What's wrong with Polish children?

Contents

Obesity, digital addiction, allergies… I talk to Dr. Wojciech Feleszka, a specialist in pediatrics, clinical immunology, and lung diseases, about the challenges facing Polish children and Polish pediatrics.

Are the youngest Poles healthy?

You're probably asking in the context of the WHO report, which shows that children in Poland are gaining weight faster than in other European countries. We do indeed have a problem with obesity, but it's certainly not the case that young Poles generally get sick more often than other young Europeans. Moreover, in the context of obesity, I'd say that in my opinion, Polish food is healthier than in other countries, and certainly than in the United States. We still have fewer processed foods and greater access to completely natural foods. We just need to take advantage of this.

So what health problems, apart from obesity, do children face most often?

This is a question from the field of social pediatrics, which is an extremely interesting field. From my perspective, the most significant problem facing Polish children is mass addiction to electronic media . Besides, the pandemic has made us all somewhat addicted to them, but children, in particular, have become "grown into screens." This is a new and very difficult situation for us, because we haven't created mechanisms to limit children's use of phones or the internet. And we're groping for ways to address this: we encourage reading books and limiting time on the computer, but we don't have clear, standard guidelines on how to counteract digital addiction.

So we're back to obesity again, because a computer or phone means less exercise.

Yes, but digital addiction also results in slower development and mental health problems. Research suggests that excessive screen use can reduce creativity and academic performance, increase the risk of mood disorders, and even—according to some studies—be associated with a higher risk of autism spectrum disorders. While I would be cautious about interpreting the causality of these associations, it's true that research on this topic has been published in JAMA Pediatrics (JAMA).

The impact of electronic media on teenagers is certainly very visible. In their case, media can, among other things, lower self-esteem, lead to bullying at school, and contribute to depression, not to mention the frequent "robbing" of children of sleep .

Who is to blame for this state of affairs? Parents? Lack of systemic solutions?

I wouldn't blame parents alone. We certainly lack systemic solutions at the national, or even supranational, level. Electronic media target children as potential consumers and have no limits. Recently, the Institute of Digital Citizenship prepared a report, "Children's Internet," monitoring the online activity of children and young people. Its findings are alarming: for example, over half of children aged 7-12 use at least one social media site or instant messaging app, which is permitted from the age of 13. Therefore, government regulations are needed to prevent younger children from using platforms like TikTok, Messenger, Instagram, and Facebook. They are incredibly addictive, breed numerous pathologies, and children use them en masse.

Or maybe a proper education system would help?

We should certainly teach children critical media thinking , but parental or school education alone isn't enough. Top-down restrictions are needed.

A good alternative is also needed – if children shouldn't sit in front of a computer or smartphone, where should they spend their time?

Surrounded by greenery. I'm an advisor at the Children's Development Foundation, which initiated the "Children Have Days Out" program. The goal of the program was to encourage preschools to conduct activities outside their classrooms, including trips to forests, meadows, and so on. This initiative yielded very good results, as the children were simply healthier, more physically and mentally resilient, and had better emotional functioning. Moreover, in allergology, in which I am heavily involved in research, there has been a trend for several years showing that a biodiverse environment has a beneficial effect on the immune system. And research on this topic began with... butterflies. Scientists observing them noticed that butterflies thrive in a biodiverse environment.

Following this theory, some time ago I proposed to Harvard University researchers, who had been conducting research for many years on a large cohort of 1,000 children, that I examine the impact of green environments on their health. The cohort included children who, at the age of a few or a dozen months, had been hospitalized for respiratory illnesses. They came from various geographic zones, represented many races, had varying economic status, and lived in diverse environments, including concrete-lined cities and leafy suburbs. Such a large and diverse cohort, analyzed over many years, allowed for highly reliable research results. These results showed that environmental greenery has a profoundly positive impact on health. And it's not just about looking at greenery, but also at the biochemical mechanisms that somehow stimulate the body. We are currently awaiting the outcome of a grant that will deepen our observations.

Can it be so?

When you go out into the forest at night with a headlamp, you can observe many particles floating in the air. These are dew, pollen from trees and grasses, but also perhaps protozoa and fungal spores that modify something and affect us and our immune system... After all, we inhale all of this.

It's strange that scientists haven't investigated this before.

Indeed, we have been examining harmful smog, we have been examining allergy-causing pollen, but only now have tools emerged that can examine the air from a metabolic perspective, and only now are we beginning to examine the respiratory microbiome.

Referring to pollen and allergies, is it more common in children now than it was several decades ago, or are there simply better diagnostic options?

Since 1989, after the systemic change, we've observed a significant increase in allergies. When I was a young doctor, I didn't see peanut allergies as common as they are today. On the one hand, this is probably a result of children eating more peanuts than before, but also of the changing environment. We've changed our consumption patterns, societies, and the environment, and this has resulted in, among other things, a more frequent occurrence of allergies.

Is this trend growing?

We are currently developing an innovative epidemiological project, Aller Scan, for which we received a grant from Polpharma. As part of this project, we have developed a tool for doctors, currently undergoing validation using AI tools, that will allow us to continuously monitor the number of allergy sufferers in Poland. Parents will be able to complete a survey on their mobile phone, which will likely answer the question of whether their child has asthma, hay fever, etc. The survey lasts approximately seven minutes and includes not only questions but also images, sounds, and videos – so parents can accurately identify their child's symptoms. This means that next year, we will likely have the opportunity to understand the incidence of the three allergic diseases in Poland and the areas where they occur most frequently.

Does this mean that AI is also entering pediatrics at full speed?

Absolutely! This is a rapidly evolving field in medicine. I sometimes use artificial intelligence myself and encourage all my colleagues to do the same. AI, of course, won't replace doctors, but it does support diagnostics, data analysis, and patient communication.

What, in your opinion, are the biggest challenges facing Polish pediatrics?

There are several. First, a generational shift. Pediatrics has long been associated with a rather static field, with older doctors. This may be slowly changing now, but the challenge is to present a fresher face to this specialty. However, to make pediatrics more dynamic, appropriate remuneration for pediatricians is also necessary. And they usually don't earn as well as other specialists. I don't know the exact Polish statistics, but they likely don't differ much from those in other countries, and in the United States, for example, pediatricians are at the bottom of the pay scale among all medical specialties.

The second area requiring change is the approach to children themselves. Pediatricians and parents alike support the phenomenon of "overparenting," or over-caring for a child. A hat on a slightly cooler day, postponing vaccinations, overprotectiveness, and driving a child to classes because they can't walk – all of these can limit a child's psychosocial development.

The third challenge facing all of medicine in Poland is the study of medical communication. This may not be as acutely apparent in pediatrics, as empathy is practically ingrained in the DNA of this specialty. However, the fact is that communication education in Poland is still in its infancy. In the UK, a doctor who fails the exam cannot practice. This is a new development here. Therefore, together with Maria Nowina Konopka and Łukasz Małecki, I wrote a textbook on this topic, "Medical Communication for Students and Doctors," published by Medycyna Praktyczna, to fill the gap. This coincided with a European Union directive requiring Poland to introduce communication education into medical school curricula. I therefore hope that doctor-patient communication will gradually improve.

author: Aleksandra Sokalska, editor-in-chief, "Puls" - monthly District Medical Chamber in Warsaw