Back to school: The future of children’s health

By Russell Bailey, M.D., MBA, specialist leader, and Sameer Khan, principal, Deloitte Consulting LLP

Early this summer, we—along with our colleagues Dr. Jay Bhatt and Sona Dave—were invited to speak to clinical and non-clinical executives from a children’s health system. We were asked to discuss Deloitte’s vision for The Future of Health^TM and, more specifically, the future of children’s health. While much of the discussion focused on possibilities, we also talked about the challenges of increasing the focus on prevention and intervention, while also ensuring that care is accessible, affordable, and equitable.

Four factors that could drive the future of children’s health

Over the next decade, we expect four factors will be instrumental in shaping the future of children’s health: prevention and well-being for physical and mental health; new technologies and digital transformation; health equity, and workforce transformation. Here is a closer look at each:

1. Prevention and well-being for physical and mental health: Hospitals and health systems in the US tend to rely on fee-for-service payments for the care they provide. This means they have little financial incentive to keep patients healthy and out of the hospital. We are optimistic this scenario may be changing as the health care sector pivots from sick care to well-care, early detection, and prevention. Pediatricians have long recognized the importance of prevention in ensuring children’s health. It is hardwired in the pediatric approach to patient care.¹ Wellness checks and preventive care—everything from car seats and helmets to well-baby check-ups to mental health checks to vaccinations—are a major part of what they do to ensure the health of kids from the day they are born.²

As kids begin a new school year, many pediatricians are providing required immunizations and performing physicals for those participating in sports. Mental health is likely also being evaluated. Prior to COVID-19, about 20% of children experienced a mental health issue. The pandemic seems to have exacerbated this problem.³ Mental health-related emergency room visits between March and October of 2020 jumped 24% among ages 5 to 11 and 31% among those 12 to 17.⁴ With a new school year underway, children may be dealing with stress and anxiety. Some children’s hospitals have expanded, opened, or intend to open, facilities that focus on mental health screenings, prevention, and care. UPMC Children’s Hospital of Pittsburgh recently launched a pediatric behavioral health walk-in clinic where same-day care will be available without an appointment.⁵ Children’s Hospital & Medical Center of Omaha is adding a behavioral health and wellness center to its campus.⁶

2. New technologies and digital transformation: Advancements in technology, such as artificial intelligence (AI), virtual health, robotics, and cloud computing, have the potential to revolutionize pediatric care delivery. Pediatric patients tend to be accepting of technology.⁷ As such, children’s hospitals are potentially fertile grounds to test and develop these technologies, serving as first or fast movers to accelerate adoption. Case in point: There seems to be an increased use of social bots in pediatrics, particularly among children who have neurodevelopmental disorders such as autism. Some children with neurodevelopmental disorders are using robot-guided activities to help improve social functioning as well as other developmental domains.⁸ At Loma Linda University Children’s Hospital in California, pediatric patients are encouraged to create a personalized animal avatar that will follow them throughout their stay.⁹ In 2016, Boston Children's Hospital launched an app that uses AI to provide health guidance to parents. Imagine a new parent at three o'clock in the morning worried about something such as a new fever, rash, or change in their child’s breathing. A smart speaker could be programmed to offer health advice regarding common childhood illnesses and dosing for over-the-counter medications.¹⁰ The adoption of increasingly sophisticated technologies could help usher in a new era of care in pediatrics.

3. Health equity: Children are generally a vulnerable population because they tend to depend on other people for their health care. A child’s physical and social environment can contribute to chronic illnesses. Addressing preventable conditions at the earliest stages can have a long-term impact on the health of children. Poor nutrition, for example, can lead to a host of chronic conditions including obesity and diabetes. Poor air quality could increase the risk of asthma and subsequent exacerbations. Our colleague Dr. Elizabeth Baca, a pediatrician, recalled working with young children who suffered from high blood pressure, hypertension, depression, obesity, Type 2 diabetes, and other diseases typically only seen in adults. In her blog, she noted that the percentage of US children with a chronic disease nearly quadrupled between 1960 and 2005 (see No one should be surprised that low-income populations are being hit harder by COVID-19). Preventing childhood obesity in particular is a top challenge and priority in pediatrics. An obese child often becomes an obese teenager who is likely to become an obese adult, which can result in a lifetime of chronic health conditions.¹¹ Obesity is now classified as a complex multifactorial chronic disease and not just a risk factor for other noncommunicable diseases and comorbidities.¹²

Focusing on the non-medical drivers of health (e.g., housing, education, food, and physical and social environments) can have a significant impact on health, outcomes, and costs (see our report, Addressing the drivers of health). The social environment can start to influence a newborn’s health immediately after leaving the hospital. Some children, for example, are born into food insecurity, or might live in an area that has poor air quality. Pediatric offices and children’s hospitals should try to identify drivers of health that could have an impact on the lives of the children and families they serve.

4. Workforce transformation: Deloitte’s vision for the future of children’s health and pediatric care will rely on a transformed and mission-driven workforce. Turnover and workforce challenges are not new to children’s hospitals. Some children’s hospitals have struggled to sustain access to an adequate workforce of pediatric-trained physicians, particularly pediatric subspecialties including developmental pediatrics, pediatric psychiatry, pediatric neurology, and genetics.¹³ Quarterly turnover among registered nurses topped 75% between the first quarter of 2019 and the third quarter of 2021, according to a survey of children’s hospitals.¹⁴ Stress, burnout, and retirement are often cited as the main drivers of pediatric workforce challenges.¹⁵ Creating a more flexible staffing model, reducing low-value and administrative tasks, and helping clinicians advance their careers could help reduce burnout while also improving retention, according to Deloitte’s survey of 500 frontline clinicians (see Addressing health care's talent emergency).

Children often have different care needs than adults. In children’s medicine, we like to remind people that kids are not just small adults, creating unique workforce needs for children’s health systems. For example, an adult who needs an MRI typically lies still in an MRI machine until the test is complete. A young child, on the other hand, might not be able to lie quietly and may need to be sedated, creating additional risks and additional workforce requirements. For example, child life specialists often work with children and their families in clinical settings to help them cope with the challenges of illness, disability, or hospitalization. They are typically trained in child development and provide critical services such as therapeutic play to reduce a child’s anxiety level during a hospitalization. Kid-friendly devices could also help to reduce anxiety. Celebration Health in Florida, for example, turned its imaging area into a four-dimensional beach scene, complete with ocean sounds and smells. MRI and CT machines are housed in faux sandcastles, and the walls are painted with tranquil beach scenes.¹⁶

Finally, technological advances, particularly around AI, could also impact the pediatric workforce of the future. For example, Boston Children’s Hospital’s chief innovation officer is increasing investment in AI-based tools that could help increase staff efficiency and reduce burnout. Their goal is to begin building out some of these tools internally, identify use cases, and then train their workforce accordingly.¹⁷

Conclusion

As another summer fades away, children may be heading back to classrooms and daycares. As kids get exposed to various viruses, children’s hospitals and pediatricians are likely to see a wave of patients. In addition, the stress and anxiety of starting a new school year could exacerbate existing physical or mental health conditions or trigger new ones.

We believe the four factors laid out above, while not an exhaustive list, will likely be instrumental in shaping the future of children’s health. These factors could build upon recent progress to advance the ability to predict, diagnose, treat, and prevent childhood illness. We are optimistic about the future of children’s health and look forward to a future where care may be accessible, equitable, enhanced by technology, and delivered by a mission-driven workforce that is positioned to experience a sizeable transformation. 

Acknowledgements: Elizabeth Baca, M.D., M.P.A., managing director, Deloitte Consulting LLP, and Jay Bhatt, D.O., managing director of the Deloitte Health Equity Institute and the Deloitte Center for Health Solutions, Deloitte Services, LP

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Endnotes:

¹ Bright Futures, American Academy of Pediatrics

² Vaccines: How they are just like your baby’s car seat, Texas Children’s Hospital

³ Children’s mental health is in crisis, American Psychological Association, January 1, 2022

⁴ Pediatric emergency department visits associated with mental health conditions before and during the COVID-19 pandemic, Centers for Disease Control and Prevention, February 25, 2022

⁵ UPMC Children's Hospital launches pediatric behavioral health walk-in clinic, Trib Total Media, August 14, 2023

⁶ Behavioral Health & Wellness Center at Children’s, press release, Children’s Hospital & Medical Center, Omaha

⁷ Parenting kids in the age of screens, social media and digital devices, Pew Research Center, July 28, 2020

⁸ Robots help children with autism improve social skills, YaleNews, August 22, 2018

⁹ Covid sparked a mass adoption of technology, Forbes, June 7, 2023

¹⁰ KidsMD at Boston Children's Hospital

¹¹ Progress on childhood obesity, Centers for Disease Control and Prevention, September 4, 2018 

¹² Regarding obesity as a disease: Evolving policies and their implications, Endocrinology and metabolism clinics of North America, September 2016

¹³ Statement for the Senate HELP Workforce Hearing, Children’s Hospital Association, February 26, 2023

¹⁴ Staff shortages make patient surges harder for children's hospitals, CNN, October 28, 2022

¹⁵ Occupational well-being in pediatricians, European Journal of Pediatrics, February 19, 2019; Children’s Hospitals work to address nursing staffing challenges, Children’s Hospital Association, April 26, 2022

¹⁶ Healing environment at Florida's Celebration Health, Press release, Wacky World Studios, December 6, 2011 

¹⁷ Why Boston Children's is hiring an in-house ChatGPT expert, Becker’s Health IT, May 2, 2023

This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor.

Deloitte shall not be responsible for any loss sustained by any person who relies on this publication.

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