The greatest challenge facing children in 20 years’ time will be mental health problems, the Royal College of Paediatrics and Child Health has warned.

The College asked almost 300 members what they envisage will be the biggest health issue affecting children and young people in 2040. The top three responses were mental health (43.71%), obesity (31.14%) and climate change (10.78%).

“For adolescents and young adults, we forecast significant future increases in poor mental health, substance use and the consequences of prematurity. This was set to happen even before the impact of COVID-19, based on previous trends,” said the report.

“Paediatricians will likely need to spend a greater proportion of their time looking after children with more complex healthcare needs and working across physical and mental health,” it added.

For paediatricians, there will be a need for broader training that includes increased numbers with skills in dealing with mental health problems, broader adolescent health issues as well as the consequences of neonatal survival, such as neuro-disability and epilepsy.

The last decade has seen a dramatic increase in referrals to child development centres or child and adolescent mental health services when there are concerns regarding social communication disorders, such as autism in children, behavioural issues and attention deficient hyperactivity disorder. Throughout the United Kingdom the services offered for community, neuro-disability and CAMHS differ depending upon place, which means it is difficult to generalise on appropriate models of care. However, the pathways for these children are complex, often involving social services and education as well as medical provision.

The failure to provide timely and effective services increases the vulnerability of these children, resulting in increased risk of harm especially to their mental health and resulting risk of self-harm and suicide. Their social vulnerability is evident in multiple environments and pathways that ensue. Timely diagnosis and intervention are needed to ensure educational attainment is achieved, alongside a reduction in social vulnerability and improved mental health. There is evidence that integration of services with a multidisciplinary team-based approach - where competencies are more important than role definition - results in a timely cost-effective service provision with improved health outcomes.

The College warns that without implementation of integrated care, they expect to see a significant rise in the number of children and young people needing paediatric care via both emergency department and outpatient routes.

Without targeted investment in existing roles and funded expansion of new workforces, such as Advanced Clinical Practitioners, paediatric workforce pressures are set to worsen, with projected decreases in the SAS doctor role and community paediatric workforce, and more doctors working less than full time.

There will also there will continue to be increasing challenges to child health as a result of the impact of worsening poverty and climate change.

The College asked the following questions in addition to their question around the greatest challenge to children’s health:

- In 2040, what do you think will be the biggest innovation that has changed practice in your field?
The top themes were new models of care, technology, and personalised medicine.

- In 2040, what is the top thing you want to be different about the delivery of paediatric care?
The top themes were moving care out of hospitals, staffing, and using technology to strengthen IT systems.

- In 2040, what is the top thing you want to be different about the working lives of paediatricians?

The top things they said were working hours, flexibility, better treatment and protection of paediatricians, and more staff.

The report outlines that paediatricians will remain a central part of the integrated child health workforce in 2040, however, their roles will look different. There will be increases in technology to support care which will mean that paediatricians will be supporting children and young people in new ways. Those conducting face to face work may not be seeing patients in the traditional settings expected today.

Paediatricians will likely need to spend a greater proportion of their time looking after children with more complex healthcare needs and working across physical and mental health. They will also spend more time working at a global health level, supporting colleagues with the impacts of emerging pandemics and population health issues.

Paediatricians will also need their colleagues in other healthcare roles to be appropriately trained and supported to see the healthier child, giving them time to support children with complex needs.

“We want to see significantly improved integration across physical and mental health, challenging management to enable working across professional and organisational boundaries, to provide the best possible care for children and young people. This is in response to our forecasts of future burden of disease expected in 2040, especially among adolescents,” the report concluded.

Paediatrics 2040 Forecasting the future