These slides contain the lecture content for Week 10.

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Week 10
CHILDREN’S
COMMUNICABLE
DISEASES
Instructor: Gina Crosley-Corcoran, MPH
PBH 805 – Maternal & Child Health

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Introduction
Toddler and preschool years: children from 1 to 5
years of age
• A period of rapid physical, cognitive, and emotional
development
• Vulnerable to external factors, such as poverty, environmental
toxins, and violence, during this time
• Integral to setting a solid foundation of health and well-being
across the life course
• Health disparities that occur during this phase may persist
throughout an individual’s life

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The Toddler/Preschool Age Child
During the second and third years of life, the toddler can move independently, can communicate
more clearly, and has a sense of identity as a separate person with specific characteristics.
Language development: beginning at age 18 months, a toddler’s working vocabulary catapults
from about 50 words to learning approximately 5–10 new words every day.
Ages 3 to 5 (toddler years to the preschool period)
• Develop a sense of identity and initiative and can follow directions
• Play with words and ideas, invent new games and demonstrate symbolic pretend play, acquire new social skills, and learn
moral rules
• By age 4 or 5, preschoolers develop a rudimentary but well-organized theory of mind for understanding other people’s
behavior.
• Use words to manage their thoughts and feelings
• Rapid growth in areas of the brain associated with self-regulation (defined as the ability to focus attention, delay of
gratification, and impulse control)

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Toddler/Preschooler Demographics
In 2017, children younger than age 5 years accounted for
approximately 6% (estimated 16 million children) of the
total U.S. population (Source: U.S. Census Bureau, 2018).
• Slightly less than half of these toddlers and preschoolers (7.8
million) were female.
• Consistent decrease in the proportion of children classified as non-
Hispanic White, with a corresponding increase in the percentage of
children in the U.S. who are Hispanic—this trend is projected to
continue over the next several decades.
• The proportion of the population comprised by other races has
been, and is projected to remain, relatively consistent (Source:
Childstats.gov).

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Overall Health Status of Toddlers and Preschoolers
Overall health status of toddlers and preschoolers
• General Health Status (Source: National Survey of Children’s Health)
• 92.8% of children younger than 6 years of age are in “excellent or very good” overall health,
as rated by their parents.
• The health of children in this age group is rated higher than that in any other age group.
• One-fifth of children (21.5%) have at least one current or lifelong health condition (such as
allergies, concussions, mental health conditions, and diabetes) that could impact health and
functioning.
• 23.7% of children have at least one functional difficulty, such as frequent or chronic
problems with breathing, eating or swallowing, or digesting food, as well as chronic pain and
difficulties with movement.
Factors contributing to the overall health status of children
• Genetics, family systems, social determinants of health, access to and utilization of health
care, including preventive health care in the form of well-child visits.

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 American Academy of Pediatrics (AAP, 2020b)
recommends 7 well-child visits from 1 to 4 years of age
 Opportunity for physicians to monitor children’s growth
and development, obtain a medical history, conduct a
physical examination, administer screening tools and
questionnaires, provide anticipatory guidance to parents
and caregivers, and administer vaccinations
Well-child visits
(health supervision visits)

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Well Child Visit Schedule
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Vaccinations Under 6 yrs
 According to the CDC’s vaccination
schedule, children should receive
10 vaccines in the first 6 years of
life, with each typically delivered
through multiple doses.
 Despite the effectiveness of
vaccinations, there have been
steady decreases in vaccine uptake
and compliance with the
recommended immunization
schedule due to misinformation
about the safety of vaccines and
false claims about a link to autism.
 Community (or herd) immunity to
overall population-level health is
important; increases in vaccine
exemptions are concerning.

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Vaccine-Preventable Disease
SOURCE: https://www.cdc.gov/vaccines/parents/diseases/index.html

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Parental Vaccine Refusal/Hesitancy
 From the NEJM article (https://www.nejm.org/doi/full/10.1056/NEJMms2101220):
 Modifying beliefs of vaccine hesitancy is more difficult than first
thought
 Emotional appeals tend to have the opposite effect and instead
create fears of side effects, rather than instilling fear of the disease
that vaccines help prevent
 CDC Recommends that providers automatically assume
that parents will vaccinate by default, rather than
passively offering vaccines (https://www.cdc.gov/vaccines/hcp/conversations/talking-
with-parents.html)

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School-Aged Demographics
Children 5 to 9
years old represent
6.6% of the
American
population (2010).
There are more
school age boys
(10,389,638) than
girls (9,959,019)
(2010).
Of this population,
74% are White,
15% are Black or
African-American,
4.6% are two or
more races
In 2010, 9.7% of
school age-children
are Hispanic or
Latino.

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Global Burden of Disease
The JAMA study found:
• Child and adolescent mortality decreased
throughout the world from 1990 to 2017
• Morbidity has increased as a proportion of total
disease burden, because the major causes of
nonfatal health loss during childhood and
adolescence have not changed dramatically.
SOURCE: Reiner, R. C., Olsen, H. E., Ikeda, C. T., Echko, M. M., Ballestreros, K. E., Manguerra, H., ... &
Kassebaum, N. J. (2019). Diseases, injuries, and risk factors in child and adolescent health, 1990 to 2017:
findings from the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study. JAMA pediatrics, 173(6),
e190337-e190337.c

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SOURCE: Reiner, et. al.

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Health Trends
Between 1990 and 2017, globally,
the aggregate health status of
children and adolescents
improved dramatically
particularly owing to declines in
death owing to infectious
diseases
However, nonfatal health loss has
increased in both absolute and
relative terms

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Week 10 Assignments
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