Reflections on Well-Child Care Practice: A National Study of Pediatric Clinicians

Tanner, J. Lane; Stein, Martin T.; Olson, Lynn; Frintner, Mary Pat; Radecki, Linda

doi:10.1542/peds.2008-2351

Cited by 54 publications

(46 citation statements)

References 30 publications

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“…Tanner et al 26 found that pediatricians echoed the importance of ongoing relationships with families, endorsed individualized care and the key role of parents in priority-setting, and emphasized the value of visits more attuned to development and behavior. These areas of common interest may serve as building blocks to move forward the rethinking discussion in a way that is embraced by families and pediatricians.…”

Section: Discussionmentioning

confidence: 99%

What Do Families Want From Well-Child Care? Including Parents in the Rethinking Discussion

et al. 2009

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WHAT'S KNOWN ON THIS SUBJECT:Schor called on pediatricians to rethink well-child care. Gaps exist between traditional wellchild care and contemporary needs and pressures. A key, but largely missing, perspective in the rethinking of discussions has been that of parents. WHAT THIS STUDY ADDS:In this qualitative study, we asked parents to address several core issues including why they attend well-child care visits, the aspects of care they find most valuable, and what changes could enhance the well-child experience.abstract OBJECTIVE: The content and systems surrounding well-child care have received increasing attention, and some propose that it is time to rethink both the delivery structure and central themes of well-child visits. A key, but largely missing perspective in these discussions has been that of parents, whose experiences and expectations are central to developing approaches responsive to family needs. In this study, we asked parents to address several core issues: why they attend wellchild visits; aspects of well-child care that they find most valuable; and changes that could enhance the well-child care experience. METHODS: Twenty focus groups with parents (n ϭ 131 [91% mothers])were conducted by using a semistructured interview guide. Verbatim transcripts were coded for key words, concepts, and recurrent themes. RESULTS:Primary reasons for visit attendance included reassurance (child and parent) and an opportunity to discuss parent priorities. Families valued an ongoing relationship with 1 clinician who was childfocused and respected parental expertise, but continuity of provider was not an option for all participants. Suggestions for enhancement included improved promotion of well-child care, greater emphasis on development and behavior, and expanded options for information exchange. CONCLUSIONS:As the consumers of care, it is critical to understand parents' needs and desires as changes to the content and process of well-child care are considered. Taking into account the multifaceted perspectives of families suggests both challenges and opportunities for the rethinking discussion. Pediatrics 2009;124:858-865

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Section: Discussionmentioning

confidence: 99%

What Do Families Want From Well-Child Care? Including Parents in the Rethinking Discussion

et al. 2009

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“…92 The obstacles to progress in this area have been formidable at both ends of the process-beginning with the logistical and financial challenges of conducting routine developmental screening in a busy office setting and extending to significant limitations in access to evidencebased services for children and families who are identified as having problems that require intervention.…”

Section: Defining a Distinctive Niche For Pediatrics Among Multiple Ementioning

confidence: 99%

“…92 A parallel survey of parents also noted the limited communication that exists between pediatric practices and community-based services, such as Supplemental Nutrition Program for Women, Infants, and Children; child care providers; and schools. 93 Perhaps most important, both groups agreed that pediatricians cannot be expected to meet all of a child' s needs.…”

Section: Defining a Distinctive Niche For Pediatrics Among Multiple Ementioning

confidence: 99%

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Shonkoff¹,

Siegel²,

Dobbins³

et al. 2012

Pediatrics

3,959

2,375

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Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health.

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“…Rather than continuing the current trend of "doing more with less," as pediatricians take on a wide range of additional responsibilities, payment reforms should reflect the value of pediatricians' time and knowledge, as well as the importance of a pediatrician-led medical home serving as a focal point for the reduction of toxic stress and for the support of child and family resiliency. This additional work and the reprioritization of efforts should reflect pediatricians' interest in preventive care that is more developmentally relevant, 32 parents' desire for a greater emphasis on their child' s emerging skills and behavior, 33 the commitment to team-based services within the pediatric medical home, 28 and the growing evidence base that early developmental interventions can have significant effects on life-course trajectories. 34 As the most logical candidate for a universal platform to promote healthy development and optimal life course trajectories, the pediatric medical home has become the focus of both increasing expectations and formidable challenges.…”

Section: An Important Role For the Pediatric Medical Homementioning

confidence: 99%

“…32 All confront the limited availability of accessible and affordable preventive supports for children and families experiencing significant adversity.…”

Section: Screening For Children and Families At Riskmentioning

confidence: 99%

Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health

Care¹,

Developmental²,

Garner³

et al. 2012

Pediatrics

762

300

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Advances in a wide range of biological, behavioral, and social sciences are expanding our understanding of how early environmental influences (the ecology) and genetic predispositions (the biologic program) affect learning capacities, adaptive behaviors, lifelong physical and mental health, and adult productivity. A supporting technical report from the American Academy of Pediatrics (AAP) presents an integrated ecobiodevelopmental framework to assist in translating these dramatic advances in developmental science into improved health across the life span. Pediatricians are now armed with new information about the adverse effects of toxic stress on brain development, as well as a deeper understanding of the early life origins of many adult diseases. As trusted authorities in child health and development, pediatric providers must now complement the early identification of developmental concerns with a greater focus on those interventions and community investments that reduce external threats to healthy brain growth. To this end, AAP endorses a developing leadership role for the entire pediatric community—one that mobilizes the scientific expertise of both basic and clinical researchers, the family-centered care of the pediatric medical home, and the public influence of AAP and its state chapters—to catalyze fundamental change in early childhood policy and services. AAP is committed to leveraging science to inform the development of innovative strategies to reduce the precipitants of toxic stress in young children and to mitigate their negative effects on the course of development and health across the life span.

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Reflections on Well-Child Care Practice: A National Study of Pediatric Clinicians

Abstract: Pediatric clinicians' support a vision of preventive care that is comprehensive, family centered, and developmentally relevant, both for children with greater risk to long-term healthy development and for families with more normative child-rearing concerns.

Cited by 54 publications

References 30 publications

What Do Families Want From Well-Child Care? Including Parents in the Rethinking Discussion

What Do Families Want From Well-Child Care? Including Parents in the Rethinking Discussion

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health

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