US Children Get Uneven Health Care, Report Finds

WASHINGTON (By Maggie Fox, Reuters) April 15, 2004 - U.S. children are not getting the best health care and are often given inappropriate drugs and untested treatments, according to a report published on Thursday.

The report from the Commonwealth Fund also found large disparities in care for children, based on geography as well as on ethnic group and income.

"Given the fact that we spend far more on health care than other countries, we should be doing better for our children," said Sheila Leatherman, research professor at the University of North Carolina School of Public Health, who helped write the report.

"The report shows dangerous lapses in patient safety, substantial shortcomings in providing effective and recommended care, persistent racial and ethnic disparities in care, and widespread failure to provide needed preventive services to teens," Leatherman added in a statement.

The Commonwealth Fund, a private foundation supporting independent research on health and social issues, reviewed 500 different studies for the report.

It found that 25 percent of young children do not get all recommended doses of five key vaccines on time. The rates vary widely, with 14 percent of children in Massachusetts getting vaccinated late or not at all but 37 percent in Colorado.

Poorer children were less likely to be fully vaccinated, as were black, Hispanic and inner-city children, and the differences persisted from 1994 to 2002 even though overall vaccination rates went up during that time.

A third of children with asthma did not get the correct medication, and low-income children with sickle cell disease were prescribed, on average, less than half of the recommended supply of antibiotics to keep on hand and 10 got none at all.

"Medication mistakes were detected in six out of every 100 medication orders for pediatric patients," the report reads. In one of every 100 cases, the child was hurt or died.

For instance, doctors prescribed the wrong dose, or the wrong frequency, or the wrong method of administration, the report found.

OVERLOOKING STD RISKS

Looking at older children, the report found that as many as three-quarters of sexually active adolescents had not been tested for chlamydia infections in the past year, although fully half could be expected to become infected with a sexually transmitted disease at some point.

The report estimated that 79 percent of children with serious mental health problems got no evaluation or treatment and that 7.5 million children failed to get needed mental health care.

Some issues are being addressed. For instance, a federal law enacted last November allows the U.S. Food and Drug Administration to require drug companies to study how children react to medicines, and which doses are best.

Experts have been complaining that children are often just given reduced doses of drugs that have been tested only on adults, although much evidence suggests children may react differently to some treatments.

"As a society, we too often think of children as little adults," said Douglas McCarthy, president of Colorado-based Issues Research, Inc., who co-wrote the report.

"But they aren't. Their unique developmental needs, different disease patterns, and dependency on adults means that quality of health care for children deserves special attention."

The report found improvements in some areas, such as reduced hospital-acquired infections in some pediatric intensive care units. Initiatives in some areas had improved lead screening in children, also.

The report found a 50 percent reduction in the number of prescriptions written by doctors for antibiotics when they saw a child who had a cold. Antibiotics are useless against colds, which are caused by viruses, and overuse can help drug-resistant bacteria evolve.