Thirty years ago this month, Seattle’s Child was born, becoming the first local parenting publication in the country and spawning a veritable publishing industry. Since then, the magazine has given parents a world of information.
To commemorate our 30th anniversary, longtime Seattle’s Child contributor Cheryl Murfin reached out to several of our region’s leading experts, people who have become renowned the world over for their vast knowledge about kids and families.
This month, we start with a conversation Murfin had with Dr. Steven Dassel, a widely respected pediatrician, who has been treating kids for four decades. In the coming months, you’ll hear from other experts – from childbirth education specialist Penny Simkin to Sharon Osborne, who for the past 25 years has been at the helm of Children’s Home Society of Washington, one of the state’s oldest and largest child welfare organizations. Though times have changed plenty over the past 30 years, Dassel and his colleagues agree that one thing has not: Just like their parents three decades ago, moms and dads today need information and support for the very hard work of raising healthy children.
How Pediatric Care Has Evolved over the Years: More Specialized Care, Less Continuity
Dr. Steven Dassel was one decade into his pediatric career and starting his own family 30 years ago, when Seattle’s Child first hit the local parenting scene. Between then and now, Dassel has served in numerous pediatric leadership positions, including head of the emergency room at Seattle Children’s Hospital.
SC: What are the major trends that have guided pediatric care and children’s health care over the last three decades?
Dr. Dassel: There has been a general overall trend in decreasing the continuity of care that was the mantra of the 1970s – that is, one family, one patient, one doctor. Due to the move in pediatric care toward specialization and sub-specialization, rather than receiving the majority of their care from one doctor, most kids are exposed to a lot more health care providers. This change has, of course, resulted in both benefits and problems.
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A second significant change is that a lot more women have come into the field of pediatrics or pediatric specialties. Ultimately, this change has meant a decrease in the number of full-time practitioners. Where one doctor may have had a single practice in the 1970, two providers are now covering the same practice. At the same time, we’ve seen most pediatricians giving up rounds at hospitals.
The trend today is that doctors admit their patients to the hospital and then turn care over to the hospital-based doctors. A good example of this is the neonatologist. In the 1970s, there were no neonatologists in the hospitals. Many times I would be called to rush down to Swedish to help with an infant in distress. With the advent of the neonatologist, that changed. This has been a major improvement in this area of health care delivery.
SC: Has there been a change in where kids are seen?
Dr. Dassel: Yes. In the 1980s we started to see an increase in the use of emergency rooms and urgent care centers to deliver after-hours care for kids. Part of why we are seeing this change in access is because more and more parents are isolated. Parents do not have a nearby grandparent to talk to or confer with in the home. There is no one nearby to answer the little questions that parents used to not want to bother their pediatricians with, in the middle of the night. And, with most parents using a third party payer (insurance) rather than paying out-of-pocket for care, there is less of a reluctance to bring kids into the ER.
SC: Are parents more or less attentive to kids’ health issues today?
Dr. Dassel: I think parents are more attentive to their kids’ health needs, and I think that is largely because the media has made them much more aware. We have seen a definite increase in autism diagnosis, for example, and part of that comes from parents understanding that kids who we all previously might have just considered “a little odd” could have a real problem.
SC: How do the major health concerns of children today compare to those of 30 years ago?
Dr. Dassel: There’s been a shift from more of a metabolic, organic, structural concept in pediatric care to more pediatricians doing what we call behavioral care. Pediatricians are dealing more with things like autism and depression, and there is a difference in recognition of potential medical concerns. For example, we are moving a lot of what we previously would have considered normal kids into a diagnosis of autism. That’s not just recognizing the issue better – although that is happening. The fact is there has been a definite increase in autism that may very well be associated with what is in our environment, but is also attributable to that fact that we’ve changed how we define problems.
In this time, we faced AIDS as a new and great threat. … Today obesity is the disease du jour. Kids really are more obese than 30 years ago, and there have been a lot changes to precipitate that. There’s a lot more opportunity, both with more television and more parents working and using it as a babysitter, to sit on the couch and watch TV. There is a lot less physical play and kids today are being driven to school out of concerns for children’s safety. At the same time there’s been an encroachment on recesses and a lot of schools are eliminating recesses to get more bang from their classrooms. So there are a lot of things that have led kids to be more sedentary.
SC: What are the major health successes?
Dr. Dassel: One of the things that really impresses me is how quickly we are able to change people’s behavior today. It’s one of the incredible benefits of more media. We didn’t even think about the possibility of childhood depression 30 years ago and yet the media has had a big role in shifting the public conscience to address this growing concern area. In the last 30 years we’ve been able to convince kids to wear helmets, parents to put babies to sleep on their backs, women to not drink during pregnancy.
SC: Are kids better off or worse off health-wise than 30 years ago?
Dr. Dassel: On balance kids are better off. Immunizations are a good indicator and all things I’ve mentioned that we do behaviorally now. Patients who would have died 30 years ago wouldn’t even get the disease that killed them today. A diagnosis of leukemia in the 1970s would have brought the expectation of death, but with such a diagnosis today you are not expected to die. All childhood cancers have a much better prognosis today than three decades ago. We are not only saving more lives today, but we are making kids much more functional. I think by and large kids are healthier, with the caveat of violence and obesity.
SC: Are there areas of concern today that need more time and attention?
Dr. Dassel: We are learning a lot more about depression in children, and I believe this is one area where kids are really under-medicated. The fact is that life now is a lot more stressful for kids. Kids experience a lot more anxiety and depression than they used to. The world is a lot more dangerous place for them. Behaviorally kids are also very much impacted by technology.
