How many young children and their parents receive basic preventive guidance and developmental services during well-child visits?

Two-thirds of young children received what experts considered to be a good to excellent level of basic preventive and developmental services during well-child visits with their health professional in 2000.

Overall Quality of Preventive and Developmental Care Received by Children Ages 4–35 Months at Well-Child Visits, Percentage Distribution, 2000

Why is this important?

• Parents often look to their child's doctor as a trusted source of information on child behavior and development (Schuster et al. 2000).
• Some evidence suggests that clinical guidance can positively impact child safety practices, mother-child interactions, infant crying and sleep patterns, and child literacy development (Regalado and Halfon 2002). Early identification of developmental delays can help the family seek services when chances are better to effect change (AAP 2001).
• Parents in one study reported more confidence in parenting skills and less concern about their child's behavior when they talked to their child's health professional about such topics (Bethell et al. 2001).

Findings

In a survey of young children ages 4 to 35 months, parents reported that only two-thirds (67%) received what experts considered to be a good to excellent level of basic preventive and developmental care during well-child visits in 2000 (Zuckerman et al. 2004).

• Almost nine of 10 parents received guidance to help prevent sudden infant death syndrome, and three-quarters were asked about parental smoking.
• Only a little more than half received a developmental screening, expert-recommended guidance on injury prevention and language development, and other health promotion topics that parents wished to discuss.

Implications

About one-third of young children do not receive what experts consider an adequate level of basic preventive and developmental services, resulting in missed opportunities to help improve child and family well-being. Further analysis found that parents of children with lower scores on this measure tended to report lower satisfaction with their child's care.

Improvement Ideas and Resources

• Parents with concerns about their child's learning, development, or behavior are more likely to get needed information when their child's health professional asks whether they have any concerns (Bethell et al. 2002).
• The use of a questionnaire or checklist may facilitate discussion of these topics (Regalado and Halfon 2002). Providing printed materials to parents, or showing instructional videotapes in the waiting room, can reinforce discussions and facilitate parent recall and use of information (Glascoe et al. 1998).
• System-level issues that may increase these services include assuring adequate time and reimbursement and providing education and training for health professionals (Halfon et al. 2003).
• Parents of children who see the same practitioner for well-child care report more discussion of these topics (Halfon et al. 2003), suggesting that assuring continuity of care can be beneficial.

Measure:

The denominator includes children ages 4–35 months. The numerator includes those in the denominator who received basic preventive services recommended by the American Academy of Pediatrics (AAP 1997) and the national Bright Futures initiative sponsored by the federal Maternal and Child Health Bureau (Green and Palfrey 2002). The composite measure shown in the pie chart measures the receipt of a developmental assessment, injury prevention counseling, screening for parental smoking, guidance on reading to the child, and whether there were missed opportunities for providing guidance on any of 14 age-appropriate topics that the parent reported would have been helpful to discuss with their child's provider. A score of excellent means that children and their parents received nearly all the services while a score of poor means that nearly none of the services were received.

Limitations:

"Measures were based on parental reports, without validity checks of observable behavior, and might not reflect accurately the preventive services actually delivered or whether problems were prevented effectively… Missed opportunities may reflect both clinician practices and parental preferences and reporting" (Zuckerman et al. 2004).

Source:

Results were compiled by researchers at Boston University School of Medicine and the University of California, Los Angeles (Zuckerman et al. 2004) using data from the 2000 National Survey of Early Childhood Health, a nationally representative telephone survey of U.S. children ages 4 to 35 months in which parents report on their children's health and health care.

References:

* Indicates source of data used in the chart(s).AAP (American Academy of Pediatrics). 1997. Guidelines for Health Supervision III. Elk Grove, Ill.: American Academy of Pediatrics.

AAP (American Academy of Pediatrics). 2001. Developmental Surveillance and Screening of Infants and Young Children. Pediatrics 108(1): 192–6.

Bethell, C., C. Peck, M. Abrams et al. 2002. Partnering with Parents to Promote the Healthy Development of Young Children Enrolled in Medicaid. New York: The Commonwealth Fund.

Bethell, C., C. Peck, and E. Schor. 2001. Assessing Health System Provision of Well-Child Care: The Promoting Healthy Development Survey. Pediatrics 107 (5): 1084–94.

Glascoe, F. P., F. Oberklaid, P. H. Dworkin et al. 1998. Brief Approaches to Educating Patients and Parents in Primary Care. Pediatrics 101 (6): E10.

Green, M., and J. S. Palfrey, Eds. 2002. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. Arlington, Va.: National Center for Education in Maternal and Child Health.

Halfon, N., M. Regalado, K. T. McLearn et al. 2003. Building a Bridge from Birth to School: Improving Developmental and Behavioral Health Services for Young Children. New York: The Commonwealth Fund.

Regalado, M., and N. Halfon. 2002. Primary Care Services: Promoting Optimal Child Development from Birth to Three Years. New York: The Commonwealth Fund.

Schuster, M. A., N. Duan, M. Regalado et al. 2000. Anticipatory Guidance: What Information Do Parents Receive? What Information Do They Want? Archives of Pediatrics & Adolescent Medicine 154 (12): 1191–8.

* Zuckerman, B., G. D. Stevens, M. Inkelas et al. 2004. Prevalence and Correlates of High-Quality Basic Pediatric Preventive Care. Pediatrics 114 (6): 1522–9.