Well-child care is one of the hallmarks of a family-centered medical home. Despite what some might think when hearing "medical home" for the first time, a medical home is not a physical place. Rather, it is an approach to providing primary care in a way that looks at the entire picture incorporating all the things that are important to the health and wellbeing of a child.
As part of the care provided within a medical home, the well-child care visit is an opportunity to raise general questions and concerns about your child's development, behavior, and general well-being. Many parents also use this well-child visit as a time for scheduled vaccinations and to see how much their child has grown since the last check-up. Pediatricians are used to discussing common concerns with parents such as eating, sleeping, toilet training, and social behaviors, as well as attention and learning difficulties. This type of visit differs from a "sick visit" in which you might take your child to the doctor for a specific problem like an allergic reaction, an ear infection, or breathing trouble.
Having regular well-child visits with your child's doctor and raising the concerns that matter most to you are key ingredients in helping the doctor know you and your child and forming a reliable and trustworthy relationship.
The American Academy of Pediatrics (AAP) recently conducted 20 focus groups with parents and 31 focus groups with pediatricians and pediatric nurse practitioners to gather recommendations about how to make the most of the well-child office visit. From these conversations, four common ideas arose:
- Pediatricians and parents share the goal of healthy children.
- Pediatricians want the well-child visit to best serve the needs of children and their families.
- Pediatricians are experts in child health, but parents are experts on their child.
- A team approach can best develop top physical, emotional, and developmental health for the child.
Making the Most of Doctor Time
"In our study that included parent and pediatrician focus groups, we found that both groups felt an ongoing, continuous relationship between family and pediatrician was a first requirement for high quality care," said Lane Tanner, M.D., FAAP, associate director, Division of Developmental and Behavioral Pediatrics at Children's Hospital and Research Center in Oakland, California. "That continuity of care helps build trust, and that can lead to better communication at the well-child visit."
Tip for Parents: Create a list of things you want to discuss with your child's pediatrician to ensure you get all the information you need. Jotting down your top three to five questions or concerns, bringing them to the visit and presenting these to the pediatrician at the beginning of the visit will help you focus on your issues of concern and start the dialogue with your pediatrician.
"Any question that reflects your concern about your child's development, behavior, sleep, eating or relations with other members of the family is appropriate," suggested Martin T. Stein, M.D., FAAP, professor of pediatrics at the University of California San Diego Rady Children's Hospital. "Asking what you can do to help your child's development and learning is probably the best question."
Other ideas include researching on HealthyChildren.org and in parenting books for developmental skills and typical issues your child may be experiencing by age level. Knowing what to expect makes what is new feel more familiar (and less intimidating).
"Talk to others who may care for your child — the other parent, a grandparent, child care provider — and ask for their input. They may notice something different to offer a new perspective," Dr. Stein offered.
According to Dr. Tanner, parents should not hesitate or feel embarrassed to share information that further opens the doors of communication. "As your child's most important advocate, you have valuable information that will help your doctor better understand your child and your family," he said.
An Ounce of Prevention...
Immunizations are a big part of the preventive care visit, but talking about other topics can be helpful. As part of providing a comprehensive medical home for patients and their families, pediatricians also address safety in the home and at the playground, optimal nutrition, toilet training, and environmental concerns such as lead paint exposure.
Many first-time parents may not realize that they can ask about any and everything related to the care of their child — medical or not.
"I recommend talking about what you see as either a special trait or a concern about your child," Dr. Stein explained. "This helps your pediatrician get to know you and your child on a more personal level. Pediatricians also like to know how much you appreciate their care. This helps build a stronger bond with your family. We can all use positive feedback!"
A Healthy Future
The AAP developed a set of comprehensive health supervision guidelines for well-child care, called Bright Futures, for pediatricians to follow. The mission of Bright Futures is to promote and improve the health, education, and well-being of infants, children, adolescents, families, and communities.
Some pediatricians send out reminder cards for these planned appointments, much like dentists' offices do for twice yearly cleanings. This was one of the recommendations that emerged from the focus groups.
"Well-child care is so important," stresses Dr. Tanner. "Taking your child to the doctor when he or she is feeling under the weather is simply not enough. The AAP recognized the need for a schedule of visits (see below) to the pediatrician because when you know a visit is approaching, you can prepare for topics of discussion. Starting the dialogue can lead to a healthier life for your child overall, and that is the ultimate goal."
Schedule of Well-Child Care Visits
Visits can include physical measurements, patient history, sensory screenings, behavioral assessments, and planned procedures (immunizations, screenings and other tests) at the following suggested intervals:
And once every year thereafter for an annual health supervision visit that includes a physical exam as well as a developmental, behavioral, and learning assessment.