More children are avoiding or recovering from disease, but trouble spots persist
In August, 1988, doctors gave Lee and Elizabeth Wells the kind of news parents dread. Their daughter Allison—a spunky four-year-old with long blond hair—had a cancerous tumor on her right kidney. The prognosis was grim: the tumor was too big to be surgically removed, and the cancer had spread to other parts of the child’s body. For nearly a year, parents and child made regular
forays from their home in Prince George, to the British Columbia Children's Hospital in Vancouver, where medical teams used chemotherapy, radiation and more chemotherapy in an effort to shrink the tumor. Finally, a year after it was discovered, surgeons successfully removed the tumor. But the cancer persisted in Allison’s bones, and it was not until the spring of 1995 that tests showed she was finally free of it. Today, at 16, Allison is a Grade 11 student at Pinetree Secondary School in the Vancouver suburb of Port Coquitlam, where she, her parents and sister Lucy, 18, now live. Her interests are those of a healthy, middle-class teen: hanging out with friends, attending dance class, going to summer camp. And what of the hard-won medical miracle that saved her life? “It’s pretty cool,” allows Allison.
Even amazing. Thanks to increasingly sophisticated drugs, improved diagnostic and surgical techniques and other medical advances, sick or injured children in Canada have a better than ever chance of recovering. And despite stresses, the nation’s generally excellent health-care system and a high national standard of living mean that Canada’s children are mostly a healthy lot. A federal study tracking 23,000 youngsters in 1996-1997 found that nearly 90 per cent of parents judged their offspring to be in good health. In 1997, only one Canadian child in 182 failed to survive the first 12 months of life—compared with one in seven a century ago—and only one child in 366 died between the ages of 1 and 15. “If you look at the health of our children and youth, we can’t afford to be smug,” observes Dr. Roger Tonkin, director of the Burnaby, B.C. - based McCreary Center Society, which studies youth health issues. “But overall, I think we are doing pretty well.”
“Pretty well,” of course, leaves room for improvement. Increasing numbers of children are being diagnosed with autism, attention deficit hyperactivity disorder and other neurological and behavioral problems—and in the worst cases, they are committing suicide (page 54). As well, the incidence of asthma and other respiratory diseases is soaring (page 58). “If you look at these things,” says Dawn Walker, executive director of the Ottawa-based Canadian Institute of Child Health, which is publishing a major report on child health next month, “then it is not so clear that all Canadian children are better off than in the past.” Too many are using drugs to manage chronic diseases like asthma and ADHD, says Walker. “We need a lot more research into why this is happening.” Walker and fellow experts point to other negatives, including a small but puzzling increase in childhood cancer cases in some hospitals, and a growth in the number of overweight children that some experts say amounts to a major public health crisis (page 60). And then there are the swelling ranks of Canadian kids—nearly 1.4 million in 1997—whose health may be at risk because they and their families live below the poverty line and cannot afford adequate food, shelter and other necessities of a healthy childhood.
Canada’s poorest neighborhoods still have infant death rates much higher than those in affluent districts
In fact, income-related disparities in infant mortality have narrowed during the past 30 years. Even so, Canada's poorest neighborhoods still had death rates for babies averaging 6.5 for every 1,000 births in 1996, compared with 3.9 per 1,000 in more affluent neighborhoods. The plight of impoverished children, critics claim, has worsened during the past decade with the erosion of public financial support. “Government deficits,” says Dr. Paul Munk, a Toronto physician and president of the Canadian Pediatric Society, “have been reduced on the backs of the children of Canada. Politicians pay a lot of lip service to children's health, but nothing much is done.”
Paradoxically, the technologies and achievements of modern medicine sometimes lead to ethically agonizing consequences. Fifty years ago, few babies survived a birth at 24 weeks’ gestation—a little more than halfway through a normal pregnancy—or earlier. Today, many live. But partly because of the measures required to keep them alive, the tiny preemies can become blind or suffer brain damage leading to cerebral palsy, learning disabilities and mental deficiencies. “It becomes a philosophical issue,” says Dr. Jacob Langer, chief of general surgery at Toronto’s Hospital for Sick Children. “We always save these babies when there’s a chance they’ll have a reasonable quality of life. But sometimes, after talking to the parents, we decide not to be aggressive in trying to save a child.”
Once children have survived the perils of birth and infancy, the disease most likely to take their lives is cancer. About 250 Canadians between 5 and 19 die each year of leukemia and brain tumors—the biggest killers—and other types of cancer. According to Statistics Canada, the incidence of pediatric cancer grew by four per cent between 1984 and 1995, a change the agency considers statistically insignificant.
Still, specialists at some major hospitals report more cases of childhood cancer. “We don’t know why,” says Dr. Paul Rogers, an oncologist at the B.C. Children’s Hospital, “but we’re definitely seeing a slight increase.” (International studies, including several by Canadian researchers, have discredited the notion that electromagnetic emissions from power lines and other sources could cause childhood leukemia. Another unproven theory: childhood viral infections can combine with genetic factors to trigger cancer.)
The good news is that about 70 per cent of children stricken with cancer now survive, compared with 25 per cent a generation ago. Better chemotherapy techniques are a major factor, physicians say, along with the fact that almost three-quarters of all children with cancer in Canada are enrolled in clinical trials to test new drugs and other therapies, leading to a steady improvement in treatment.
One revolutionary change over the past decade has been the belated realization that children feel pain as keenly as adults do—and that their pain should be treated. As recently as a decade ago, even school-age children often underwent painful procedures without the benefit of painkillers. “We would just hold a child down and let it scream,” says Lawrence Roy, head of anesthesiology at Toronto’s Hospital for Sick Children. Since then, the treatment of pediatric pain has steadily improved as physicians learn more about safe combinations and dosages of painkillers. There are still pockets of resistance among physicians, experts say, particularly about using the powerful narcotic drugs known as opioids (including Demerol and Dilaudid). But Dr. Gerri Frager, a pediatrician at IWK-Grace hospital in Halifax, thinks that hesitancy is shortsighted. “We should always use whatever drug we have to treat pain in children—and not just when they’re dying,” says Frager, who provides palliative care for children in terminal pain because of AIDS, cancer and other diseases.
Still, most childhood deaths in Canada are caused not by disease, but by what statisticians blandly label “external” causes, including murder, suicide and—above all—accidents. Thanks to stricter anti-speeding and drunk-driving laws, the number of children struck and killed by motor vehicles has fallen precipitously since the early 1970s—to nine children per million by 1996 from 76 per million. In the same period, the number of children fatally injured while riding in vehicles has been halved. Yet as a shocking van accident that killed eight youngsters near Trois-Rivières, Que., in March showed, there is room for improvement. Despite child-seat and seat-belt laws, says Emile Thérien, president of the Canada Safety Council, “fewer than 10 per cent of children riding in vehicles are properly restrained.”
For many Canadian youngsters, their own risky behavior presents health dangers. Despite the chances of contracting HIV and AIDS, 19 per cent of girls and 13 per cent of boys aged 15 to 19 said they had unprotected sex with two or more partners in 1994-1995. Ignoring evidence of the link between tobacco use and cancer, 28 per cent of Canadian teenagers over 15 still smoke. More than half of boys and 35 per cent of girls aged 15 to 19 admit to occasional alcohol binges, while 26 per cent of teenagers aged 15 to 17 said they used marijuana or other illegal drugs in 1994, the most recent year for which figures are available.
Sadly, more young Canadians are taking their own lives than in the past. The number of suicides among youngsters, most of them in the 10-to-14 age-group, increased from about three in every million in the early 1970s to eight per million in 1996. Worst hit are aboriginal communities, where the suicide rate among young people is four times the national average. Boys are five times as likely as girls to kill themselves. The majority of young people who take their own lives, says Dr. Dan Offord, a child psychiatrist who runs a center for children at risk at McMaster University in Hamilton, “are either depressed or have substance abuse problems—or both.”
Another cause for alarm is the use of alcohol by pregnant women. The condition known as fetal alcohol syndrome is associated with neurological and development problems affecting as many as three in every 1,000 Canadian children. Researchers first identified FAS—a condition characterized by facial deformities and brain anomalies—in the early 1970s. Since then, they have uncovered a spectrum of problems known as fetal alcohol effects—including intellectual deficits, attention disorders and hyperactivity—that can result from maternal alcohol use during pregnancy. “It’s a huge problem and I don’t think it’s getting better,” says Dr. Albert Chudley, a pediatrician and geneticist at Winnipeg Children’s Hospital. “Alcohol is a poison, especially in high doses. And as far as anyone knows, there is no safe amount that women can drink during pregnancy.”
Controversy surrounds claims of another cause of children’s illness—the very vaccinations intended to keep them healthy. At a time when health authorities credit vaccinations with virtually eliminating such childhood diseases as diphtheria and polio and taming many others, some critics insist that the shots actually cause other disease. Because some vaccines contain live disease viruses as well as potentially harmful chemicals, those researchers and activists blame vaccination programs for the growing incidence of asthma in children.
They also claim there is evidence linking childhood vaccinations to autism. “We’re seeing a lot of very sick children,” says Mary James, a co-founder of the Winnipeg-based Association for Vaccine Damaged Children, “because this is the most vaccinated generation in history.” However, most physicians reject the claims, insisting that adverse reactions to vaccine shots are rare—and that giving children immunity from measles, mumps, rubella and other diseases outweighs the risks. “This movement is fed by isolated incidents,” says the pediatric association’s Munk. “I have yet to see any scientific evidence to support the accusations.” www.macleans.ca for links
When illness strikes a child, the big issues preoccupy the family. Lee Wells recalls that during his daughter Allison’s battle with cancer, he and his wife felt tormented by “feelings of helplessness, of anger and the question, ‘Why us?’ ” The physicians and others at B.C. Children’s Hospital who cared for Allison “were just excellent” throughout those harrowing years, he adds. “Medically, we couldn’t have been in a better place for an awful thing like that to happen.” Happily, that judgment applies to ever-growing numbers of children who face, and overcome, grave hazards on the road to adulthood.
HOW CHILDREN DIE
Percentage of childhood deaths, 1977
Aged 5 to 9 years
Diabetes and other endocrine disorders 4%
Heart and circulatory diseases 4%
Birth defects 6%
Nervous system disorders 9%
Other non-medical** 23%
Motor vehicle accidents 18%
Aged 10 to 14 year
Diabetes and other endocrine disorders 3%
Heart and circulatory diseases 6%
Birth defects 5%
Nervous system disorders 7%
Other non-medical** 19%
Motor vehicle accidents 20%
*includes infectious and parasitic diseases and respiratory problems
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