"There is nothing in a caterpillar that tells you it's going to be a butterfly."
—R. Buckminster Fuller, architect, designer, inventor, author
Today, we know what is "in" a caterpillar: its DNA, which can tell us a lot, but obviously not everything. The deeper layers of meaning to these words, when applied to pediatric healthcare, can be fuel for discovery.
During my eight years as CEO of Boston Children's Hospital, the most profound lessons I learned came from those who care for children. I have been fortunate to witness their search for answers with one goal in mind: to advance and improve the health and well-being of children. The caterpillar-to-butterfly journey is their everyday path.
There's a tremendous amount of work ahead of us to secure our children's future. Here are five of the most important lessons I've learned that can guide our work going forward:
We are only just now beginning to understand the long-term impacts of COVID on children
It may be years before we fully understand how the pandemic impacted children and adolescents. But at Boston Children's, our research teams are leading multiple efforts to understand the long-term impacts of the pandemic on children. In just one recent example, our own Dr. Adrienne Randolph is leading a CDC-sponsored, nationwide study—involving research conducted at 66 hospitals in 31 states and recently published in JAMA—to distinguish COVID-related multisystem inflammatory syndrome in children (MIS-C) from severe, acute COVID-19 infection.
Behavioral health was an epidemic before COVID, now it's a crisis
Currently, too many behavioral health challenges are caught way too late. Too many children begin their care in the emergency department, which is neither optimal care nor sustainable.
While we witness huge spikes in demand for behavioral healthcare, there are still long-term shortages in staffing, capacity and appointment availability, as well as serious disparities when it comes to access by race, ethnicity, geography and socio-economic status.
Pediatric behavioral health requires new thinking on a national level—approaches to care that address each child's whole health across the spectrum of factors including: food, exercise, housing, education, environmental conditions and community supports.
Children are not little adults
Our goal as a society must be to help each child start his or her life as healthy as possible. Boston Children's—like pediatric hospitals across the country—is a specialized care environment for children; our patients come with many unique needs–from premature babies to adults with congenital conditions that require lifetime care.
The ability to care for young and adolescent patients requires not just specialized equipment, but also expertise, technology and therapies. That specialization and the attention to how care is delivered to include the whole family is part of the important role that pediatric hospitals play in society. To reduce the countless threats to children at risk, we must seek a better understanding of the value and return on our collective investment in both pediatric care and research. Both federal and state governments can play a critical role in assuring adequate funding for pediatric care providers and researchers, and should increase their focus on the evaluation of long-term health, economic and social benefits of investing in children. Investing in children can generate substantial and measurable long-term benefits, ranging from improved behavioral health outcomes to better high school graduation rates.
Pediatric research is a multilegged marathon
My colleagues never give up. Across a network of pediatric research institutions, we are part of an endless relay, run by thousands, where work is often handed off after years of investigation to be carried further by a new generation.
In unpredictable time frames, but still consistently delivering, we have translated research into care and witnessed how this work helps patients in need. In our labs, the next big discoveries are truly just around the bend. We are just beginning to discover the genetic basis of pediatric diseases which will lead to new innovative gene and cell therapies for conditions currently untreatable.
Children are 25% of our population, but 100% of our future
Healthy children are the foundation of a healthy society. Yet, today, 20% of children live in poverty; 50% of children live with chronic disease; 1 in 5 kids suffers from mental and behavioral health issues.
To make the transformational change our children need, we must pause and look at these issues through a different lens and time frame, not budget cycles and election cycles, but life cycles.
We must recommit to investing in our children. We must invest in their health, development, education and their well-being, to ensure that their future is the strongest and healthiest it can be. Opportunities exist, through the existing COVID relief packages and upcoming infrastructure bill, to invest in the people, facilities, technology. We should not miss them.
Across children's hospitals and pediatric research, we continue to look "in a caterpillar" to find answers and reveal beauty yet to unfold. The payoff will come not just tomorrow, but for generations, as we help to build the strongest and healthiest future possible for every child.