Bonita F. Stanton, MD, Consulting Editor

Expectations for childhood outcomes have radically changed over time and by nation. When infant and childhood mortality approached 150-300/1000 live births, survival was the main focus. As vaccines and antibiotics became available, followed by oral rehydration solution, many nations began to enjoy rapidly decreasing rates of mortality and could focus on major morbidities such as malnutrition. The role of education in improving health outcomes became accepted in many—and then most—nations. During much of the twentieth century, efforts focusing on psychosocial development seemed to be limited to wealthier nations and populations, but over the past two to three decades, there has been an expanded focus among nations across the globe on prevention and early treatment in this area.

In recent years, we have begun to understand the long-term consequences of early childhood diseases, conditions, and exposures. We now understand that such disorders or exposures in childhood can permanently impact metabolic and structural pathways, rendering (for example) weight loss or learning substantially more difficult and/or greatly increasing the risk of cardiovascular disease in adulthood, even when the childhood morbidity is overcome.

The ever-increasing evidence regarding the contributions of perinatal adversity—and even prenatal stressors—on long-term outcomes remind us of the long reach of environment and the need to constantly have a lifespan approach to growth and development.

In this issue, the authors provide a superb collection of state-of-the-art conditions for which effective primary and/or secondary prevention are now available. Consistent with the epidemiology of chronic illness, this issue has a particular emphasis on at-risk populations. Several articles also address how changes in the systems of health care delivery can make the goal of healthy children more attainable, regardless of demographic and/or socioeconomic factors. In some cases, the updates reaffirm earlier studies and understandings of disease causation and prevention, but in many others, our knowledge and understanding have advanced greatly in the new millennium. Today, major goals for childhood throughout the world must include happiness and optimal growth and development, leading to successful and healthy adult status.

Pediatricians have long accepted responsibility for the health of children; it is time that we also accept responsibility for the health of the adults that our children will become.