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Challenges to 21st century paediatrics

In this issue of Acta Paediatrica, a working group at the European Paediatric Association and the Union of National European Paediatric Societies and Associations (EPA ⁄ UNEPSA) examines the challenges and goals of 21st century paediatrics (1). The report focuses on the future of primary paediatric care in Europe. Paediatricians in the 19th century had a very limited ability to cure disease. However, their skill when it came to describing clinical symptoms was well developed and our 19th century colleagues were able to provide good supportive care. During the 20th century, we saw a dramatic change in morbidity and mortality as a result of the development of vaccines and new medicines, most importantly antibiotics. Today, we are not only able to diagnose and care, we can often also cure. Over the next few decades, the challenge for paediatricians in primary care is not only to consolidate the achievements that have been made but also to develop preventive medicine and health care. To do this, physicians and healthcare staff caring for children must have the appropriate training and skills. The presence of paediatricians in primary care varies between the European countries and also within countries. We believe that a strong presence of paediatricians in primary care is in line with what young families want, as well as being cost effective (2). However, in most European countries, a large percentage of the children in primary care is seen by general practitioners, GPs. For this reason, it is essential to include a satisfactory paediatrics curriculum in the training of all the doctors in primary care. As things stand, this differs substantially. So the time GPs spend on paediatric training needs to be increased in many European countries, including Sweden. It is important that GPs are well acquainted with the preventive aspects of paediatrics in their work at child healthcare centres and schools, as well as in outpatient paediatric practice (3).