The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational.
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First, it presents a scientifically grounded, ecobiodevelopmental (EBD) framework to stimulate fresh thinking about the promotion of health and prevention of disease across the lifespan.
Second, it applies this EBD framework to better understand the complex relationships among adverse childhood circumstances, toxic stress, brain architecture, and poor physical and mental health well into adulthood.
As concerns continue to grow about the quality of public education and its capacity to prepare the nation’s future workforce, increasing investments are being made in the preschool years to promote the foundations of learning.
Although debates about early childhood policy focus almost entirely on educational objectives, science indicates that sound investments in interventions that reduce adversity are also likely to strengthen the foundations of physical and mental health, which would generate even larger returns to all of society.
An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice.
It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health.
In the middle of the 20th century, as effective vaccines, antibiotics, hygiene, and other public health measures confronted the infectious etiologies of childhood illness, a variety of developmental, behavioral, and family difficulties became known as the “new morbidities.” By the end of the century, mood disorders, parental substance abuse, and exposure to violence, among other conditions, began to receive increasing attention in the pediatric clinical setting and became known as the “newer morbidities.” Most recently, increasingly complex mental health concerns; the adverse effects of television viewing; the influence of new technologies; epidemic increases in obesity; and persistent economic, racial, and ethnic disparities in health status have been called the “millennial morbidities.”Advances in the biological, developmental, and social sciences now offer tools to write the next important chapter.
The overlapping and synergistic characteristics of the most prevalent conditions and threats to child well-being—combined with the remarkable pace of new discoveries in developmental neuroscience, genomics, and the behavioral and social sciences—present an opportunity to confront a number of important questions with fresh information and a new perspective.
Although new discoveries in basic science, clinical subspecialties, and high-technology medical interventions continue to advance our capacity to treat patients who are ill, there is growing appreciation that a successful well-care system must expand its scope beyond the traditional realm of individualized, clinical practice to address the complex social, economic, cultural, environmental, and developmental influences that lead to population-based health disparities and unsustainable medical care expenditures.
The science of early childhood development has much to offer in the realization of this vision, and the well-being of young children and their families is emerging as a promising focus for creative investment.
The history of pediatrics conveys a rich narrative of empirical investigation and pragmatic problem solving.