Is Your Child's Asthma affected by Your Marriage?

In 2007 a study by the CDC reported that over 9 million children were reported to have the diagnosis of asthma.  They studied this information to see if the family structure affected whether a child's asthma was kept under control.   What they found was very interesting: 

1. Children living with biological or adoptive parents—either in nuclear families or unmarried biological or adoptive families—were less likely to have ever suffered from asthma than children in the remaining family types 
2. Children in single-parent families were more likely than children in nuclear families to have asthma regardless of their gender, race/ethnicity, parent’s education, family’s poverty status, place of residence, or region.  
3. Among children with private health insurance, those living in nuclear families (10.4%) were less likely to have asthma than children in single-parent (15.3%), unmarried biological or adoptive (15.5%), blended (13.7%), extended (13.9%), or other (18.7%) families. Among children with Medicaid, those living in nuclear (11.4%) and unmarried biological or adoptive (9.3%) families were less likely to have asthma than children in single-parent (20%), blended (15.3%), cohabiting (16.5%), extended (16.4%), or other (17%) families.  

I think this is rather interesting, but that may be because I see it so much in my practice.  The #1 Children living with biological or adoptive parents were less likely to have ever suffered from asthma.  That doesn't mean that there are not children in two-biological homes that suffer from asthma, there are! But what it's saying is that children in a nuclear or two-parent home have less chance of suffering from asthma.  

I can understand now how this might be affecting the children.  When there are two parents in the home, there is more help.  In other words, it's not just mom that has to watch for the symptoms and give the medications.  When I have children going back and forth from one home to the other the compliance is a bit more tricky.  Parents don't seem to be on the same page, there are some control issues that keep the child from being cared for and children or parents may forget the medicines.  

It might be thought of as not that big of a deal when a child forgets his/her medicine for the weekend, unless they have an asthma attack.  Asthma can kill.  I have seen children die from asthma attacks.  We have learned so much in the last few years on how to control asthma, but the medicines are a big part and it has to be daily medication.  How do you remedy this when you have two parents fighting over issues and medications are forgotten or not sent.  Or you have a single mom that is trying to survive with children and she forgets to give the medication or remind the child to take the medication.  

So this is definitely a problem.  If we know this when we do a well check or even when we do our asthma re-checks we can actually prevent the problems and help the family problem-solve.  We as medical providers MUST be advocates for the patient or the child.  If we ask non-judgementally "Are you guys married, do you live together?" then you have a better idea how to work with the family.  Also when we make notes in our charts regarding this it allows the next healthcare provider or even the present to remember the situation and work within the parameters of what the family has to work.  

This is definitely a way to prevent Asthma from being out of control.I see this as what Obamacare was originally thought to do.  When we prevent big problems such as uncontrolled asthma we can save money in our tax dollars, the children will lose less time at school and tend to do better at school and parents will have less time off of work because they have to take child to the doctor.  Seems like a Win-Win to me.  What do you think?  

Family Structure and Children’s Health in the United States: Findings From the National Health Interview Survey, 2001–2007, Vital and Health Statistics, Series 10, #26, December 2010.  

Should Marriage be talked about in the the Medical Office?

If you know me you know how passionate I feel about marriage and how it effects our children.  We are seeing more and more research that demonstrates this.  Several colleagues have questioned my desire to check with a family about how their marriage is doing.  They have expressed that this is not part of the anticipatory guidance that is needed for a child or that this is getting too personal and it's really none of a healthcare provider's business to ask these questions.  A healthcare provider should focus only on the patient's health and it's inappropriate to ask anything else.  Well, I am proposing that this is one of the MOST important ways to determine how the child is doing.  

Twenty years ago I started using a form that was provided by the government as a good check off list for anticipatory guidance.  It did include a question about the marriage relationships and how the family is doing as well as summer safety, bicycle helmets and many other issues that are important for children's safety.  In the past twenty years we have done further research and found that when there is increased conflict that leads to violence there is a greater chance that the children will be effected emotionally.  So much so that this has been determined as one factor that allows the Children and Family Services to remove a child from the home. Why aren't we asking these questions?  Dr. John Gottman has found that when there is increased violence in the home the child has many more illnesses.  So why don't we ask before we get into this situation?  Could it not be helpful to get them resources before violence occurs?  Could we prevent some problems such as non-compliance, depression, neglect, and many other stress related illnesses? We are more comfortable giving them summer safety advice and helmet safety rather than talking about relationships and how they effect a child's health.   If we do not talk about this or ask the questions do you think the patient might bring it up? 

To be honest many years ago when I was going through my tough divorce, I felt like my medical

provider would be a good resource for finding help for the children emotionally.  Unfortunately, my provider had no clue.  Most medical providers a very much trusted by their clients, so much so that they will reveal very intimate information that may not be revealed to anyone else.  If they are trusted this much don't you think it's pretty important to encourage them to get good information or to refer to good resources to prevent the problems that troubled relationships can have.  

I remember when I was young there were so many physicians that smoked, it was not even considered

a medical problem.  There were just a very few that were willing to challenge their patients on their smoking habits.  Other colleagues would scoff and seem to think it wasn't a problem. But look what we have now.  There are tobacco quit lines, all kinds of stop smoking classes and devices, because we found out it does effect our heath and life expectancy and the money we pay out for our medical insurance.  

Another recent example is the weight problem that we see.  Many 

would not address the weight of their  patients.  I remember a friend of mine being so offended because her physician labeled her as obese.  But it needed to be said.  We as healthcare providers need to be pointing out where people can improve their health.  We are not doing what we are expected to do if we don't address the issues.  But the majority of providers will not ask the question, "How's your marriage doing?" or "Are you two married?  why not?"  That might be too uncomfortable, it might offend someone, it might make them leave the practice.  I believe that most people want to know what they can do to improve their health.  But you have to say it in a way that it can be accepted.  Just as saying your fat can prove to be ineffective, you can't ask any personal question without being upfront and honest but doing it in love.  

I would love to know what you think.  Do you think this should be talked about?  Who do you ask these kind of questions.  Over the next couple of weeks I'm going to be looking at the health of your marriage and how it effects your health.  Let me know if this is helpful, ok?  Thanks for reading.