Can we stop putting the young in harm’s way?

Can there be anything more “apple pie” than Americans proclaiming how much we all love our kids? Well, it’s a cold and ugly reality check, but truth is that the hard data show the nation is falling far short of its cherished ideals.

Too many kids are getting killed by guns and becoming victims of a spiking number of homicides. Too many of our young folks aren’t getting the mental health care they need — they’re being ill treated instead. Hospitals are profiteering at the expense of caring for kids (and their moms). And product makers — yes, and consumers — too often have put their personal convenience ahead of tots’ safety and well-being. 

We can’t ignore how demographics shape the nation’s destiny. And a rising generation is watching what we do about the mistreatment of the young. We need to roll up our sleeves and do better for our collective tomorrow with at least these five unacceptable problems affecting kids:

Not long ago, diseases and vehicle wrecks were the top causes for American children’s lost lives. But adults’ weapons now have become the leading killer of our kids. As the New York Times described it: “We’re now living in the era of the gun.”

The newspaper further explained:

“The gun-death rate for children is nearly five in every 100,000. It was flat for more than a decade starting in 2000 …  In 2014, the rate began to creep up, and by 2020 guns became the leading killer. Last year was a particularly violent one: 3,597 children died by gunfire, according to provisional statistics from the Centers for Disease Control and Prevention. The death rate from guns was the highest it has been in more than 20 years.”

The Kaiser Family Foundation has contextualized this carnage, finding it a painful example of American exceptionalism. As the nonprofit, independent group reported on this country’s ranking among industrialized members of the Organization for Economic Cooperation and Development:

“[T]he United States is alone among peer nations in the number of child firearm deaths. In no other similarly large or wealthy country are firearm deaths in the top four causes of mortality let alone the No. 1 cause of death among children … Combining all child firearm deaths in the U.S. with those in other OECD countries with above median GDP and GDP per capita, the U.S. accounts for 97% of gun-related child deaths, despite representing 46% of the total population in these similarly large and wealthy countries.  Combined, the 11 other peer countries account for only 153 of the total 4,510 firearm deaths for children ages 1-19 years in these nations in 2020, and the U.S. accounts for the remainder.”

Young deaths due to suicide also are showing disturbing increases, the newspaper reported:

“The number of children who die by suicide with a gun has also risen to a historical high over the last decade. Last year, suicides made up nearly 30% of child gun deaths — 1,078. Unlike homicides, suicides disproportionately involve white children, mostly teenage boys. A decade ago, the number of white children who killed themselves with a gun totaled around 500 annually; in three of the last five years, that figure has surpassed 700. The share of gun suicides for black and Hispanic children has been growing, too. Still, in America, among children who die by gunfire, black and Hispanic children are more likely to be killed by others, and white children are more likely to kill themselves.”

[If you or anyone you know needs help in dealing with serious mental health distress, including thoughts of suicide, please call the National Suicide Prevention Lifeline hotline number 988 or 800-273-TALK (8255) or text HOME to 741741.]

Sure, the United States offers constitutional guarantees for gun ownership, the Supreme Court has decided. But the nation’s unacceptable killings of its young can be attributed without dispute to the prevalence and easy access to weapons. As the New York Times reported, quoting Jagdish Khubchandani, a professor of public health at New Mexico State University:

“’There were two things that I feel are largely responsible. One is the socioeconomic upheaval that occurred in the country. No. 2 is that the share of households with children that own guns keeps increasing.’ Uncertainty related to the pandemic, the 2020 presidential election, the protests over policing and the country’s unsettled economic outlook were all drivers of gun sales, Khubchandani said, and many buyers were people who had never owned guns. The wider presence of these weapons, he said, increased the chance of guns being involved in accidents, being used in domestic disputes, and being available to young people contemplating suicide.”

David Hemenway, a professor of health policy at Harvard University and co-director of the Harvard Injury Control Research Center, offered a pithier summary of the problems that the young — and the rest of the country — struggle with as weapons become all too common:

“Where there are more guns around, there’s more death. It’s just so easy when you get in arguments, when you rob somebody — if you have a gun, it’s so much easier to kill.”

A prescription for change: It may be safer for everyone in your household if you don’t buy weapons and bring them home. That act alone increases the risk of someone getting shot, including fatally, studies show.

Stanford University researchers, in a work published in a medical journal, scrutinized a key notion by gun owners that their weapons made them and their loved ones safer. It did not, they found. Instead, it increased the risks of shootings in households where guns were present.

Researchers at the nonpartisan, independent RAND Corporation have found in their extensive scrutiny of gun regulations that rigorous evidence supports key safety measures, including laws that push owners to lock up their arms, notably in special safes, and to “charge adults who intentionally or carelessly allow children to have unsupervised access to firearms.”

Guns in this country, as noted above, provide the means. But young people in this country also face a brutal wave of criminality with gun-related homicides and a stunning overall resurgence in juvenile crime.

The Wall Street Journal’s headline said it all: “It’s just kids killing kids.”

Here is how the New York Times reported on an important element of the wanton violence, especially in the most recent year (2021) for which complete data is becoming available:

“Last year, nearly two-thirds of gun deaths involving children — 2,279 — were homicides. Since 2018, they have increased by more than 73% … Black children represented almost half of all gun deaths and two-thirds of gun homicides involving youths last year, despite making up about only 15% of children in America. This disparity of death has grown significantly worse in recent years. Black children are now nearly six times as likely as white children to be killed with a gun … The recent spike in gun deaths for black children builds on a continuing phenomenon in which some children are exposed to much more violence than others.”

The newspaper further explained that poverty, social and economic uncertainty, and the high stresses of living in big cities contribute to emotional flashpoints, which, combined with prevalence of guns, prove deadly for black and Latino young people:

“Black and Hispanic boys and girls are likelier, on average, than their white counterparts to live in neighborhoods with high levels of poverty, a situation that often stems from structurally racist practices like segregation. And they’re more likely to be proximate to the kinds of violence that are concentrated in those neighborhoods … Jonathan Jay, an assistant professor at Boston University’s School of Public Health, recently co-published research showing that racial disparities in childhood exposure to neighborhood gun violence grew during the pandemic. ‘In places where violence is endemic, people pick up guns because they feel unsafe, and that perpetuates cycles of violence,’ Jay said. ‘During the pandemic, the trauma of losing loved ones to Covid, seeing black and brown people being killed by police and then seeing an increase in violence likely have all perpetuated cycles of violence.’”
 

Rx for change: It may be years before we know for sure. But the global public spending to protect individuals and families from economic harms caused by the coronavirus pandemic has affirmed for many reasonable economists a key contention: They say that poverty — and all its associated harms — is not a given, it is a policy choice.

It is distressing, though, that Republicans in Congress refuse to use the federal government’s great power to deal with poverty. It is a fundamental nightmare for the nation’s young, fueling the anger, despair, and violence that so afflict them and their communities.

As social justice advocates noted, the Congress, in its year-end holiday race to fund the government through September, declined to restore a much-praised child tax credit. This policy initiative, costing what some analysts estimated would have been $12 billion annually, died in the Senate before the House took up the appropriation bill.

Child advocacy groups, including the nonpartisan Annie E. Casey Foundation, had reported, based on U.S. Census data, that the measure during its short life as part of coronavirus pandemic relief had worked. Remarkably. “The nation’s child poverty rate dropped by half in 2021, from an estimated 10% in 2020 to a historic low of 5%.”

To hear the experts tell it, young people in this country have pressing need for mental health care. This vital demand existed before the pandemic but has worsened exponentially due to the isolation, loneliness, stress, anxiety, and depression that school-aged folks have endured as the coronavirus has raged.

But publicized incidents have provided disturbing indicators of how the U.S. health system has responded to the psychological distress of teens and young adults. Clinicians say the nation falls far short in its available residential care for youthful patients with mental ills.

That has led to grim reports about already troubled and traumatized young patients languishing for not hours, not days, not weeks but up to months in hospital emergency departments awaiting psychiatric beds. ER doctors, already overwhelmed by physical trauma cases and respiratory infections tied first to the pandemic then the tripledemic, have made clear that they aren’t prepared to provide sustained pediatric psychiatric care. Patients can go from bad to worse awaiting psychiatric treatment, their parents and ER doctors agree.

At the same time, the dearth of resources for young patients pushes parents to their own desperation, the New York Times has reported. The newspaper cited a study published in a medical journal in which researchers found that a significant part of the pediatric psychiatric cases hitting ERs may be due to parents seeking help in controlling their teens and young adults who display disruptive, unruly conduct linked to mental health ills.

These parents and young patients pose a big challenge for emergency medical staff, because they become repeat visitors and doctors are wary of the ethical and medical implications of drugging patients not to improve their conditions but just to restrain them.

Critics have assailed modern medicine for its unsavory use of powerful psychiatric medications to make patients of many different ages easier to handle and more compliant for caregivers. Pediatricians drugging tots with powerful anti-psychotics have been under fire, especially by federal regulators. So have nursing homes, for dosing elderly residents with dementia with potent psychotropic and  anticonvulsant medications. The regulators have announced they (again) will investigate and crack down on nursing homes with abusive medication practices. Critics say the use of potent drugs in walloping, sustained dosages turns patients into zombies.

In the meantime, at one elite university, administrators have been sued by students, parents, faculty, and mental health advocates for what critics have called their brusque, stigmatizing approach to young adults with psychological problems. Yale fails to provide sufficient on-campus mental health services to students, then shuns and treats them harshly if their conditions worsen and they find they must take leave from the school. The university mistreats those with mental illness, forcing them to overcome huge hurdles and demonstrate their wellness before they are permitted to return to campus. This is markedly different from how the university treats students with physical illness. While Yale has borne the brunt of negative coverage of its handling of students with mental health issues (and it reversed policies that many found so objectionable), critics say other colleges and universities also have far to go to improve in this area.
 

Rx for change: This country, especially since the Obama Administration, has sought to put mental health care on an equal footing as other medical treatment. But the nation has a far way to go to improve its mental health services, especially for the young.

The Biden Administration and congressional Democrats pushed for and won additional federal financing for health care programs, including mental health services and programs targeting the young in the whopping, omnibus budget bill that lawmakers passed just before the ’22 holidays. Advocates will be watching closely to see if this funding increase, which they say was welcome but far too paltry still, will be sustained and will lead to progress.

But because the Congress is more riven than ever by partisan politics, experts who follow the doings on Capitol Hill have little cause for optimism that significant health or mental health care laws or funding will be passed by lawmakers in, perhaps, the next two years.

For contemporary consumers, convenience rules. But does their ease of use with various products take priority over the health and safety of youngsters?

This clash of values could not be more starkly drawn, especially as it involves consumption of pleasure items versus kids’ well-being, specifically with rashes of poisonings and drug overdoses involving tots ingesting marijuana edibles and flavored liquids or “juices” used in vaping.

As the 46^th commander in chief of the United States is wont to observe, C’mon, man!

Grownups and young adults, as well as manufacturers and regulators, must have enough common sense to know that tots can’t help themselves. They love to put all manner of items in their mouths. Their older siblings and adults, as well as product makers, must protect the little ones by keeping harmful items away from them and by ensuring they can’t reach harmful goods.

That is not occurring with increasingly legal, edible marijuana products, the New York Times and other media outlets have reported, based on a study published in a medical journal. As the newspaper said:

“The accidental consumption of marijuana edibles, such as brownies and gummies, among children under the age of 6 has surged in recent years as more states have legalized the recreational use of pot, a new study has found. The study … in the journal Pediatrics … analyzed reports of child exposure to edibles from 2017 to 2021. The authors concluded that there had been a ‘consistent increase in pediatric edible cannabis exposures over the past five years, with the potential for significant toxicity.’ In 2020, pediatric cases of edible marijuana ingestion accounted for more than 40% of all human poison exposures reported that year, according to the study, which relied on statistics from the National Poison Data System. ‘These exposures can cause significant toxicity and are responsible for an increasing number of hospitalizations,’ the authors wrote.

“There were more than 7,000 reported cases of accidental ingestion by children 5 and under between 2017 and 2021, and cases rose 1,375% over that period, the study found. In virtually all of them, the edibles were ingested in a residential setting. About 90% of the cases originated from the child’s home, the study said. Nearly 23% of the patients were hospitalized, with a ‘significant increase in both ICU and non-ICU admissions,’ the study found.”

Researchers criticized marijuana edible manufacturers for packaging their products in bright, colorful, candy-like wrappers.

This has become an all too common and detrimental advertising and marketing technique employed by enterprises targeting youth markets. As the vaping craze exploded, critics assailed Big Tobacco for appealing to young consumers by using candy-like flavored liquids sold in colorful, shiny packaging. Regulators quickly cracked down on this aspect of vaping when parents began taking increasing numbers of young children to hospital emergency departments after the kids ingested their older siblings’ vaping liquids and other products associated with “smokeless” e-cigarettes.

In recent months, of course, federal regulators have issued warnings and have threatened to crack down on companies that supply and employ button- and coin-sized lithium-ion batteries. As the New York Times reported, round, shiny, and ubiquitous batteries have proven to be irresistible to the pint-sized and curious, who gulp them down after they find them scattered around or pry them free from an array of gadgets, including cell phones, “television remotes, key fobs, thermometers, scales, toys, flame-free candles — even singing greeting cards.” The newspaper noted:

“A report published [Aug. 29] in the journal Pediatrics suggests that the problem is growing in the United States. There were more than twice the number of pediatric battery-related visits to the emergency department from 2010 to 2019 compared with 1990 to 2009 — a majority in children under 5. From 2010 to 2019, there was an average of one battery-related pediatric visit to the emergency department every 1.25 hours …, according to data from the National Electronic Injury Surveillance System. Swallowing a button battery is dangerous because the battery generates an electric current when it comes into contact with bodily fluids like saliva that can burn through a child’s body tissue and lead to life-threatening complications or even death. The data in the new study did not provide detailed information on patient outcomes, but 12% of the children who were taken to the emergency department required hospitalization, most because of ingestion.”

 
Rx for change: Grownups periodically must child-proof their homes, adopting the toddler mindset to see all items that youngsters might grab, put in their mouths, and swallow. Adults should not tarry in calling pediatricians or emergency numbers, or in rushing kids to an ER or urgent care center if they suspect they have ingested something harmful. It may be helpful to take along what’s left of suspect materials.  The national Poison Help Line (800-222-1222) also can be a useful resource, not only in providing fast information but also in raising awareness about and reporting risky items or packaging. Another vital and helpful resource: The U.S. Consumer Product Safety Commission

The persistent pandemic, especially this year’s onslaught of a tripledemic — an early, severe wave of seasonal flu, combined with increasing coronavirus cases, and a surge in respiratory syncytial virus (RSV) infections — hammered home a grim reality about hospital care for the young. It is lacking and shrinking.

As the New York Times reported:

“Hospitals around the country, from regional medical centers to smaller local facilities, are closing down pediatric units. The reason is stark economics: Institutions make more money from adult patients. In April, Henrico Doctors’ Hospital in Richmond, Va., ended its pediatric inpatient services. In July, Tufts Children’s Hospital in Boston followed suit. Shriners Children’s New England said it will close its inpatient unit by the end of the year. Pediatric units in Colorado Springs, Raleigh, N.C., and Doylestown, Pa., have closed as well. ‘They’re asking: Should we take care of kids we don’t make any money off of or use the bed for an adult who needs a bunch of expensive tests?’ said Dr. Daniel Rauch, chief of pediatric hospital medicine for Tufts Medicine, who headed its general pediatric unit until it closed over the summer. ‘If you’re a hospital, that’s a no-brainer.’”

The newspaper further explained:

“Many hospitals have converted children’s beds to adult [intensive care] beds during the pandemic and are reluctant to change them back … Young patients … occupy beds to recover from infections or asthma attacks but don’t undergo lucrative, billable procedures — like joint or heart surgeries — that are more common among aging patients. Physician reimbursement through Medicaid, the insurance program for low-income people, is often only about 70% of the amount reimbursed through Medicare, the insurance program for elderly people of all incomes. More than a third of children in the United States are enrolled in Medicaid. There have been no aggressive legislative efforts to keep hospitals from closing or shrinking their pediatric units.”

The health care system so lacks capacity for pediatric care now that patients in need fast find themselves in bad situations, the newspaper found:

“Hospitals that no longer admit children rely on transferring them to pediatric units at other hospitals. But when even the largest pediatric floors in the country are at capacity, the pileup of critically ill children in ERs can cause patients’ conditions to worsen.”

The newspaper, in a detailed dig into the issue, quoted multiple experts explaining that pediatric care is a different and important specialty. Youngsters need differentiated treatment, with highly trained nurses, specialized equipment, and tailored procedures. Even “routine” care of kids, such as inserting intravenous lines or breathing assistance devices, can be challenging and intimidating to clinicians unaccustomed to dealing with tiny patients:

“’Children are not small adults,’ said Dr. Meredith Volle, a pediatrician at Southern Illinois University School of Medicine in Springfield, Ill., who routinely sees patients who travel from two to three hours away. The number of pediatric beds in Illinois has declined, and 48 of its counties now have no pediatrician at all. ‘When nurses and respiratory therapists become less comfortable with children’s cases, when the units don’t have child-sized equipment,’ Dr. Volle said, ‘at a certain point, you really shouldn’t treat kids anymore because you don’t treat them often enough to be good at it.’ Critically ill children are four times as likely to die in hospitals and twice as likely to die in trauma centers that scored low on a ‘pediatric readiness’ test, according to research. Only one-third of children in a national research survey had access to an emergency department deemed highly ‘pediatric-ready,’ and of those, nine out of 10 lived closer to a less-prepared one.”

Rural and exurban areas struggle the most with declining pediatric hospital capacity. But even big cities can see their major, well-known specialized facilities overwhelmed, as has occurred during the tripledemic.

 
Rx for change: Health care regulation is notoriously complex and difficult, and hospitals have great leeway as private enterprises in determining the services they offer or don’t. Getting the MBAs in suits who run health care facilities to think about the good of their patients and communities versus profits and shareholders — that’s no easy path, either. That said, the pandemic clearly exposed huge misalignments in hospitals and the care they offer, including treatment for kids. Many states do provide health care oversight via a “certificate of need” process, forcing hospitals and other institutions to justify certain of their plans for facilities or services. And the Internal Revenue Service and Congress, as recommended by the watchdog U.S. Government Accountability Office, could reform hospitals’ “community benefit” regulations. Those laws give hospitals whopping tax savings in exchange for demonstrating (too often in dubious fashion) how they benefit their communities. Critics already have taken big aim at hospitals for short-shrifting charitable care while reaping billions of dollars in tax savings. Surely improved care for the nation’s kids is a community benefit — but can the IRS or Congress recognize this?