Pediatrics
Julia Heneghan, MD, MS (she/her/hers)
University of Minnesota Masonic Children's Hospital
Minneapolis, Minnesota
Mallory Perry-Eaddy, PhD, RN, CCRN, (she/her/hers)
Assistant Professor
University of Connecticut
Storrs, Connecticut
Poverty and racial bias are linked to adverse health outcomes for U.S. children and extend to pediatric and adult critical illness. The effects of structural racism, healthcare inequities, and social determinants of health (SDH) are often neglected in addressing pediatric critical illness, yet they account for a third to half of health outcomes. SDH impacts health outcomes and post-hospital recovery of pediatric ICU (PICU) patients. In addition to individual risk factors, population-based SDH also contribute to health. Several mechanisms help explain the effects of SDH on the risk and severity of critical illness. Living in substandard conditions with lack of access to healthy food, lack of green space for recreation, or high levels of environmental pollution carry higher risk of critical illness for children. The link between long-standing toxic stress and adverse childhood experiences may also worsen illness severity. Financial hardships and lack of access to high-quality healthcare may lead to fewer preventive medical care visits and the inability to afford medication, resulting in higher risk of more severe critical illness and contributing to post-critical illness morbidity. SDH is seldom factored into the care of critically ill children; therefore, we do not know its full impact on incidence, severity, and outcomes of pediatric critical illness. One solution is to implement universal social needs assessment screenings of patients and their families in the PICU to facilitate early identification of those at risk for poor outcomes and afford the opportunity to address the needs of children recovering from critical illness. However, screening for social needs without establishing appropriate strategies or interventions to address these needs is ineffective and unethical. The pediatric critical care community must be aware of the role SDH plays in pediatric care, implement social screening in the PICU, and collaborate with other stakeholders in the healthcare system and communities.