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PEDIATRICS Vol. 113 No. 6 June 2004, pp. 1907-1916

SUPPLEMENT ARTICLE

Overview of the Content of Health Supervision for Young Children: Reports From Parents and Pediatricians

Lynn M. Olson, PhD*, Moira Inkelas, PhD{ddagger},§, Neal Halfon, MD, MPH{ddagger},||, Mark A. Schuster, MD, PhD§,¶, Karen G. O’Connor* and Ritesh Mistry, MPH{ddagger}

* Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, Illinois
{ddagger} UCLA Center for Healthier Children, Families and Communities, Los Angeles, California
§ UCLA School of Public Health, Los Angeles, California
|| UCLA Schools of Medicine, Public Health, Public Policy, and Social Research, Los Angeles, California
RAND, Santa Monica, California

Objective. To describe the content of anticipatory guidance provided to parents of infants and toddlers and to identify primary areas of unmet need as reported by both parents and pediatricians.

Methods. Parent data were obtained from the National Survey of Early Childhood Health, a nationally representative sample of parents of 2068 US children aged 4 to 35 months. Pediatrician data were obtained from the Periodic Survey of Fellows, a national survey of members of the American Academy of Pediatrics.

Results. Parents and pediatricians tend to agree on the relative ranking of which topics are most frequently addressed. Parents and pediatricians both report that the traditional topics of preventive care—immunizations, feeding issues, and sleep patterns—are most frequently discussed, whereas topics that were more recently introduced into pediatric care related to developmental needs and family context are less commonly addressed. Parent-reported discussion of these topics include reading (discussed for 61% of children 19-35 months) and child care (discussed for 26% of children 19-35 months). Parent reports of some unmet need—defined as topics not discussed that the parent believes would have been helpful to them—affect 36% of children aged 4 to 9 months and 56% of children aged 10 to 35 months and are highest for the topics of discipline strategies and toilet training. Other specific areas of unmet need reported by at least 15% of parents are burn prevention, child care, reading, vocabulary development, and social development. Rates of unmet need vary with family characteristics and health system factors, including maternal education, race/ethnicity, and length of well-child visits.

Conclusion. Parents and pediatricians report high rates of discussion on many topics that are critical to healthy development in the first years of life. They also identify areas of need that largely address health supervision on developmental topics. Findings indicate that additional research is needed to understand issues related to specific topic areas as well as the dynamics of personal and system factors that determine what is discussed.

Key Words: children • health supervision • preventive care • anticipatory guidance

Abbreviations: AAP, American Academy of Pediatrics • NSECH, National Survey of Early Childhood Health

Received for publication Oct 20, 2003; Accepted Jan 13, 2004.




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