Different. In health and even in sickness, men and women are different. Well, so are boys and girls: who get sick from the same diseases but not always in the same way, with the same severity and complications, or with the same frequency, and who don’t always respond in the same way to treatment.
A few examples? Male infants have a double risk of bronchiolitis than girls. Females on the other hand have a more efficient immune system which makes them stronger against infections and allergies, but over time more at risk of autoimmune diseases. Girls have a 10-20 times higher chance of experiencing precocious puberty than boys. Scoliosis is up to 7 times more prevalent in girls than in boys. Autism spectrum disorders are 4 times more frequent in boys but girls with anorexia are 4 times more than boys.
The SIP, the Italian Society of Pediatrics, to help parents to orient themselves towards the gender approach in medicine and to develop a sensitivity, attention towards their children depending on whether they are male or female, has drawn up the first a Guide on gender differences in pediatrics which was presented during the 77th SIP congress underway in Sorrento from 18 to 21 May.
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In adult medicine, we have been talking about gender for at least a couple of decades. In pediatrics, the attention towards sex is much more recent “Yes, and the data published on the subject in the literature are still limited”, he says on the sidelines of the SIP congress Isabella Tarissi de Jacobissecretary of the study group on gender medicine that SIP instructed in 2019, and 1st level medical director of the General Pediatric Department of the Bambino Gesù Pediatric Hospital in Rome
“We doctors too are learning little by little to approach boys and girls differently,” he adds. Because then this is what we are talking about, about approach: in fact, we are not talking about a new specialty of medicine, and in this case about pediatrics, but about a new dimension, a different vision which, in order to obtain ever better health results, also takes into account gender .
Knowing the difference makes the difference
Developing a sensitivity that takes into account sex towards diseases for parents means paying more attention to any signals, monitoring, observing sons and daughters in a different way, with evident positive effects on their health. Knowing the difference, in short, makes the difference. For doctors and health systems, gender pediatrics implies different prevention paths, and different therapeutic paths.
For instance? “For example, if a disease is more frequent in one or the other sex, we could think of screening differently distributed over time for males and females. To different future vaccination schedules, based on the different immune response in boys and girls. then, on the level of treatment: if it is known that a pathology causes more complications in one sex, as Kawasaki syndrome does in children, it is possible to consider immediately providing the males with first-level therapy “, explains Tarissi de Jacobis .
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Because boys and girls are different
The reasons for the gender difference with regard to diseases are unknown. According to experts, the phenomenon is multifactorial: we speak of genetic causes (starting from the presence of two X chromosomes in the female genome), epigenetic: the environment impacts differently on the DNA in the two sexes, “we know, to say, that males and females they respond to cigarette smoking and maternal alcohol consumption in a different way when they are still in utero – the pediatrician continues – and then there are hormonal and metabolic causes “.
Gender-related diseases
In light of all this, what diseases are we talking about? What are the pathologies that behave differently with boys and girls?
Immune system and gender vaccinology
The female immune system is more efficient, more reactive, than the male one, which results in a greater susceptibility of males to infections and allergies but in adulthood that females are more at risk of autoimmunity: autoimmune diseases concern in the 80% of cases women. However, males less than 2 years old are more often affected by respiratory infections. And children contract protozoan infections (malaria, leishmaniasis and amoebiasis) and fluke infections or roundworms more than girls. The risk of tuberculosis in males is double that of females and the susceptibility to infection with hepatitis B virus and even influenza is also greater, but females are more likely to become seriously ill.
More intense immune responses in females than males would also underlie a different immune response to vaccines. In fact, females – resumes Tarissi de Jacobis – in response to vaccines produce more protective antibodies than males. These are differences that are deepening and could pave the way for a more targeted and gender-differentiated prevention “.
The bronchiolitis it is an infectious disease usually caused by the respiratory syncytial virus (RSV) which affects children especially under 2 years of age. it typically resolves spontaneously, but sometimes has a very severe course and requires hospitalization. well, bronchiolitis is more frequent in males, who are also more likely to develop a severe form of the disease, with a 50% higher risk of hospitalization than females. The indication of the pediatrician is to more closely monitor the males with bronchiolitis.
The malattia in Kawasaki (which has been talked about very recently for its link to covid-associated Mis-C) is a pediatric vasculitis (inflammation of the blood vessels) that can involve coronary arteries. The incidence among children under the age of 5 ranges from one case in 6,500 to one in 20,500 in Europe and is higher in males, with a ratio of 1.6 to 1. Also in males, more sex complications and fewer responses are observed. to first-line therapy.
Hip dysplasia and scoliosis
Congenital hip dysplasia is more common in girls. An early diagnosis in the first days or weeks of life greatly increases the effectiveness of the therapy. therefore “it is important to have all children checked on schedule, but in girls it is not possible to do without” says the pediatrician. Adolescent idiopathic scoliosis is the most common form of scoliosis, with a prevalence of 2-3% in school age. About 10% of these cases require conservative treatment and 0.1-0.3% surgery. In the mild-moderate forms the ratio between affected girls and boys is similar (1.3 on 1), but in the most important scoliosis the differences increase passing to 5.4 affected females on 1 male, to arrive in the most severe forms at a ratio of 7 females affected on 1 male. “Furthermore, adolescent scoliosis in females has an earlier onset for this reason females must be evaluated before males, even in the absence of familiarity: by intervening immediately complex therapists can be avoided” says Tarissi de Jacobis.
The precocious puberty it is a condition that occurs when the signs of development appear before the age of 8 in females and 9 in males. The incidence of precocious puberty in females is 10 to 20 times higher than in males. Furthermore, precocious puberty in females is idiopathic in 90% of cases (ie it has no recognized cause), while in males the idiopathic form accounts for 60% of cases.
The celiac disease it affects females more: it concerns 0.7% of the Italian population but 2/3 are females and 1/3 are males. In addition to a greater frequency in females, it was observed that in girls under 14 the classic presentation with iron deficiency anemia (inadequate iron level) and with a lower percentage of silent disease (which proceeds without clear signals for years) seems to prevail. . However, males would have an increased risk of developing T-cell lymphoma.
Liver disease
Chronic liver disease in children is relatively rare, but can be precursors to chronic pathologists as adults, from cirrhosis to cancer. Fatty liver disease – fatty liver: a condition that affects the liver cells, in which there is an abnormal accumulation of triglycerides – according to some studies, it affects 3-10% of the pediatric population, a percentage that can increase up to 70% in children with severe obesity. According to some studies this pathology is more frequent in males.
I eating disorders for many decades they have been considered the exclusive prerogative of girls, with a male-female ratio of 1 to 10. Today things have changed: the age of onset has dropped dramatically, and the relationships between the sexes have changed. Currently in anorexia the prevalence is 1 affected male for every 4 females and 1 male for every 8-11 females in bulimia. For binge eating disorder, the differences are less pronounced. It is essential to promptly recognize symptoms in females, who are most affected, but also in males.
I autism spectrum disorders (ADS) recently they are diagnosed much more than in previous years: estimates indicate that males are affected with a frequency about 4.4 higher than females. However, there is still little information on the role of gender in symptoms, functioning and quality of life in the long term. From early studies it seems that females with ASD tend to present more serious psychopathologies over time. Therefore, there are gender differences but at the moment, there are no differences in the approach to the treatment of children and young people in relation to gender.
Il bullying it is declined differently in the two genders: according to a survey conducted by Istat, girls are mainly victims of psychological violence (68% of cases), while among males psychological violence represents 35% of cases. Teasing about physical appearance or speech is more common among girls (7.1% females versus 5.6% males), while hitting, kicking and punching are more common among males (2.2% females compared to 5.3% males). Furthermore, girls confide in each other more, only a little over 25% prefer to be silent, while 33% of boys prefer silence.