medicine to reduce costs and improve longevity. This shift toward preventive care is correct, but the focus is too narrow.

Providing more resources

After all, unhealthy children are prone to become sick adults. Giving parents and their pediatricians the resources they need to influence the tabula rasa of young gut microbiota is one of many opportunities to improve the long-term health and quality of life of children.

There are several innovative companies and organizations getting started on this work. Some, like Tiny Health and Snapi, are making gut microbiome tests and insights more widely accessible to parents, children and their pediatricians. Some health systems are integrating new, AI-powered digital tools that make it easier for neonatologists to focus on nutrition-based outcomes for the tiniest of children.

As more research and new technologies emerge, it is clear that our healthcare system will have an opportunity to progress pediatrics beyond the antiquated conveyor belt of care. Getting there will take a coordinated effort by healthcare leaders, researchers, pediatricians, parents, technologists and social services systems.

We have a chance to help our children live longer, happier, healthier lives and, in the process, gradually reduce economic strain on the healthcare system. Every day the conveyor belt of care remains in place is another window closed for millions of children.

Tracy Warren is CEO of Astarte Medical.

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