Children are not small adults

English2021. jan. 14.Növekedé

A very significant proportion of adult chronic diseases can be traced back to childhood, so it is very important to have enough well-qualified family paediatricians in Hungary, says Katalin Havasi, recently elected president of the Association of Family Paediatricians.

A very significant proportion of adult chronic diseases can be traced back to childhood, so it is very important to have enough well-qualified family paediatricians in Hungary, says Katalin Havasi, recently elected president of the Association of Family Paediatricians.

A few months ago Bea Pászthy, a child psychiatrist, gave an interview to our portal and talked about the fact that one quarter of children suffer from mental problems. How can family paediatricians help to recognize and treat these problems?

Our role is still very limited at the moment, though many children would need this kind of help. Mental problems or poor coping strategies are unfortunately inherited within families the same way as the predisposition to physical illnesses. That is why it is important that psychologists and psychiatrists should also be involved in the work of future practice communities, where we will be able to work together with other professionals for the health of the rising generations.

What other professionals should be involved in these practice communities?

Any professionals who can help and complement our work. I would personally rely on developmental educators and physiotherapists, because I know that children who get help in time to get over a problematic period will have a much better chance of becoming healthy adults than those who do not receive such help.

Statistics show that there are more and more obese children, as well as teens suffering from diabetes and hypertension.

Common diseases such as high blood pressure, heart attack or stroke, which today play a major role in causing disability and mortality in Hungary, are very often rooted in childhood and adolescence, and the processes that lead to them can start as early as 4-16 years of age.

However, they are not easy to recognize; for example, blood pressure may not be permanently high at first, but it already worsens the condition of the wall of blood vesselsjust like obesity and diabetes. The problems may also have spiritual causesand we can also rely on the help of psychologists and psychiatrists in the exploration and elimination of these, but it may also be necessary to involve cardiologist, diabetologistdietician or physiotherapist. A single paediatric practice alone cannot fully solve these tasks.

Are children in a worse state of health now than at the time of the regime change?

I have been a paediatrician for thirty years now, and during this time, unfortunately, we have not achieved significant breakthrough in either the early recognition of high blood pressure or the reduction in the number of obese people. In families where an unhealthy lifestyle has been a family tradition, unfortunately, almost every effort is ineffective. What’s a positive change ishowever, that it is becoming more and more fashionable to do sport, although unfortunately many people believe that sport is all they need to remain healthy.

Will there be extra funding to run these practice communities?

Yes, funding for primary care will be raised, and practices that join forces will receive extra support so that they can involve different specialists if necessary. It is very important that children receive a wider range of specialist care within the primary care system than at present; and the relationship between hospitals and family paediatricians should be closer, because this is what can expectedly reduce the number of people hospitalized and help people stay healthy as children, and as adults later on, as well.

At the press conference following your election it was said that there aren’t equal opportunities in paediatric care today because there is no family paediatrician everywhere.

This is because in settlements where the family paediatrician retires or dies and there is no paediatrician to take over the practicechildren will be referred to an adult general practitioner. The focus and approach of the training of general practitioners is very different from that of paediatriciansand the experience provided by the large number of cases is also very different, similarly to other medical specialties.

Children are not small adults; even the same disease can show completely different symptoms in them than in adults.

In Great Britain, where adult general practitioners have been responsible for the primary care of children for a few decades, it has been proven that in some cases children have been hospitalized although they needn’t have, and the incidence of preventable infant and child mortality has also increased. The restructuring in Britain not only destroyed the children’s primary care system, but also put children in a worse position. Fortunately, this kind of thing is out of the question in Hungary (at least we hope so), since

it is a great value that the vast majority of children in Hungary are cared for by qualified paediatricians. However, the family paediatric care system needs to be strengthened so that nothing similar could happen here to what happened in Great Britain.

Practice communities can only be established in surgeries which have a paediatrician. How many practices have ceased to exist or are simply vacant now?

The number of vacant paediatric practices is growing year by year. In 2016 there were 67 unfilled practices, while this number was 97 and 114 in 2019 and in the spring of 2020, respectively. And the real picture is even worse because local governments often address the problem by closing down practices and redistributing patients, or setting up mixed practicesthese practices therefore do not appear in the statistics. During the same period, 10 family paediatric practices ceased to exist. Despite all these difficulties, 1,500 family paediatric practices in Hungary today provide continuous care for almost 80 percent of the children. Despite the difficulties, this is not a moribound profession.

What does the age pyramid of family paediatricians look like right now?

Age is our biggest enemy’, just like in primary care, in general. The average age is very high, 60.5 years, and every third family paediatrician is of retirement age.

Only about 30 percent are under the age of 55, and nearly as many are in the 56-65 age group. Unfortunately the proportion of under 40s is below 15 percent, slightly lower than those over 70. That’s why we want to do everything we can to show the beauty of this wonderful profession to young paediatricians and make it an attractive choice for them.