The child is father of the man: Paediatricians should be more interested in adult disease

Abstract

We expect that most pregnancies will bear normal babies, which will grow up into healthy young adults free of the risk of serious disease. We also believe that many common diseases and causes of death in adulthood may be preventable through changes in living conditions, diet and lifestyle.

The 20th century saw a massive decline in childhood mortality and morbidity as well as improvements in child health. The relations between environmental influences and genetic endowment in the genesis of disease are ever clearer, and at their ‘extremes’ susceptible to interventions. The burden of infectious disease has been reduced to 5% of what it was a century ago, and many chromosomal and monogenic diseases can be avoided or their effects ameliorated before or soon after birth.

Nevertheless, there is strong evidence that poor environmental conditions are the principal determinants of ill health at all stages of life, and it follows that the optimal time to intervene to correct them is in early life. Moreover, we recognise the principal risk factors for chronic adult disease, and also have the tools to measure genetic susceptibility to them. There is, therefore, hope that as their natural history becomes better defined, they will be increasingly preventable or treatable.

The challenge to paediatricians now is to ensure that children are not only born healthy and remain healthy, but also grow up to be healthy adults. When it is increasingly clear that the origins of many adult diseases are in childhood or before, paediatricians should strive to work closely with their colleagues in primary care, public health, clinical genetics, education, government, housing, environmental and social services, toward the common goal of promoting optimum health throughout the fullness and completeness of life.