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Stunting the growth of child health research: a need to reframe "children are not small adults".

The notion that “children are not small adults” has deep roots in intellectual thought. Influential scientists (Jean Piaget, PhD), educators (Maria Montessori, MD), and philosophers (Jean-Jacques Rosseau) each described how children are not only shorter in stature than adults, but also fundamentally different in their thoughts, actions, and consciousness. Pediatricians have long adopted “children are not small adults” as a motivating mantra. Child health researchers utter the same aphorism to justify scientific inquiries specific to children’s health conditions and concerns and to remind public and private stakeholders (including Congress) why it is essential to conduct research regarding children.1 However, “children are not small adults” is not working as a rallying cry. A recent comprehensive assessment concluded that “lack of research, poor research, and poorly reported research”2 greatly limit child health research. Children participate in medical research at rates less than one-half those of adults, perhaps attributable to inadequate opportunities, ineffective recruitment strategies, and parents’ greater concerns about their children’s safety than their own in research settings.3 Meanwhile, health care spending on children declines every year as a share of national expenditures, causing concern that investment in child health research will decline as well.4 Contrary to intentions, “children are not small adults” has led research priority setters to disconnect the needs of children from the predominant national focus on the health and health care needs of adults. Children are indeed different from adults—but that does not imply that children are not connected to adults. Rather, the exquisitely meaningful links between children and their caregiving family members, and between children and their later adult selves, are keys to converting current child health research challenges into opportunities. If researchers seize the moment to reframe their field in terms of the burden of disease that is similar in consequences to that of adults and origins of disease that lay groundwork for many health conditions that affect adults, it may be possible to infuse the field of child health research with new justification, rigor, and intensity.