How many children and adolescents received preventive health and dental care in the past year?
Among children and adolescents in 2003, almost eight of 10 (78%) had a preventive health visit in the past year, more than seven of 10 (72%) had a preventive dental visit, and about six of 10 (59%) had both. Rates were much lower among the uninsured. Among the states, the proportion who received both preventive health and dental visits ranged from 46 percent to 75 percent.
Why is this important?
Pediatric experts recommend a series of regular well-child visits from birth to age 21 (AAP 1997; Green and Palfrey 2002) to: "screen for disease, provide counseling about how to foster healthy development of the child and prevent disease and injury (anticipatory guidance), identify problems at a sufficiently early stage to intervene to prevent further problems, provide immunizations, answer questions, and allow a physician to become familiar with a child and his/her family" (Schuster 2000).
Children's receipt of regular preventive health visits is associated with fewer emergency room visits and avoidable hospitalizations (Gadomski et al. 1998; Hakim and Bye 2001; Hakim and Ronsaville 2002), suggesting a link to health outcomes.
Tooth decay is largely preventable with good oral hygiene, diet, and fluoride. About one of five children have untreated tooth decay (NCHS 2005), which can lead to abscesses and infections, pain, dysfunction, and low weight (NIDCR 2000). Pediatric dental experts recommend two dental visits annually starting at age one year to provide education and services to help prevent tooth decay (AAP 2003; AAPD 2002), although a single annual dental visit may be a more customary practice.
Among U.S. children and adolescents in 2003, 16 million (22%) ages birth to 17 years did not have a preventive health visit in the past year, 19 million (28%) ages one to 17 did not have a preventive dental visit in the past year, and 29 million (41%) did not receive both a preventive health visit and a preventive dental visit in the past year, according to parents (CAHMI 2005).
- Young children were more likely than school-age children and adolescents to have a preventive health care visit but less likely to have a dental visit.
- Children and youth with special health care needs were more likely than those without special needs to have preventive visits.
- Uninsured children and adolescents were less likely than insured children to have preventive visits.
- Among the states, the proportion who received both preventive health and dental visits ranged from 46 percent to 75 percent. Rates were highest in New England and some north Atlantic states and lowest in many western and some southern states.
Private and public coverage appear about equally effective for facilitating childhood preventive care, after controlling for other factors (Selden and Hudson 2006). Enrollment in Medicaid or State Children's Health Insurance Programs (SCHIP) improves access to physicians and preventive care for lower-income children (Banthin and Selden 2003; Dick et al. 2004). Further improvement is needed to ensure that all children receive recommended visits.
Among parents of children (ages 117) who did not receive a preventive dental visit in the past year, 90 percent reported that the child did not need dental care (MCHB 2005), suggesting that these parents were not educated about the need for preventive dental care. Low-income parents often have difficulty accessing dental care and report poor treatment by staff at dental offices (GAO 2000; Mofidi et al. 2002), which may influence their sense of need or willingness to seek care.
Improvement Ideas and Resources
Offering evening or weekend clinic hours may be important to facilitate visits for parents who cannot take time off from work. Other interventions that can increase childhood preventive care include reminders and outreach activities (Briss et al. 2000; Rodewald et al. 1999) and augmented services such as case management and home visitation (Cuellar et al. 2003; Minkovitz et al. 2003). Some improvement efforts have not been successful, however (Hambidge et al. 2004).
To improve access to dental care, some states are increasing participation by dentists (through higher reimbursement and simplified administration) and making greater use of dental hygienists (Almeida et al. 2001; Gehshan et al. 2001). Some state dental societies are collaborating with Medicaid agencies and communities to improve dental care for young children through outreach, professional training, and enhanced fees (Grembowski and Milgrom 2000; Pervez and Silow-Carroll 2005).
For preventive health visits, the denominator is community-dwelling children and adolescents ages 017. The numerator is the subset of the denominator population who received one or more visits based on their parent's answer to the following question: "During the past 12 months, how many times did [CHILD'S NAME] see a doctor, nurse, or other health care professional for preventive medical care such as physical exam or well-child check-up?"
For preventive dental visits, the denominator is community-dwelling children and adolescents ages 117. The numerator is the subset of the denominator population whose parent answered affirmatively to the following question: "During the past 12 months, did [CHILD'S NAME] see a dentist for any routine preventive dental care, including checkups, screenings, and sealants?"
For the combined measure, the denominator is children and adolescents ages 017. The numerator is the subset of the denominator population whose parents reported that they received at least one preventive health visit and a preventive dental visit in the past year.
Parent-reported information is subject to potential recall bias. It is not known to what degree the survey questions capture health or dental care obtained in school settings. The preventive health measure does not strictly track guidelines, which call for nine visits during the first two years of life and exclude seven- and nine-year-old children from annual visits (AAP 1997; Green and Palfrey 2002).
This measure was calculated by the Child and Adolescent Health Measurement Initiative using data from the 2003 National Survey of Children's Health, a nationally representative, random-digit-dialing telephone survey of households with one or more children under 18 years old. Survey respondents are parents or guardians who know the most about a randomly selected child's health and health care (CAHMI 2005).
* 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). 2003. "Oral Health Risk Assessment Timing and Establishment of the Dental Home." Pediatrics 111(5): 11136.
AAPD (American Academy of Pediatric Dentistry). 2002. Clinical Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance and Oral Treatment for Children. Chicago: American Academy of Pediatric Dentistry.
Almeida, R., I. Hill, and G. Kenney. 2001. Does SCHIP Spell Better Dental Care Access for Children? An Early Look at New Initiatives. Occasional Paper Number 50. Washington, D.C.: The Urban Institute.
Banthin, J. S., and T. M. Selden. 2003. The ABCs of Children's Health Care: How the Medicaid Expansions Affected Access, Burdens, and Coverage between 1987 and 1996. Inquiry 40 (2): 13345.
Briss, P. A., L. E. Rodewald, A. R. Hinman et al. 2000. Reviews of Evidence Regarding Interventions to Improve Vaccination Coverage in Children, Adolescents, and Adults. The Task Force on Community Preventive Services. American Journal of Preventive Medicine 18 (1 Suppl): 97140.
* CAHMI (Child and Adolescent Health Measurement Initiative). 2005. National Survey of Children's Health, 2003. Data Resource Center for Child and Adolescent Health. Portland: Oregon Health & Science University.
Cuellar, A. E., T. H. Wagner, T. W. Hu et al. 2003. New Opportunities for Integrated Child Health Systems: Results from the Multifaceted Pre-to-Three Program. American Journal of Public Health 93 (11): 18891890.
Dick, A. W., C. Brach, R. A. Allison et al. 2004. SCHIP's Impact in Three States: How Do the Most Vulnerable Children Fare? Health Affairs 23 (5): 6375.
Gadomski, A., P. Jenkins, and M. Nichols. 1998. Impact of a Medicaid Primary Care Provider and Preventive Care on Pediatric Hospitalization. Pediatrics 101 (3): E1.
GAO (General Accounting Office). 2000. Oral Health: Factors Contributing to Low Use of Dental Services by Low-Income Populations. GAO/HEHS-00-149. Washington, DC: General Accounting Office.
Gehshan, S., P. Hauck, and J. Scales. 2001. Increasing Dentist's Participation in Medicaid and SCHIP. Denver, Colo.: National Conference of State Legislatures, Forum for State Health Policy Leadership.
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.
Grembowski, D., and P. M. Milgrom. 2000. Increasing Access to Dental Care for Medicaid Preschool Children: The Access to Baby and Child Dentistry (ABCD) Program. Public Health Reports 115 (5): 44859.
Hakim, R. B., and B. V. Bye. 2001. Effectiveness of Compliance with Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries. Pediatrics 108 (1): 907.
Hakim, R. B., and D. S. Ronsaville. 2002. Effect of Compliance with Health Supervision Guidelines Among U.S. Infants on Emergency Department Visits. Archives of Pediatric and Adolescent Medicine 156 (10): 101520.
Hambidge, S. J., A. J. Davidson, S. L. Phibbs et al. 2004. Strategies to Improve Immunization Rates and Well-Child Care in a Disadvantaged Population: A Cluster Randomized Controlled Trial. Archives of Pediatric and Adolescent Medicine 158 (2): 1629.
MCHB (Maternal and Child Health Bureau). 2005. The Oral Health of Children: A Portrait of States and the Nation. Rockville, Md.: U.S. Department of Health and Human Services.
Minkovitz, C. S., N. Hughart, D. Strobino et al. 2003. A Practice-Based Intervention to Enhance Quality of Care in the First 3 Years of Life: The Healthy Steps for Young Children Program. Journal of the American Medical Association 290 (23): 308191.
Mofidi, M., R. G. Rozier, and R. S. King. 2002. Problems with Access to Dental Care for Medicaid-Insured Children: What Caregivers Think. American Journal of Public Health 92 (1): 538.
NCHS (National Center for Health Statistics). 2005. Health United States, 2005. Hyattsville, Md.: Centers for Disease Control and Prevention.
NIDCR (National Institute of Dental and Craniofacial Research). 2000. Oral Health in America: A Report of the Surgeon General. Rockville, Md.: U.S. Department of Health and Human Services.
Pervez, F., and S. Silow-Carroll. 2005. South Dakota Enhances Access to Oral Health Care for Young Children. Vol. 3 (Winter) of States in Action: A Quarterly Look at Innovations in Health Policy. New York: The Commonwealth Fund.
Rodewald, L. E., P. G. Szilagyi, S. G. Humiston et al. 1999. A Randomized Study of Tracking with Outreach and Provider Prompting to Improve Immunization Coverage and Primary Care. Pediatrics 103 (1): 318.
Schuster, M. A. 2000. "Well Child Care." In Quality of Care for Children and Adolescents: A Review of Selected Clinical Conditions and Quality Indicators, ed. McGlynn, E. A., C. L. Damberg, E. A. Kerr et al, 391404. Santa Monica, CA: RAND.
Selden, T. M., and J. L. Hudson. 2006. Access to Care and Utilization Among Children: Estimating the Effects of Public and Private Coverage. Medical Care 44 (5 Suppl): I1926.