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Have professional recommendations and consumer demand altered pediatric practice regarding child development?

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Abstract

Objective

Amid growing consumer demand and professional society recommendations for more information on early childhood development, current practices of pediatricians in regard to children's development remain largely unknown. We investigate whether there are differences in provider practices and satisfaction with regard to children's development (based on length of time in practice).

Design

A self-reported survey was conducted of physicians at 30 pediatric practices participating in the Healthy Steps for Young Children Program. Healthy Steps is a national program to enhance the developmental potential of young children. Comparisons were made among physicians categorized as in training (n=88), recently in practice (completing residency from 1984 to 1996, n=69), or more experienced (completing residency prior to 1984, n=52).

Principal Findings

Relative to those recently in practice and in training, more experienced pediatricians spend less time in well-baby visits in the first 2 months of life. One-third of physicians conduct family risk assessments, half complete routine developmental screening, and over half do safety risk assessments in the first 2 months of life. There were few differences by provider experience in the topics covered under anticipatory guidance for new parents. Nearly all discussed infant car seats, sleep position, feeding practices, and temperament, but less than half routinely discussed domestic violence, and between half and three-quarters discussed infant bathing, maternal depression, and appropriate discipline practices. While all three groups of physicians were satisfied with the amount of time to discuss growth and development and parenting issues, more experienced physicians were more satisfied with their own and their staff's abilities to meet new parents' needs on these issues.

Factors that over one-third of physicians reported affected their ability to deliver the best-quality care were shortage of support staff, limited referral sources, managed-care restrictions on referrals for special services, excessive paperwork, and lack of time for follow up, teaching parents, and answering questions. Physicians in recent practice were more likely than more experienced physicians to cite reimbursement concerns and limited staff to address the needs of parents regarding development.

Conclusions

Most pediatricians do not conduct routine developmental screening in the first 2 months of life, and most discuss safety, as opposed to developmental and mental health, concerns with parents of newborns. Pediatricians with more experience believe they are better meeting new parents' needs and are less likely to cite systems and organizational factors as limiting their ability to deliver high-quality care.

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References

  1. Special Report: How A Child's Brain Develops.Time. February 3, 1997.

  2. Your Child from Birth to Three.Newsweek. Spring/Summer 1997. Special Edition.

  3. Young KT, Davis K, Schoen C, Parker S. Listening to parents: a national survey of parents with young children.Arch Pediatr Adolesc Med. 1998;152:255–262.

    CAS  PubMed  Google Scholar 

  4. Foye H, Chamberlin R, Charney E. Content and emphasis of well-child visits.Am J Dis Child. 1977;131:794–797.

    Google Scholar 

  5. Reisinger KS, Bires JA. Anticipatory guidance in pediatric practice.Pediatrics. 1980;55: 889–892.

    Google Scholar 

  6. Osborn LM, MI Reiff. Teaching well child care.Clin Pediatr. 1983;22(7):505–508.

    CAS  Google Scholar 

  7. Stickler GB, Simmons PS. Pediatricians' preferences for anticipatory guidance topics compared with parental anxieties.Clin Pediatr. 1995;384–387.

  8. Bennett FC, Guralnick MJ, Richardson HB, Heiser KE. Teaching developmental pediatrics to pediatric residents: effectiveness of a structured curriculum.Pediatrics. 1984;74: 514–522.

    CAS  PubMed  Google Scholar 

  9. Camp BW, Gitterman B, Headley R, Ball V. Pediatric residency as preparation for primary care practice.Arch Pediatr Adolesc Med. 1997;151:78–83.

    CAS  PubMed  Google Scholar 

  10. Burnett RD, Bell LS. Projecting pediatric practice patterns: a survey by the American Academy of Pediatrics, Committee on Manpower.Pediatrics. 1978;62(suppl 2):625–665.

    Google Scholar 

  11. Dworkin PH, Shonkoff JP, Leviton A, Levine MD. Training in developmental pediatrics: how practitioners perceive the gap.Am J Dis Child. 1979;133:709–712.

    CAS  PubMed  Google Scholar 

  12. Report of the Task Force on Pediatric Education: The Future of Pediatrics. Evanston, Ill: American Academy of Pediatrics; 1978.

  13. Breunlin DC, Mann BJ, Richtsmeier A, Lillian Z, Richman JS, Bernotas T. Pediatricians' perceptions of their behavioral and developmental training.J Dev Behav Pediatr. 1990; 11:165–169.

    CAS  PubMed  Google Scholar 

  14. Korsch BM. Critical issues in behavioral pediatric training.J Dev Behav Pediatr. 1985; 6(4):215–219.

    CAS  PubMed  Google Scholar 

  15. Phillips S, Friedman S, Zebal B. The impact of training in behavioral pediatrics: a study of 24 residency programs.J Dev Behav Pediatr. 1984;6:15–21.

    Google Scholar 

  16. Friedman SB, Phillips S, Parrish JM. Current status of behavioral pediatric training for general pediatric residents: a study of 11 funded programs.Pediatrics. 1983;71:904–908.

    CAS  PubMed  Google Scholar 

  17. Guralnick MJ, Bennett FC, Richardson HB, Shibley RE. Training residents in developmental pediatrics: results from a national replication.J Dev Behav Pediatr. 1987;8:260–265.

    CAS  PubMed  Google Scholar 

  18. Yancy WS, Coury DL, Drotar D, Gottlieb MI, Kohen DP, Sarles RM. A curriculum guide for developmental-behavioral pediatrics.Dev Behav Pediatr. 1988;9(6):S1-S7.

    CAS  Google Scholar 

  19. Sargent JR, Osborn LM, Roberts KB, DeWitt TG. Establishment of primary care continuity experiences in community pediatricians' offices: nuts and bolts.Pediatrics. 1993; 91(6):1185–1189.

    CAS  PubMed  Google Scholar 

  20. Charney E. The education of pediatricians in primary care: the score after two score years.Pediatrics. 1994;95(2):270–272.

    Google Scholar 

  21. Accreditation Council for Graduate Medical Education.Program Requirements for Residency Education in Pediatrics. 1996.

  22. Wender EH Bijur PE, Boyce WT. Pediatric residency training: ten years after the task force report.Pediatrics. 1992;90:876–880.

    CAS  PubMed  Google Scholar 

  23. Dobos AE, Dworkin PH, Bernstein BA. Pediatricians' approaches to developmental problems: has the gap been narrowed?Dev Behav Pediatr. 1994;15:34–38.

    Google Scholar 

  24. Green M, ed.Bright Futures: Guideline for Health Supervision of Infants, Children, and Adolescents. Arlington, Va: National Center for Education in Maternal and Child Health; 1994.

    Google Scholar 

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Cynthia Minkovitz MD, MPP.

Additional information

This study was presented at the meeting of the Association of Health Service Research, Washington, DC, June 22, 1998.

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Minkovitz, C., Mathew, M.B. & Strobino, D. Have professional recommendations and consumer demand altered pediatric practice regarding child development?. J Urban Health 75, 739–750 (1998). https://doi.org/10.1007/BF02344504

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