Discover how medtech devices that connect, ‘gamify’ – or are just plain wearable – are transforming child health, by giving the IT-savvy Generation Z the confidence to self-manage their conditions
Coping with a long-term health condition is hard, whatever age you are when diagnosed. But when the patient is a child, the care provision and the relationships around child health become more complex. As a GP, healthcare writer and mother of a child with a long-term health problem, Dr Juliet McGrattan knows this more than most.
‘My son, now 11, developed Kawasaki disease when he was five months old. It’s an autoimmune condition (of unknown cause) where the body starts damaging its own blood vessels, mainly the coronary arteries that supply blood to the heart muscle. If it’s not treated early, aneurysms develop in the arteries, with a risk of rupture and clot formation,’ Dr McGrattan explains. Medication is required to thin the blood.
‘Controlling the blood levels of a growing, active and accident-prone child is a real challenge. Even heading a heavy football could potentially cause a problem,’ she adds. As her son’s caregiver, McGrattan sees it as her role to help him ‘understand and manage his condition himself while he’s young. It’s also vital that he develops good habits to maximise his cardiovascular health.’
As his mum, her feelings are complex. ‘It would be easy to wrap him up in cotton wool and stop him from doing some activities,’ she says. ‘I don’t, however, want him to grow up risk-averse. Active play and adventure is an important part of a child’s development.’
Where the mother/son, doctor/son relationship comes together is in the use of technology to manage the condition. ‘We have a machine at home that allows us to test his blood level with just a finger prick of blood. We get an immediate result and can liaise with our specialist team if the result is out of the target range, and they can then adjust his medication dose. He likes that he can test himself and certainly feels more “ownership” of his condition; this means he’s the first to remind me if he’s late with his medication,’ McGrattan adds.
McGrattan and her son aren’t alone in recognising how medtech can help improve child health through enabling patients – and their parents – to better manage chronic conditions. Dr Terri Carney, a consultant clinical psychologist in medical paediatric psychology, sees technology as a means of not only making their care easier to manage but of also helping young patients view their illnesses in a more positive light. ‘We know that young people with positive perceptions of their illnesses find diagnosis and the resulting life changes easier to accept and adapt to, and are more adherent to treatment,’ says Dr Carney.
Around 10 to 15 per cent of under-16s in the UK are affected by long-term health conditions. Three of the most common are diabetes, asthma and epilepsy, and there’s a lot of work being in done in these areas. Here are just three new or near-to-market devices that can help children manage and monitor their own healthcare.
According to the International Diabetes Federation (IDF), 140,000 under-14s in Europe have Type 1 diabetes. And the biggest source of stress in managing diabetes, according to the European Pediatrics survey, for both caregivers and child patients, is needles and the daily finger prick required up to six times a day to monitor glucose levels.
Of the 600 children and caregivers surveyed, 44 per cent of parents saw measuring glucose levels as the biggest source of disruption in the condition’s daily management, while children pointed to the hassle (45 per cent), pain (30 per cent) and embarrassment (14 per cent) as key reasons for their dislike of these vital tests.
In 2015, global healthcare firm Abbott launched FreeStyle Libre, a wearable glucose monitoring system for adults, in Europe. In February this year, the company announced the paediatric indication was suitable for children aged four to 17. The device consists of a small, round sensor – approximately the size of two stacked five pence pieces – which can be worn on the back of the upper arm for up to 14 days. The sensor measures blood glucose every minute of the day through a small filament that’s inserted just under the skin and held in place with a small adhesive pad. All the caregiver or child has to do is scan a reader over it to get a real-time reading, as well as an eight-hour glucose history and the direction the glucose is heading.
Dr Emanuele Bosi, Associate Professor at the Department of Endocrinology and Diabetology, Università Vita-Salute, San Raffaele Hospital in Milan, Italy called the technology ‘transformative because it changes how self-monitoring has been done for decades – and is proven to be accurate and stable’.
For the children using FreeStyle Libre, it’s a fortnight’s respite from the daily sharp reminder that their diabetes disrupts their everyday life. For their caregivers, it’s a solution that keeps levels in check without the hassle involved in using needles.
Epilepsy currently affects more than 300,000 children under the age of 14 in the US alone and, according to the Epilepsy Foundation, the social impact for children is ‘often severe, producing isolation and loss of self-esteem.’ Epilepsy in children may be time-limited or long-term. It may also be associated with serious, difficult-to-treat syndromes, including Lennox-Gastaut syndrome, genetically related conditions or developmental disorders.
‘Seizures are well managed by medication or surgery in two out of three people with epilepsy, but there are several factors that can lead to seizures including missed medications, stress, and sleep disturbance,’ explains co-founder and CEO of Empatica, Matteo Lai.
Lai’s company has created Embrace, a smart watch-style wearable with inbuilt sensors that continuously measure the physiological signals and movement that can indicate potentially life-threatening seizures. This device is paired with the Empatica Alert app that sends caregivers an automated call or SMS when the signals picked up by Embrace’s sensors match a pattern trained on convulsive seizures.
‘Some families use hospital equipment, such as a wired SpO2 monitor which is attached to the toe and has an oxygen saturation alarm that goes off after a person desaturates [the oxygen levels in the blood drop],’ says Lai. ‘Some parents sleep in the same bed as their child, or use a baby monitor, in the hope that they will be awoken in the event of a dangerous motor seizure.’
A wearable device that can both monitor and alert, and looks as mainstream as a smart watch, not only provides the wearer with the data and connectivity to keep a check on their wellbeing, but also offers a sense of normality that most health monitors don’t offer.
‘Usually devices like Embrace take three to five years to get to the market. But with the support we received, we were able to bring Embrace to market in a year and a half,’ says Lai. The Embrace watch is now available for consumer use, and the Alert app is in clinical trials to measure the efficacy of the convulsive seizure detection and alerting system. A usability testing programme was launched in early 2016, and the device is available for pre-order.
‘Overall, we hope the information gained in these tests will improve the daily lives of people living with epilepsy so they receive help when they need it, and have more freedom to carry out their daily activities independently,’ Lai says.
Worldwide, asthma is the most common chronic disease among children. In the UK, a child is admitted to hospital every 20 minutes because of an asthma attack, and statistics suggest attacks still kill the equivalent of a classroom of children every year. While younger children between seven and nine years old are likely to adhere to their treatment, ten to 16 year olds are must less inclined or likely to do so.
A recent survey by the European Federation of Allergy and Airway Diseases Patient Associations (EFA) of 200 young people with asthma showed that one in four didn’t adhere to their treatment, and the more frequently they needed to take their meds, the less likely they were to do so consistently.
Afternoons are the mostly likely period of the day for doses to be missed, with 47 per cent admitting that they hadn’t taken their meds. The most common reasons given for missing doses were forgetfulness or rebellion – some young people simply didn’t want to do what the doctor had told them.
The report highlighted four factors to improve adherence in this age group – alongside care co-ordination and additional research, patient empowerment and the use of health tech were seen to be key. In particular, ‘use of smart ICT tools to support self-management, including patient dose tracking’ and ‘electronic and telephonic reminders to help patients improve adherence and eliminate forgetfulness’.
As digital natives, it’s no surprise that tech was highlighted as a way to engage Generation Z in their treatment. Handling the rebellion aspect is harder. This is where a new form of behavioural psychology comes into play in the form of gamification, which makes adherence more rewarding and fun.
Created by startup Gecko Health Innovations and acquired by Teva Pharmaceutical Industries, CareTRx is a Bluetooth-enabled device that attaches to most metered-dose inhalers (MDIs). It lights up when it’s time for the child to use their inhaler, and it sends dosage data to an app that translates correct usage into points that children can accumulate to earn good behaviour badges – much in the same way that wearers of fitness devices can earn badges for hitting their daily step count. Caregivers are provided with the data, too, which allows them to track and spot any potential trigger factors as they arise.
The use of devices and apps don’t just add value to a child health, they provide ‘a personal, contemporary and non-judgmental way of managing aspects of their physical condition,’ says Dr Terri Carney. It can also be a talking point, ‘a tangible resource that facilitates shared communication and discussion with family members and their peers. This enhances social and family support, which has a protective function in terms of improving confidence and psychological wellbeing,’ she adds.
For a child, anything that makes managing a long-term illness easier is a bonus. That it’s done with tech can give it the credibility that illness management mostly lacks.
As her son heads towards adolescence, this device/app combo is something Dr Juliet McGrattan is keen to find to help her son continue to manage his condition. ‘He would love being able to use technology to take his treatment to the next level. If it could connect to a child-appropriate app, he would be able to see his results over time, spot trends as he grows and get feedback about medication and suitable activities. The cooler the better,’ she says.
Recommendations on how we should use AI, genomics and medtech in the NHS – click here for 98 pages to guide us to the future. ‘The greatest challenge is the culture shift in learning and innovation, with a willingness to embrace technology for system-wide improvement. An ambitious drive “towards the NHS becoming the world’s largest learning organisation”’.
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