Commentary
AI is here to stay. Its design shouldn’t leave kids behind
Seattle Children’s Research Institute weighs the implications of AI in pediatric care
By Rob Smith July 23, 2024
Seattle is at the forefront of the AI revolution, and while we don’t work in the technology industry, we see the promise for our field of pediatrics. AI is already shaping a new era in medical breakthroughs and improved care, with expanded diagnostic capabilities, improved access to specialty care services, and the ability to analyze massive amounts of health data.
AI is analyzing brain scans of infants at high risk for autism, allowing the detecting of subtle differences in brain structure that were associated with later development of autism-related behaviors. This early identification could lead to earlier intervention and support for children with autism, improving their long-term outcomes.
For rural communities in the United States and around the world that have become pediatric care deserts, AI can help bring specialized care to more children, regardless of their proximity to a specialist.
And perhaps more relevant than ever post-pandemic, AI may have a role in adolescent mental health. The continued deployment of advanced technologies in healthcare can create a more equitable and multidisciplinary healthcare environment.
It’s important to remember the standard approach with new tools and technologies is to keep kids at the margins. We do this to avoid exposing them to excessive risks. While appropriate, this approach comes with drawbacks: kids are often the last to benefit from the new technology. This tension between protection and access reached a peak when considering enrollment of minors in Covid-19 vaccine trials, spurring calls for change.
The rapid rise of AI in medicine offers another opportunity to try and get it right. We can’t wait too long to include kids in the development and evaluation of AI, nor can we have kids be first in line to test AI technology. Instead, we need a middle ground: a systematic approach that prioritizes inclusion of children in a safe way. We otherwise risk building systems not fit for the intricacies and special needs of the youngest and most vulnerable among us.
The medical community has been here before. When medical devices are adapted from an adult version to a pediatric version, kids’ unique needs, biology, and growth patterns are rarely top of mind. With a less profitable marketplace for pediatric innovations in devices compared to the larger adult market, there is less motivation to invest finite research dollars. Additionally, rules and regulations are often different for pediatric populations, such as those surrounding adolescent confidentiality. Deploying technologies designed for adults into pediatric settings compromises the clinical care we can provide.
We also saw harm in the transition to electronic health records given most systems weren’t designed with pediatric patients in mind. One Massachusetts General Hospital study found a five-fold increase in reports of medical safety incidents due to the electronic health records system failing to encompass all age contexts.
To help ensure kids are not left behind, they must be at the center of discussions on how to govern the responsible and ethical use of AI. As clinicians and investigators at the Seattle Children’s Research Institute, we have established a governing board to oversee AI in pediatric applications. Our intent is to ensure the appropriate use of AI in accordance with proposed principles, and that promotes inclusion of parents and children in how and whether it is used. We have also convened the national pediatric bioethics community to determine how we can achieve those principles in practice with a focus on accountability, equity, and transparency.
The longer we keep kids on the margins as we establish standards, the less potential there is for AI to advance pediatric health outcomes. Even worse, our youth are at risk of becoming susceptible to potential dangers of unfettered AI. After decades in the pediatric field, we’ve watched as kids are almost always the last to be thought of as medicine adapts and innovates. That must change. With a consortium charged to focus on the child, we will be better able to deliver and integrate AI into pediatric health care in a way that leads to better outcomes, more cures, and equitable care. That ensures kids come first.
Dr. Vittorio Gallo is the chief scientific officer and a principal investigator at the Seattle Children’s Research Institute.
Dr. Doug Opel is the director of the Treuman Katz Center for Pediatric Bioethics and Palliative Care at the Seattle Children’s Research Institute and a pediatrician at Seattle Children’s Hospital and the University of Washington Medical Center.
Dr. Clara Lin is a pediatrician and chief medical information officer at Seattle Children’s Hospital.