Pediatric Counseling Research Articles

Motivational Interviewing and Pediatric Health Behavior Interventions

Motivational interviewing (MI) is an empirically supported intervention with a large evidentiary base in the adult behavioral medicine and addictions literature. In the last decade, a growing body of research has shown promise for the use of MI in health behavior change settings with pediatric populations. This article provides a description of MI and its differences from other pediatric counseling and medical management approaches. A review of outcome studies of health behavior change interventions using MI with pediatric populations (age 18 and younger) and parents is provided, and implications for clinical development, research, and training are discussed.

Experiencing the Genetic Body: Parents' Encounters with Pediatric Clinical Genetics

Because of advancements in genetic research and technologies, the clinical practice of genetics is becoming a prevalent component of biomedicine. As the genetic basis for more and more diseases are found, it is possible that ways of experiencing health, illness, identity, kin relations, and the body are becoming geneticized, or understood within a genetic model of disease. Yet, other models and relations that go beyond genetic explanations also shape interpretations of health and disease. This article explores how one group of individuals for whom genetic disorder is highly relevant formulates their views of the body in light of genetic knowledge. Using data from an ethnographic study of 106 parents or potential parents of children with known or suspected genetic disorders who were referred to a pediatric genetic counseling and evaluation clinic in the southeastern United States, we find that these parents do, to some degree, perceive of their children's disorders in terms of a genetic body that encompasses two principal qualities: a sense of predetermined health and illness and an awareness of a profound historicity that reaches into the past and extends into the present and future. They experience this genetic body as both fixed and historical, but they also express ideas of a genetic body made less deterministic by their own efforts and future possibilities. This account of parents' experiences with genetics and clinical practice contributes to a growing body of work on the ways in which genetic information and technologies are transforming popular and medical notions of the body, and with it, health, illness, kinship relations, and personal and social identities.

Primary care pediatrics: 2004 and beyond.

Changes in medicine domestically and globally are transforming primary care in the United States. Many have suggested that primary care is in crisis or at least at a crossroads in the United States. The Annals of Internal Medicine recently devoted much of one issue to this topic.1 Primary care for children and adolescents, however, was not addressed specifically. This article focuses on pediatrics and identifies potential roles and new models for primary care pediatrics. The Institute of Medicine has defined primary care as “the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”2 Starfield3 has defined 4 attributes of primary care including first-contact care, longitudinality, comprehensiveness, and coordination. September 11, 2001, the anthrax scare, and emerging threats such as severe acute respiratory syndrome (SARS) have brought a new focus on the importance of individual-level contacts in addressing population-level threats. Before these world events, however, primary care pediatrics was already grappling with its identity and responding to significant changes in medical systems, science, and family needs. The pace and scope of these changes are such that primary care pediatricians of the future will not be performing the same role as today. Historically, American medicine has tended to be reactive rather than proactive in defining its roles in society. However, dynamic change demands collective reflection; it is time to be proactive in assessing the needs of patients, exploring potential roles as health care providers, and developing the mechanisms to redefine the primary care pediatrician of the future. Projecting future trends requires reflection on the history of the profession of preventive pediatrics. In the 1800s, few physicians in the United States routinely … Address correspondence to Tina L. Cheng, MD, MPH, Johns Hopkins University Department of Pediatrics, 600 N Wolfe St, Park 392, Baltimore, MD 21287. E-mail: tcheng2{at}jhmi.edu

Postpartum Counseling Perceptions and Practices: What's New?

The in-hospital postpartum period is a critical opportunity for health care providers to enhance maternal understanding of newborn care, yet few studies have determined whether health care providers' educational priorities match those of new mothers. To document how well pediatricians' perceptions of educational priorities for counseling about care of the newborn match those of new mothers during the postpartum hospitalization, and to determine whether pediatricians' actual counseling practices reflected maternal priorities. Cross-sectional study of perceived educational needs with direct observation of pediatrician counseling practices. A suburban Washington, DC, community hospital. All pediatricians on staff and a convenience sample of postpartum mothers were asked to rate the importance of newborn counseling issues using lists generated from focus groups and interviews. Pediatricians were observed while counseling mothers, and their postpartum counseling practices were scored using a template derived from the rating procedure. Comparison of pediatricians' and mothers' perceptions of educational priorities and the description of pediatricians' actual counseling practice. Mothers listed 9 issues as "very important" and expected the pediatrician to address health problems, especially jaundice, feeding, testing, pain medications for circumcision, behavior, and when to call the pediatrician for concerns or to schedule well-child care. Pediatricians and mothers agreed on 6 out of 11 very important issues. Pediatricians were observed to discuss an average of 8 issues per session, especially those they rated as very important, but they frequently failed to mention safety, sleep position, when to call for advice, testing, infant behavior, or circumcision issues. Mothers desire to learn a significant amount of information regarding the care of their newborn before hospital discharge. Although pediatricians discussed more issues than in a previously reported study of postpartum counseling, they still fell short of maternal expectations. Pediatricians must ensure that other sources of information, such as nurses, media, and reinforcement at postpartum well-child visits, supplement the information they provide in their in-hospital counseling sessions.

Pediatric counseling and medication management services: opportunities for community pharmacists.

By providing services tailored to children and their parents, pharmacists can help ensure safe and effective pediatric medication use.

Development of a pharmacy residency program in home care.

A residency training program developed by a college of pharmacy in conjunction with a home care company is described. The 12-month program is based on the ASHP Residency Learning System and the goal statements and educational objectives of ASHP's accreditation standard for pharmacy practice residency training with emphasis in home care. Establishing the program involved identifying goals, objectives, and learning experiences consistent with the expected outcomes. Specific objectives for meeting goals in four categories--practice foundation skills, direct patient care, drug information and drug policy development, and practice management--were linked to expected program outcomes. Learning experiences that would lead to achievement of the program objectives and outcomes were selected and organized into one- to eight-week rotations (e.g., in acute care, care of pediatric patients, pain management, nutrition, patient education and counseling, and administration and practice management). Throughout the program, residents gain experience in pharmaceutical services and research. Skills in care planning and monitoring are emphasized, as is practicing pharmaceutical care in an interdisciplinary environment. Residents who have completed the program have found employment immediately as pharmacy managers of home infusion centers. Pharmacy residency training in home care provides the experience needed to function as a competent clinician and manager who can identify and solve problems to improve patient care.

Injury Prevention Counseling by Pediatricians: A Benefit-Cost Comparison

The American Academy of Pediatrics believes that health education, through office-based counseling, can contribute to childhood injury prevention. This report extends previously published work on the effectiveness of primary care-based counseling and compares the costs and estimated monetary value of the benefits of safety counseling targeting children ages 0 to 4 years. We estimate the savings achievable with comprehensive childhood injury prevention counseling organized around the three Framingham Safety Surveys used in The Injury Prevention Program (TIPP) developed by the American Academy of Pediatrics. We verify the estimated savings by comparing them with the effects of pediatrician counseling from separate analyses of the most fully evaluated interventions--in child motor vehicle occupant injuries, burns, and falls. TIPP pediatrician injury counseling sessions between the ages of 0 and 4 years can achieve estimated savings of $880 per child or $80 per visit. If all 19.2 million children ages 0 to 4 years completed TIPP, we estimate that $230 million would be saved annually in medical spending, and injury costs would decline $3.4 billion. each dollar spent on TIPP childhood injury prevention targeting children ages 0 to 4 years returns nearly $13. TIPP pediatrician injury counseling is a cost-effective method of preventing childhood injuries and should be more widely adopted.

Protecting the weakest link: a proposal for universal, unblinded pediatric HIV testing, counselling and treatment.

This paper argues that a system of unblinded, universal testing, counseling and treatment for pediatric HIV should be implemented immediately in New York State. First, it argues that New York's health and social services bureaucracies, in conjunction with special interests that do not represent the interests of children, have resisted efforts to have infants tested and treated for HIV. Second, the paper suggests that the campaign against universal infant screening and treatment reflects our society's continuing, calculated decision to ignore the complexity of the HIV/AIDS epidemic. Third, the paper outlines a plan for a prompt and comprehensive system of HIV testing, counseling and treatment for infants and children, as well as for their parents and families, who are HIV-positive. In the process of articulating the above positions, the paper documents the failure of universal blinded infant HIV screening in New York since 1987. It further explores the inadequacies of the proposed efforts by state and city regulatory authorities to improve the testing and counseling available for pediatric HIV. Although encouraged by New York State's recent move aggressively to test and treat HIV-positive infants and children in foster care, the paper argues that this effort must be expanded to apply to the entire newborn population. Finally, the paper examines in detail the limitations of testing and counseling provided to children in the foster care system.

Letter to the Editor

In response to Dr Blackman: Dr Blackman's letter confuses several distinct issues: 1) gun exposure of children seen in pediatric practices, 2) teen gun use, 3) the root causes of violence (eg, poverty), and 4) his model of "a stable and moral family environment." Our paper addresses only the first issue. Guns in the homes of pediatric practice attenders are not the cause of all of society's ills, nor of all gun violence. On the other hand, guns in the home are a proven hazard,1-4 which pediatric counseling may help to reduce.

The Effects of Age and Gender on Reading Achievement

The hypothesis that age of school entrance and gender interact to affect academic achievement was tested on three samples of children at the end of 1st (n = 1215), 2nd (n = 1141), and 3rd grade (n = 1037). Multiple regressions of age, gender, and their interaction on reading achievement resulted in significant effects of age for each sample. However, these variables together accounted for less than 1% of the variability in reading scores at each grade. There was a significant interaction between age and gender for the 3rd grade sample. Separate gender analyses of variance by age class revealed that girls who were 6 years or older at the time of entrance achieved significantly lower than middle-entrance-age or younger girls. Contrary to popular belief, there were no significant age class effects for boys. These findings indicate that significantly more attention should be focused on the specific skills that children bring to the learning process than on their age and gender in assessing readiness. Implications for pediatric counseling are discussed.

Movies, Guns, and Kids

To the Editor.— Professionals in pediatric medicine can be effective in preventing firearm injuries to children. In addition to influencing gun control legislation, pediatricians can promote gun safety awareness through counseling and education, and we believe that a pediatrician counseling adolescents or parents of younger children regarding handgun policy will be more persuasive by being more authoritative. It has been suggested that pediatricians counseling patients about home safety issues include education about the risks of keeping guns in the home.1

The role of the pediatrician in the prevention of coronary heart disease in childhood.

Recent epidemiologic and clinical studies have led to a much better definition of coronary heart disease risk factors and to the conclusion that an effective primary prevention program should begin in the pediatric age group. What remains unanswered is who should start the process in the pediatric age group and how? In view of the high degree of pediatric involvement in prevention and the family contacts, pediatricians are high on the list of suitable candidates for implementing coronary heart disease preventive measures in children. It nevertheless remains unclear as to how much counseling must be done by pediatricians and at what intensity, so as to avoid undue harm. There is, therefore, a clear-cut need for guidelines to the general pediatrician for a sensible, effective and specific, yet harmless and cost efficient, approach. Since eating habits in infancy establish the basis for lifetime eating habits, pediatricians can have a significant impact by encouraging a diet low in sodium, saturated fat and cholesterol, while adequate in calories and thoroughly meeting the nutritional needs of a growing child. Counseling regarding dietary moderation, avoidance of obesity and smoking, and regular exercise can and should become part of a pediatrician's counseling aimed at the prevention of coronary heart disease.

Pediatric counseling and subsequent use of smoke detectors.

Effects of a brief educational and purchase program concerning home fires and smoke detectors by two pediatricians were compared to "routine" counseling without such a program using two groups each of 120 patients of well children. Inspection performed four to six weeks after the office visits showed that of 55 experimental group parents without detectors prior to the program, 26 purchased and 19 installed them correctly. No control group parents did so.

Pediatric Counseling with Parents Regarding Childhood Behavior Problems

The role of the pediatrician is being expanded to encompass parent counseling regarding childhood behavior problems. The most commonly used techniques have included praise for appropriate behavior combined with ignoring inappropriate behavior and / or providing time out for misbehavior. The present paper presents two techniques (i.e., a modified time out procedure and a response cost procedure) with which pediatricians can counsel parents regarding how to manage discipline problems outside the home and difficulties associated with children's morning routines in preparation for school.

Pediatric Counseling with Parents Regarding Childhood Behavior Problems

Pediatric Counseling with Parents Regarding Childhood Behavior Problems

Role of Pediatrician in Fostering Good Parenting

More and more articles have appeared on the negative consequences of poor parenting. Klaus and Kennel studied the impact of early separation or loss on family development. C. Henry Kemp has related the observation of faulty parent-child bonding to the subsequent occurrence of child abuse. In the April 1977 issue of Pediatrics (59:489, 1977) appeared a plea by William Turtle for group prenatal pediatric counseling to prevent childhood behavior problems. On the consumer side of the picture, groups such as the Childbirth Education Association have promoted the coming together of husband and wife in joint preparation for a more natural childbirth.

Role of Pediatrician in Fostering Good Parenting

More and more articles have appeared on the negative consequences of poor parenting. Klaus and Kennel studied the impact of early separation or loss on family development. C. Henry Kemp has related the observation of faulty parent-child bonding to the subsequent occurrence of child abuse. In the April 1977 issue of Pediatrics (59:489, 1977) appeared a plea by William Turtle for group prenatal pediatric counseling to prevent childhood behavior problems. On the consumer side of the picture, groups such as the Childbirth Education Association have promoted the coming together of husband and wife in joint preparation for a more natural childbirth.

65. Routine Pediatric Counseling — Delegated

65. Routine Pediatric Counseling — Delegated

Genetic counseling in clinical pediatrics. What to do with inquiries about heritable disorders.

Genetic counseling in clinical pediatrics. What to do with inquiries about heritable disorders.

Genetic Counseling in Pediatrics

Genetic Counseling in Pediatrics