Editor’s Note: Dr. Ella Perrin (she/her/hers) is a resident physician in pediatrics at Naval Medical Center San Diego. Her interests include disordered eating, obesity, decreasing weight stigma and bias, and the field of hospital medicine. The views expressed in this blog are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Dr. Perrin declares no conflicts of interest. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Children with medical complexity (CMC) are a unique pediatric population, with increased risk of medical complications and hospitalizations compared to the general pediatric population. At baseline, they also utilize increased medical resources, including supportive services such as therapies for developmental delays.
In the military, children are at risk for lapses in health care due to frequent moves and parental deployments, which may place CMC at risk for delayed recognition of health problems. They also have the added challenge of the need for care coordination between military and civilian providers; there is limited access to military pediatric subspecialists, so children are often referred to civilian medical facilities for specialist care.
The prevalence of CMC has been increasing, likely due to improved survival of premature infants and infants with severe medical conditions. Understanding the incidence (new cases in the at-risk population over time) of CMC is important in determining resource allocation. This is especially true in the military, as military leaders must frequently decide between training a physician in one specialty or another.
In an article being early released in Pediatrics this week, entitled “Incidence of Medical Complexity in Military-Connected Children,” Dr. JoAnna Leyenaar and colleagues from Dartmouth and several military institutions estimate the incidence of CMC-defining diagnoses in stateside military dependents in the first 5 years of life, and look at the associations between birth outcomes and these diagnoses, both during and after the neonatal period (10.1542/peds.2024-069653).
Authors analyzed electronic health record data from birth to 5 years of age for all military-connected children born in 2005–2015 using a Department of Defense database. They did not include children born outside of the US or same-sex multiple births. CMC was defined if there were qualifying diagnostic codes at two different visits. They then divided children based on when a diagnosis of CMC was made: in the neonatal period (≤28 days old) or between 29 days and 60 months of age.
The authors ended up with an impressive study population of >900,000 children. They found that:
- Overall, 12% of children had a CMC-defining diagnosis by 60 months of life.
- One-third of CMC met the diagnostic criteria by 28 days old and almost two-thirds by 1 year old.
- Preterm birth, low birthweight, congenital anomalies, and neonatal intensive care unit admission were associated with increased risk of meeting CMC criteria (though the majority of CMC did not have these risk factors).
- The organ system most frequently involved in medical complexity was the lungs.
This study is unique in that it provides longitudinal analysis of the development of CMC-defining conditions in a large population of children. Its findings emphasize the surprisingly high rates of medical complexity in young children, and the need to allocate resources to support them.
This is especially true in this population of military-connected children, who have added barriers to continuity of care and specialist referrals. The study has many more interesting findings that help better understand the risks of CMC-defining diagnoses, and I urge providers to read the article to learn more.
