Digital health in pediatrics

Mental illnesses are associated with a large disease burden with increased morbidity, mortality, and financial costs. In the United States, three of the leading illnesses associated with pediatric disease burden are psychiatric (depression, bipolar disorder, and schizophrenia). Psychiatric illness in children and adolescents is a key risk factor for completed suicide. Approximately half the adults with mental illness received the diagnosis before age 15. At least 1 in 10 children require mental health services. Most youngsters do not receive them.

Our goal as child and adolescent psychiatrists is to ensure that as many of our patients as possible are provided the comprehensive care they deserve. The challenge is that there are still not enough of us to serve patients in need. Our field is working to address the scant access to psychiatric care through the use of innovation. Successful outcomes have been reported by experts in telecommunication technology, demonstrating that teleconnection is feasible, acceptable, and highly effective. The pediatric community continues to lead efforts to do more, to find pathways that break through the limited availability of the workforce.

My role as a subject matter expert for a digital health company offered me an experience that became a “tipping point” in my career. It advanced my vision while delineating a clearer path on how to set new ways to practice and improve on the current models of care, which I want to share. Digital health technology, which has been successfully integrated into other areas of healthcare, such as neurology, endocrinology, and cardiology has lowered many hurdles, including healthcare fragmentation, sub-optimal service coordination, the provision of timely intervention, problems with accessibility, and the availability of special services. I believe that adopting those models while learning from their experiences can also benefit behavioral care in pediatrics. 

For example, due to the flexibility of delivery, e-therapeutics can reduce barriers to health care, help engage and retain patients and families in services, and provide education, guidance, and community support. Such tools are especially relevant for children and caregivers with physical disabilities or special needs that limit their ability to travel to doctors’ offices or clinics. Digital tools are particularly appealing to teens, who feel more comfortable engaging with e-technology than they do consulting healthcare providers. Well established outreach programs for college students that are used as a preventive measure against substance abuse include

Some of them hold great promise to be useful for in-the-moment intervention during an emergency. Timely delivery saves lives. Something as simple as a supportive text message to an overwhelmed diabetic teen can make a crucial difference and strengthen their commitment to treatment. Such intervention is also highly cost effective.

The strategic use of digital tools can also lead to more meaningful use of electronic health records, which, in turn, can facilitate communication among providers and families, improve service coordination, and provide links to available behavioral healthcare resources.This kind of synergy is especially crucial in the case of children, whose mental health is dependent on the harmony among their multiple caretakers.

Obtaining informed consent in pediatrics often is not linear. When parents are not willing to consent to psychopharmacological treatment, it is mandatory to honor differences of opinions while preserving the alliance with families. Therapeutic education system (TES) applications can change this challenge into an opportunity to empower families through education and cognitive shift in focus on what is possible rather than what is ideal.

Stress Tracker app and Breath2Relax app are examples among many other popular and ready-to-use behavioral health applications intended to augment coping skills. Practicing mindfulness and diaphragmatic breathing has a strong evidence base. It is also suitable for the whole family. Studies found that self-directed therapeutic applications are as effective as counseling delivered by highly trained clinicians. Learning in one’s natural environment may enable generalization of new learned skills when applied in real-world setting. In my opinion, linking TES with routine treatment have great potential to substantially augment patient care with little expense or clinical time.

Sensor technology, especially wearables with embedded sensors are evolving rapidly while transcending systems and disciplines (from forensics and laboratories to daily use). Wearables measure and monitor blood pressure, skin conductance, mobility, posture, oxygen levels, respiration, sleep, temperature and event heart rhythm. There are unlimited benefits that sensor technology holds for healthcare and especially for behavioral health in pediatrics. Precise and accurate data obtained through sensor technology is invaluable for experts in genetics, genomics, metabolomics, proteomics, neurobiology, and scientists from other disciplines searching for biological markers of illness, their evolution and adaptation in response to external influences.

Pediatricians and child psychiatrists have in-depth understanding of the importance of environment on children’s health and development. Numerous studies of ADHD, autism, anxiety-related conditions, developmental psychologists, by clinician-researchers like Dr.Heidelise Als demonstrated the environment’s potent influence on the maturational process.

We need more data to ensure effective advocacy for children through education and collaboration with healthcare delivery venues. My hope is that with help of sensory technology live data can be collected to spearhead research efforts to gain deeper understanding of the unique affinity between environmental and biological markers that determine the trajectory of symptom development.

Finally, unlike many other forms of scientific investigation, digital research is perfectly safe for children and its findings important to patients of all ages. By virtue of their dynamic, active, and anabolic nature, children can be a source of invaluable information in determining what barriers might limit human growth and treatment response, obtaining right-on-target, data-driven evidence-based valid results. The vital knowledge gained from pediatric digital research could well turn out to be a game changer benefitting the medical field at large. We should be careful not to miss this opportunity for a healthcare reset.

In summary, this is an exciting time to shape integrated pediatric care by harnessing the greatest benefits from technology-based diagnostics and therapeutics.