DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY

COMMENTARIES

A child is a child is a child? Paediatric terminology in a health context STEVEN HIRSCHFELD Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA. doi: 10.1111/dmcn.12829 This commentary is on the systematic review by Clark et al. on pages 1011–1018 of this issue.

One of the defining factors of human interactions is the ability to communicate through spoken and written language. It may be uncommon for a person to speak multiple national languages, but it is common to use the same words from a given language in multiple realms. Thus an ‘agent’ can be a chemical cleanser, a person that sells insurance, a new molecule for cancer chemotherapy, or an operative in an espionage plot. Given our incomplete understanding of health and physiology, different systems of organizing health-related concepts and terms have been developed for different purposes. Some of the major systems include the International Classification of Disease (ICD), used primarily for epidemiological analysis and also for coding and reimbursement; the Systematized Nomenclature for MedicineClinical Terms (SNOMED-CT) used primarily for clinical documentation and reporting; and the Medical Dictionary for Regulatory Activities (MedDRA) used primarily for submissions to regulatory authorities; and the dictionary endorsed by the International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use for reporting adverse events. Other more specialized systems exist, each with a particular focus. Although none of these biomedically-based systems – each endorsed and supported by different international organizations – are formal languages, similar principles apply in that each has an ontology or listing of what exists, semantics or how to describe or represent what exists, and syntax or the formal relationships among the elements of the system. Intense interest in melding human knowledge with machine readable systems produced several frameworks for general data and information exchange. For exchanging biomedical information specifically, examples of standards under development include the Health Level 7 initiative

and the Clinical Data Interchange Standards Consortium (CDISC). CDISC sponsors the Shared Health and Clinical Research Electronic Library (SHARE) which is a global electronic repository for developing, integrating, and accessing CDISC metadata standards in electronic format. Other initiatives such as the Yosemite Project have as a mission the semantic interoperability of all structured healthcare information. Until recently, most systems have emphasized instantaneous events and descriptions, for example a generic person with a specific condition, without rigorously addressing the context of human growth and development. Human growth and development have been addressed intermittently and sporadically with some well-known and credible organizations all proposing different boundaries and descriptions for the developmental period between birth and early adulthood. Even the definition of who is a child varies from region to region and jurisdiction to jurisdiction, depending upon the purpose – whether qualifying for education, social benefits, ability to enlist in the military, capacity to legally marry, or to participate in research studies. Recent studies demonstrate continued physical growth, hormonal changes, and neuronal maturation and remodeling past the age of 20 years. The study by Clark et al.1 uses an innovative hierarchal and statistical approach to review and discern the use of terms related to the healthcare of children in an Australian health and educational context. The source material was publicly available web pages from government and academic organizations and the results are based on empirical usage. Utilization was thus a reflection of directing information at general audiences in a specific context. The authors argue there is a need to standardize terminology and note some trends emerged regarding age groupings. The study provides a method to resolve some of the tension between the efforts to produce controlled terminologies and harmonize them for electronic data exchange and the dissemination of information for public consumption. By consistent retesting of the use of terms related to child health in communication materials as well as in medical records, research studies, laws, and policy statements, we all might reach consensus when we refer to matters related to a ‘child’ and ‘child health’ and know with precision what we are referring to.

REFERENCE 1. Clark R, Locke M, Bialocerkowski A. (2015) Paediatric terminology in the Australian health and health-education

context: a systematic review. Dev Med Child Neurol 2015; 57: 1011–8.

Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

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A child is a child is a child? Paediatric terminology in a health context.

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