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1st appeared 3 November 1998 California Children Lucky to Have Lucy Crain Whenever she gets a chance, pediatrician Lucy Crain sits down and reads to a child. During checkups, she asks her patients' parents about time spent reading and singing to their children. She reminds them that these are good ways to teach the simple truths of how to get along in the world. "Parents listen to pediatricians," Crain says. "We have the privilege to help mold the development of future generations."
Currently she is the 1997-2000 chairperson of the AAP's ninth regional district, and a member of the AAP board of directors. When the AAP held its annual meeting in San Francisco in mid-October this year, Crain was one of the hosts to 10,000 pediatricians and other pediatric specialists from around the world, representing primary care and more than 40 medical subspecialties. "The AAP is unique among the medical professional organizations," Crain says. "We probably spend more time advocating for our patients than we do on advocacy for our own profession." In California, for example, she says that AAP, working with other child advocacy groups, deserves credit for laws governing bicycle helmets and swimming pool safety, and for the Stop Tobacco Access for Kids Enforcement act (STAKE). Currently one of Crain's chief interests is violence prevention. "We have an ongoing issue with Governor Wilson's repeated vetoes of gun control legislation," she says. To Crain, it seems obvious that children should not have access to guns -- if families must keep guns in their homes, they should lock them up securely and clamp locks on a trigger. "If you approach this from a child development perspective, you can see that a child doesn't know the gun is real, doesn't know that if you kill somebody they don't come back to life in the next TV installment." When a child kills someone with a gun -- or kills himself -- this is no accident, Crain says: these are preventable injuries. "As pediatricians, we have a responsibility not only to decrease or eliminate access to guns by children but to work for a whole attitude change on society's approach to violence. Children should not have access to weapons of destruction and murder. But in addition they and their parents and communities need to learn new attitudes to conflict resolution. In treating violence, prevention is the name of the game." Another major legislative issue is access to health insurance coverage. As many as 1.4 million California children are uninsured but 500,000 of them are thought to be eligible for insurance through the new Healthy Families Program, California's program under the federal Title XXI. However, Crain says that Californians are not being made aware of the opportunity.
For most pediatricians, however, the real opportunity to influence children's lives comes not in legislation but in everyday medical practice. Crain advocates "anticipatory guidance" -- offering advice on health and well-being that fits the child's stage of development, and looks ahead to the stages just about to come. With this approach, a physician takes advantage of prenatal care visits to talk before the baby arrives about breastfeeding and carseats, and start a dialogue on who's going to take care of late-night feedings. As the child comes in for vaccinations, the physician looks ahead to health and safety issues. "At eight or nine months, I give the mothers ipecac so they can induce vomiting if the child gets into Mom's purse and swallows a handful of pills," Crain says. Pediatricians are practicing violence prevention when they teach parents how to discipline their children with "time outs" and non-abusive interventions, Crain says. In the teenage years, "You don't wait until the 16-year-old honor student is in your office and pregnant. You talk years ahead of this about sex education and abstinence, values, peer pressure and long-term goals." This approach to children's health is not necessarily compatible with managed care, Crain says. Pediatricians -- already among the lowest paid physicians -- increasingly are being pressured to spend less time with their patients. Treatments for children with special needs -- like a 10-year-old who has outgrown the wheelchair made for her when she was six -- increasingly are being denied. "The managed care industry is not child-friendly for the most part," Crain says. "I think it's too easy for people to understand that prevention equals vaccination, but not to understand anticipatory guidance. The battles on this front are ongoing, and unfortunately, the children are the pawns." Links: American Academy of Pediatrics Source: Janet Basu, News Services |
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That idea -- that pediatricians have the opportunity
and the obligation to influence the way children are cared for, beyond the clinical tasks
of "doctoring" -- has shaped much of Crain's career. A professor of pediatrics
in the Division of Adolescent Medicine at UCSF, she is director of the outpatient
Pediatric Disabilities and Down Syndrome clinics for Lucile Packard Children's Health
Services at UCSF. She also is a leader on child advocacy issues, and has worked for many
years on local and state legislation via the Northern California chapter of the 
"California children stand to lose $1.2 billion
in matching funds if the Healthy Families Program is not successful in outreach and
enrollment of the children and procuring access to pediatricians and other primary care
providers," Crain says. There also are health coverage problems with the advanced new
vaccines for children: pediatricians consider the vaccines essential, yet they are far too
expensive for most young families, and many health plans will not adequately pay for them.