TABLE 4

Clinician Suggestions for Visit Priorities Needed to Enhance Development and Behavior in Well-Child Care

Infancy
    “At the 4-month visit I ask about the family, go over the family history in detail. I find that by then the parents are past the initial overwhelm.”
    “It seems if we're thinking about making the visits more developmentally related, we need to also take into consideration the growth and development of parents. So, the 2-week and 2-month visits often focus on the parents' adjustment … including having an eye on the infant's development … more important for first time parents.”
    “I'd like to see a 1-month visit.”
Toddler
    “It would be interesting to think about effects on later visits if there was an earlier emphasis on temperament, behavior, discipline—and introduce the concepts at 9 months—what is a spirited child, what is the power struggle that is inevitably going to happen, why that is a good thing—a normal stage—creating sort of the milieu where a parent recognizes that the child's limit-testing is a positive sign and that they need positive reinforcement.”
    “At the 18-month and 24-month visits, I like to focus on the ‘terrific two's.’”
    “For sleep problems, advice sheets are inadequate—really requires person-to-person [contact], and the extended family may be vital” … she, therefore, often invites extended family members to come to discuss the issue.
Preschool
    “Somewhere before or during preschool—a central theme that's needed—a focus on socialization.”
    “I take the prekindergarten visit very seriously. I really talk to parents … because some parents don't know you have the option, when they have that fall birthday, to wait, and if I see the kid is really not there, I tell them.”
Middle childhood
    “If we could see them more frequently between 5 and 12: ‘the trust factor will encourage talking openly about sexuality, obesity, bullying, and school issues.'”
    With 10- to 12-year-old children and families, she routinely asks, “How do you guys manage decision-making.”
    “I feel that middle school kids—especially boys—are a population that we seem to miss so frequently.” Comment especially directed to social problems, including bullying and teasing.
    “We know that there are particular times when school failure is common and kids fall apart: first grade with dyslexia, third grade with processing and language-based learning disabilities, and fifth and sixth grades when they can't get it together to get their work done—and then [when these problems are missed], we have angry adolescents.”
Adolescence
    “Often the parents of adolescents are particularly appreciative for the advice and guidance—a high stakes time, and not much counsel from others—so sometimes they are asking for more support and resources, and a listening ear.”
    “For teens—pre-middle school—I like to meet with the parents alone, asking ‘Do you know what's coming down the road?' I like to build this visit with the parents only a month in advance of the teen visit … anticipating for the parents the way in which subsequent visits will go, and including the kind of questions I'll be asking the teens.”
    “It's also important to me to have the ‘going off to college' visit.” [especially in dealing with the anxiety connected with leaving home, and discussing transition issues for children with special health needs.]