Rethinking well-child care.

Abstract

Well-child care is a core service of pediatrics, but it receives little emphasis in pediatric training, reluctant consideration by insurers, and rare attention from researchers. Although it encompasses a variety of health-promoting and disease-preventing services, the desired outcomes of well-child care and quality standards for its provision have not been specified. It is not surprising, then, that preventive care services, as they are being provided currently, are not meeting the needs of many families, especially families with the most vulnerable children. The quality of child health supervision varies greatly among physician practices, and parents are signaling their dissatisfaction by failing to obtain approximately one-half of recommended preventive care services. In addition, evidence of effectiveness is lacking for much of the content of well-child care, which may jeopardize both its place as a covered insurance benefit and its reimbursement. It is time for major revision of well-child care, taking into account the varying needs of individual children and families, the operation of child health care practices, and the broad issues of access to primary care and payment for services within the US health care system. Because preventive health care for children, at least as it occurs within well-child visits, is authoritatively guided by the American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care ,1 otherwise known as the periodicity schedule, review and revision of well-child care must begin with that document. Historically, the field of pediatrics has been as concerned with promoting children’s health and development as with treating children’s diseases.2 The current need to return to this holistic approach is evident in the trends in children’s health status. Children’s physical health is better than it ever has been.3 Scientific progress has led to substantial reductions in many of the acute morbidities of the early 20th …