Children and adolescents are not small adults: toward a better understanding of multimorbidity in younger populations

  • Marjan van den Akker
    Corresponding author. Goethe University Frankfurt, Institute of General Practice, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Tel.: +49 69 6301 80 454; fax: +49 69 6301 6014.
    Goethe University Frankfurt, Institute of General Practice, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany

    KU Leuven, Academic Centre of General Practice, Kapucijnenvoer 33, 3000 Leuven, Belgium

    Maastricht University, Department of Family Medicine, PO Box 616, 6200 MD Maastricht, The Netherlands
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  • Mirjam Dieckelmann
    Goethe University Frankfurt, Institute of General Practice, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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  • Mohammad Akhtar Hussain
    Barwon South West Public Health Unit, Public Health & Health Service Partnership, Barwon Health, 325 Ryrie Street, Geelong, Victoria, Australia
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  • Daniela Bond-Smith
    UHERO, University of Hawaiʻi at Mānoa, 2424 Maile Way, Saunders Hall 540, Honolulu, HI 96822, USA

    School of Population & Global Health, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Australia
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  • Christiane Muth
    University of Bielefeld, Medical Faculty of East Westphalia, Dep. of General Practice and Family Medicine, Universitätsstr. 25, 33615 Bielefeld, Germany
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  • Sanghamitra Pati
    ICMR-Regional Medical Research Centre Bhubaneswar, Chandrasekharpur, Bhubaneswar 751023, Odisha, India
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  • Sonia Saxena
    School of Public Health, Imperial College London, Medical School Building, St Mary's Hospital, Norfolk Place, London W2 1PG, UK

    President, Child and Adolescent Health Section European Public Health Association, Otterstraat 118-124, Postbox 1568, 3500 BN Utrecht, The Netherlands
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  • Desiree Silva
    Telethon Kids Institute, Perth, 15 Hospital Ave, Western Australia 6009, Australia

    The University of Western Australia, 35 Stirling Hwy, Crawley, Perth, Western Australia 6009, Australia

    Joondalup Health Campus, Perth, Cnr Grant Blvd &, Shenton Ave, Joondalup, Western Australia 6027, Australia

    Edith Cowan University, 270 Joondalup Dr, Joondalup, Perth, Western Australia 6027, Australia
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  • Rachel Skoss
    Institute for Health Research, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, Western Australia 6959, Australia

    School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton St, Nedlands Western Australia 6009, Australia
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  • Leon Straker
    School of Allied Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia
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  • Sandra C. Thompson
    Western Australia Centre for Rural Health, University of Western Australia, 167 Fitzgerald Street, Geraldton 6530 Western Australia, Australia
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  • Judith M. Katzenellenbogen
    School of Population & Global Health, The University of Western Australia, 35 Stirling Highway, Crawley 6009, Western Australia, Australia
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      • Multimorbidity is not an exclusive phenomenon of older adults; however, current research largely focuses on adult multimorbidity.
      • Evidence that characterizes and promotes understanding of multimorbidity in childhood and adolescence is lacking.
      • Children and adolescents should be given a voice by being involved in research relevant to their health.
      • The quality and breadth of epidemiological research in child and adolescent health is poor.


      Multimorbidity is of an increasing importance for the health of both children and adults but research has hitherto focused on adult multimorbidity. Hence, public awareness, practice, and policy lack vital information about multimorbidity in childhood and adolescence.
      We convened an international and interdisciplinary group of experts from six nations to identify key priorities supported by published evidence to strengthen research for children and adolescent with multimorbidity.
      Future research is encouraged (1) to develop a conceptual framework to capture unique aspects of child and adolescent multimorbidity—including definitions, characteristic patterns of conditions for different age groups, its dynamic nature through childhood and adolescence, and understanding of severity and trajectories for different clusters of multiple chronic conditions, (2) to define new indices to classify the presence of multimorbidity in children and adolescents, (3) to improve the availability and linkage of data across countries, (4) to synthesize evidence on the global phenomenon of multimorbidity in childhood and adolescence and health inequalities, and (5) to involve children and adolescents in research relevant to their health.


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