Current child health challenges and opportunities in the United States

This past century has seen a 15-fold decrease in child mortality and a 56% increase in life expectancy in the United States of America. A shift has occurred in morbidity and mortality from infectious diseases to that from unintentional injuries. New morbidities such as obesity, atopic disease and mental health dominate public health discussion. This article reviews factors contributing to these shifts: (1) new patterns in sociodemographic trends for children and families; (2) paradigm shifts in the financing and delivery of child health services; (3) new morbidity and mortality from changing disease patterns; (4) challenges and promise of genetic therapy and (5) E-health. In addition, we speculate on future directions in US child health and the new role of paediatricians in this century.