The use of technology in healthcare continues to boom and the challenges posed by Covid-19 have only served to increase the need for technological solutions. In particular, the use of apps to aid in patient self-care and symptom management has exploded. One area that specialists are particularly excited about is the use of HealthTech for Pediatrics and Child Health.
In many respects, the use of apps in child healthcare could be seen as a natural fit. Anyone who has watched children grow up in the last ten years will appreciate how naturally children embrace such things. Simultaneously, while the benefits of children’s understanding and participation in their own care are well-established1, their development remains a challenge for healthcare providers and families.
The interest in HealthTech for children has developed particularly quickly over the last five years. There is a considerable market for such goods in Europe with a quarter of that in Germany.2 In terms of investment Europe saw over $8 billion invested in 2021 with around $3.8 billion of that in the UK.3 Further investment in HealthTech for children was part of Health Hub Vienna’s recommendations from their Covid-19: An Opportunity For Healthcare in Austria paper.
When we talk about HealthTech for children we’re looking at any patient-facing technological intervention which would be specific for children. This means the opportunities within the field are expansive and can vary in scale and scope. Broadly speaking we could categorize these into three groups:
- Patient-centered tech – the primary user of the tech is the child
- Parent-centered tech – the primary user is the parent/guardian
- Professional-centered tech – the primary user is the clinician
In practice, there is significant overlap and many existing products could lay claim to being focused on two or even all three of the above. The tech itself could be purely diagnostic (such as an AI camera used to detect epilepsy) treatment-based (refinement of an enteral feeding pump) or a combination of both (an app that aids in diagnostics but also provides treatment advice).
HealthTech for Children in Action
A perfect example of the field’s potential was the Glue Ear App, created by Cambridge digital health.4 Glue ear is a relatively common condition in children where fluid builds up in the inner ear, obstructing the ossicles and leading to loss of hearing. Although in most cases glue ear resolves on its own, in some cases it can persist or be recurrent, potentially requiring surgical intervention.5 A cause for concern from persistent glue ear is that loss of hearing may impair the child’s development; impacting speech, language, and listening skills.
The Glue Ear App itself contains specially-designed songs, games, and audiobooks which help children to overcome language and auditory processing delays that can result from periods of poor hearing. While designed to be fun, these games can also chart metrics of the child’s hearing for their parents to see and to aid in clinicians’ assessments. The app has received widespread acclaim, winning the award for children’s app of the year at the UK app awards and being highly commended by the national institute for clinical excellence (NICE)6. Further research in the area is ongoing and home use of the app with bone conduction headphones has the potential to significantly impact the way glue ear in children is treated.
Another app that has been widely successful and is now receiving international recognition7 is Xploro. Xploro is an app designed to explain clinical procedures to children to empower them and reduce stress. The concept is that when children do not know what to expect of hospitals and their treatment within they become stressed by the experience. This can lead to unsuccessful procedures, otherwise unnecessary sedation, repeat visits, and long-term fears about healthcare settings. By explaining these things and addressing the fear of the unknown the app states that it can transform these outcomes.
Xploro is far from the only app on the market dedicated to educating children on their care, nor are the benefits of such education a new concept. Books and pamphlets designed for this purpose have been used for years, but in practice tend to have a short shelf life and many are not really fit for purpose in the digital age. It seems evident that there are great opportunities for apps across various aspects of healthcare to inform and educate.
These are examples of patient experience-centered HealthTech, but there are, of course, many other areas in which technology can be applied successfully to pediatric services. We would highly encourage anyone interested in the topic to take a deeper look at the NIHR’s Children and Young People Medtech Co-operative website.9 It identifies seven main themes for expanding Healthtech:
- Cancer
- Epilepsy, Movement, and Muscle Disorders
- Neonatal Technologies
- Rare Diseases
- Respiratory, Sleep, and Ventilation
- Surgical Technologies
- Transition (cross-cutting theme)
Transition in this instance refers to the process by which children “graduate” to adult services between the ages of 16-18. Adult-care nurses familiar with these transitions are likely to be deeply heartened to see this recognized amongst the themes, as it remains a significant area for improvement. Even when there are planned and structured transitions, in less than a month a child can be thrust from dependency into total responsibility. The effect can be particularly pronounced in patients with barriers to learning who may have benefited from heightened support in pediatrics only to be left to self-manage in adult services. The importance of Healthtech that can educate and smooth this transition should not be underestimated.
Challenges
Unfortunately while there is a great level of excitement and demand for HealthTech for children, implementation in many areas continues to lag behind their adult equivalents. Pediatric services in Europe and the US are clearly desperate to encourage a favorable environment for HealthTech startups to operate in, but at present the numbers are low. As in many other areas of medicine, HealthTech solutions available for children are frequently based around equivalent adult products that have been adjusted to fit. It is recognized that tech designed specifically for children would be far better suited to address their needs.
One contributing factor that has always affected pediatric medical device development is the relatively small population sample available for the necessary testing. Much of the European research on HealthTech for children have very small sample population sizes or focuses on case studies. That said, over 2020/21 the UK’s MedTech and In Vitro Diagnostics Co-operatives were able to recruit 5,795 participants into 76 studies, with 78% reaching their recruitment targets on time.10 The coordinated support for research in the UK has certainly gained results in this area and such approaches may offer the best hopes for gaining evidence going forward.
Another factor may be the perceived market size. As Kolaleh Eskandanian, Vice President and Chief Innovation Officer at Children’s National Hospital, puts it, part of the problem is ‘because of the mistaken perception that children are generally healthy and thus the small market does not justify the financial return on investment.’11 Clearly the demand is there.
Then there is the concern that these methods could be used to replace meaningful contact with clinicians rather than support them. This is really a question of service administration rather than being rooted in the technology itself. The research reviewed indicates high levels of support from clinicians, and also a high level of emphasis on supporting children and families’ interactions with the clinicians. In all probability, children and their families are probably one the groups least vulnerable to marginalization through HealthTech, certainly compared to older adult healthcare.
Final Words
There is great promise in the HealthTech for children industry and we as health specialists are already seeing the benefits of this. Investment and implementation are on the rise, despite the investment challenges that pediatrics have faced for some time. We have seen that the rise can be enhanced further by suitable efforts to coordinate support through clinician-led co-operatives. If we are able to successfully shape the healthcare of our children today, then we surely are set to reap the rewards in our adults of tomorrow.
