PEDIATRICS Vol. 98 No. 6 December 1996, pp. 1069-1075
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Serwint, J. R.
Right arrow Articles by Seidel, H. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Serwint, J. R.
Right arrow Articles by Seidel, H. M.

A Randomized Controlled Trial of Prenatal Pediatric Visits for Urban, Low-income Families

Janet R. Serwint MD1, Modena E. H. Wilson MD, MPH1, Judith W. Vogelhut CPNP, IBCLC1, John T. Repke MD2, and Henry M. Seidel MD1

1 The Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland
2 The Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts.

Background. Prenatal pediatric visits have been recommended by the American Academy of Pediatrics to allow the pediatrician to counsel parents on infant care issues, establish a supportive relationship, and provide pediatric practice information to parents. We hypothesized that prenatal pediatric visits would have an impact on breastfeeding decisions, health care behaviors, health care utilization, and the doctor-patient relationship.

Methods. We conducted a randomized controlled trial of prenatal pediatric visits for urban, low-income families to measure the impact on breastfeeding decisions, infant car safety seat use, circumcision, health maintenance, and emergency room visits and the pediatrician's perception that he/she would know the mother better. Pregnant women were recruited prenatally from the obstetrics clinic. Outcomes were measured by maternal interview prenatally and when the infant was 2 months old, in addition to review of the nursery record. Physicians were interviewed after the 2-month visit. Health care utilization was measured by chart review at 7 months.

Results. A total of 156 pregnant women were enrolled and randomized, 81 to the intervention group and 75 to the control group. Of mothers who breastfed, 45% in the intervention group changed their mind in favor of breastfeeding after enrollment compared with 14% in the control group. Mothers in the intervention group compared with the control group were more likely to make fewer emergency room visits, 0.58 compared with 1.0. Pediatricians were more likely to think that they knew mothers in the intervention group well, 54% versus 29% in the control group, yet 67% of mothers in both groups agreed their pediatrician knew them well. There were no differences between groups in initiation or duration of breastfeeding at 30 or 60 days, infant car safety seat use, circumcision, or health maintenance visits.

Conclusions. Prenatal pediatric visits have potential impact on a variety of health care outcomes. Among urban, low-income mothers, we found beneficial effects on breastfeeding decisions, a decrease in emergency department visits, and an initial impact on the doctor-patient relationship. We suggest urban practices actively promote prenatal pediatric visits.

Key Words: prenatal pediatric visits • breastfeeding • infant car safety seats • circumcision • doctor-patient relationship • infants • health service utilization • inner-city • lower socioeconomic status families • continuity clinic

Submitted on January 25, 1996
Accepted on May 10, 1996




This article has been cited by other articles:


Home page
 PediatricsHome page
C. E. Mercier, S. E. Barry, K. Paul, T. V. Delaney, J. D. Horbar, R. C. Wasserman, P. Berry, and J. S. Shaw
Improving Newborn Preventive Services at the Birth Hospitalization: A Collaborative, Hospital-Based Quality-Improvement Project
Pediatrics, September 1, 2007; 120(3): 481 - 488.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
U.S. Preventive Services Task Force*
Counseling about Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use while Driving: U.S. Preventive Services Task Force Recommendation Statement
Ann Intern Med, August 7, 2007; 147(3): 187 - 193.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
S. B. Williams, E. P. Whitlock, E. A. Edgerton, P. R. Smith, and T. L. Beil
Counseling about Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use while Driving: A Systematic Evidence Review for the U.S. Preventive Services Task Force
Ann Intern Med, August 7, 2007; 147(3): 194 - 206.
[Abstract] [Full Text] [PDF]

Home page
 Ann Fam MedHome page
J.-M. Guise, V. Palda, C. Westhoff, B. K. S. Chan, M. Helfand, and T. A. Lieu
The Effectiveness of Primary Care-Based Interventions to Promote Breastfeeding: Systematic Evidence Review and Meta-Analysis for the US Preventive Services Task Force
Ann. Fam. Med, July 1, 2003; 1(2): 70 - 78.
[Abstract] [Full Text] [PDF]

Home page
 Pediatr. Rev.Home page
J. R. Serwint and T. L. Cheng
The Prenatal Pediatric Visit
Pediatr. Rev., January 1, 2003; 24(1): 31 - 32.
[Full Text] [PDF]

Home page
 J Hum LactHome page
M. I. C. de Oliveira, L. A. B. Camacho, and A. E. Tedstone
Extending Breastfeeding Duration Through Primary Care: A Systematic Review of Prenatal and Postnatal Interventions
J Hum Lact, November 1, 2001; 17(4): 326 - 343.
[Abstract] [PDF]

Home page
 Qual Saf Health CareHome page
L Fairbank, S O'Meara, A J Sowden, M J Renfrew, and M M Woolridge
Promoting the initiation of breast feeding
Qual. Saf. Health Care, June 1, 2001; 10(2): 123 - 127.
[Full Text] [PDF]

Home page
 PediatricsHome page
Committee on Psychosocial Aspects of Child and Fam
The Prenatal Visit
Pediatrics, June 1, 2001; 107(6): 1456 - 1458.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
I. O. Ertem, N. Votto, and J. M. Leventhal
The Timing and Predictors of the Early Termination of Breastfeeding
Pediatrics, March 1, 2001; 107(3): 543 - 548.
[Abstract] [Full Text]

Home page
 Arch Pediatr Adolesc MedHome page
M. A. Schuster, N. Duan, M. Regalado, and D. J. Klein
Anticipatory Guidance: What Information Do Parents Receive? What Information Do They Want?
Arch Pediatr Adolesc Med, December 1, 2000; 154(12): 1191 - 1198.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. D. Kogan, G. R. Alexander, B. W. Jack, and M. C. Allen
The Association Between Adequacy of Prenatal Care Utilization and Subsequent Pediatric Care Utilization in the United States
Pediatrics, July 1, 1998; 102(1): 25 - 30.
[Abstract] [Full Text]

Home page
 J Hum LactHome page
J. H. Knopf
Article on Physician Advice Too Vague
J Hum Lact, December 1, 1997; 13(4): 275 - 275.
[PDF]

Home page
 JWatch GeneralHome page
HOW EFFECTIVE IS THE PEDIATRIC PRENATAL VISIT?
Journal Watch (General), December 20, 1996; 1996(1220): 5 - 5.
[Full Text]