Figure 2
Opinions about the United States health care system (Source: 2006 Commonwealth Fund international health policy survey of primary care physicians [unpublished data]). • Pediatricians; diagonal, US public.
Source publication
The field of pediatrics in the US began in late-nineteenth century urban slums, where young children were monitored to ensure they received safe milk and mothers were educated about nutrition and hygiene. The subsequent reduction of infectious disease through sanitation and vaccination, and a continuing appreciation of the powerful impact of the so...
Context in source publication
Context 1
... spokesperson for the AAP recently stated that "pediatricians are going to have to be more active in 'selling' their services to their patients and speaking with families about why coming to see them is a better way to care for their children." 26 Opinion polls of the general public and of pediatricians both call for fundamental changes in the US health care system ( Figure 2). 27 Pediatricians acknowledge that they are not able to provide all of the time and care that their patients want and need, 28 and many would like to use their time, their staff, and their office resources differently. ...
Citations
... Regarding physical development (11 items), we explored the information available to mothers, particularly regarding practices related to feeding and nutrition in early childhood. We included key aspects such as the pregnancy period, breastfeeding in newborns (Imdad et al., 2011;Oddy et al., 2011;Walker et al., 2011), problems of poor nutrition (Black, 2012;Boo et al., 2014;Lozoff, 2007;Ruel et al., 2013) and the monitoring of children's growth and development (Schor, 2007). Regarding neurological and psycho-affective development (six items), we explored the knowledge of the primary caregivers on early stimulation and neurodevelopment, particularly on nutritional factors associated with brain development (Kramer et al., 2008;Quinn et al., 2001;Wehby & Murray, 2008), playful learning and techniques including psycho-affective practices (Martin, 1981;McDonald et al., 2016;Pramling Samuelsson & Johansson, 2006;Ranson & Urichuk, 2008) that favor neurological development. ...
Introduction
Efforts to identify the predictors of maternal knowledge on Early Child Development (ECD) have proven inconclusive thus far, particularly with respect to socially deprived contexts in Low- and Middle-Income Countries (LMICs). We quantified the extent of ECD knowledge among mothers who were the primary caregivers of 0–38-month-old infants in marginalized communities in Mexico. We also explored the characteristics of the children, both individually and with regard to their households, given the influence of these factors on childhood development.
Methods
We analyzed primary data obtained through a questionnaire administered to mothers who were the primary caregivers of 1045 girls and boys 0–38 months of age. The instrument was specifically designed for our study in order to explore the knowledge of participants about physical, neurological and psycho-affective development during childhood. We performed fractional regression analysis to assess the predictors of ECD knowledge.
Results
The mean score of maternal ECD knowledge increased with their age and schooling as well as with their levels of cognitive ability and self-esteem. Irrespective of age at first birth, mean knowledge was relatively high for women with high school education and low for women with elementary or no formal education, a gradient with respect to age at fist birth was more marked among women with middle school education. ECD knowledge scores increased among mothers from households enjoying higher socioeconomic levels and from households with health insurance. Scores were lower for indigenous households regardless of their participation in social programs.
Conclusion
Public policies on ECD should promote programs that are not only adapted to specific contexts, but also designed to improve shared child-rearing, early childhood care and as well as psycho-emotional education skills as a pathway to healthier ECD. The participation of families and communities in sensitive childhood care should form part of multisectoral programs involving education, health and wellbeing.
... 112 For example, PPC for children aged 0 to 5 years could emphasize the contributions of health care to school-readiness outcomes, which have been previously described; although most are assessed through process measures, they document the provision of important services. 113 The creation of individualized preventive care plans and shared plans of care can guide care and provide the basis for assessing the achievement of desired outcomes. Quality measurement can also document actions consequent to screening, generally referral to community-based programs. ...
Well-child care is a near-universal service for young children toward which a great deal of time and professional resources are devoted but for which there is scant evidence of effectiveness in routine practice. It is composed of many components, the value of which likely varies with the quality of their provision and the needs and priorities of the children and families who receive them. Achieving more efficient and effective preventive care will require that pediatric practices segment the population they serve and design schedules and staffing to match patients' health, well-being, personal and social circumstances, and service needs. Care should be individualized and include essential screening, tests, procedures, and education on the basis of assessment of patients' and families' needs and priorities. The traditional schedule of individual, comprehensive preventive care visits should be reconsidered and replaced with a schedule that allows complete care to be provided over a series of visits, including those for acute and chronic care. Preventive pediatric care should be provided in family-centered, team-based practices with strong linkages to other providers in the community who serve and support children and families. Care should make use of the wide variety of modalities that exist, and face-to-face time should be reserved for those services that are both important and uniquely responsive to in-office intervention. This model of preventive care will require changes in training, responsibilities and reimbursement of health care team members, and enhanced communication and collaboration among all involved, especially with families.
... The role of pediatrics within the multisectoral context of early childhood policies and programs has been a topic of spirited debate for decades, yet the gaps between unmet needs and the realities of day-to-day practice have remained difficult to reduce. [23][24][25][26][27][28] Efforts to improve developmental screening and referrals to appropriate services continue to be particularly challenging to implement. 29 With current early childhood policies focused predominantly on school readiness, academic achievement, and later economic productivity, a strong case is emerging that scienceinformed investments in young children and their families could generate even larger returns to society by reducing the social and financial costs of preventable disease. ...
Advances in science are fundamentally changing the way we understand how inextricable interactions among genetic predispositions, physical and social environments, and developmental timing influence early childhood development and the foundations of health and how significant early adversity can lead to a lifetime of chronic health impairments. This article and companion article illustrate the extent to which differential outcomes are shaped by ongoing interactive adaptations to context that begin at or even before conception and continue throughout life, with increasing evidence pointing to the importance of the prenatal period and early infancy for the developing brain, the immune system, and metabolic regulation. Although new discoveries in the basic sciences are transforming tertiary medical care and producing breakthrough outcomes in treating disease, this knowledge is not being leveraged effectively to inform new approaches to promoting whole-child development and preventing illness. The opportunity for pediatrics to serve as the leading edge of science-based innovation across the early childhood ecosystem has never been more compelling. In this article, we present a framework for leveraging the frontiers of scientific discovery to inform new strategies in pediatric practice and advocacy to protect all developing biological systems from the disruptive effects of excessive early adversity beyond providing information on child development for parents and enriched learning experiences for young children.
... Günümüzde çocuk sağlığı ve hastalıkları uzmanlarının, çocukların iyilik hali üzerindeki güçlü etkileri nedeni ile gelişimsel ve sosyal bağlamda da sorumlu oldukları kabul edilmektedir (4). Çocukların en üst gelişimsel potansiyellerine ulaşabilmelerini sağlamak için erken tanı ve erken müdahale esastır ve çocuk sağlığı hizmeti verenlerin bir önceliği olmalıdır (1)(2)(3)(4). ...
... 14,15,16 The emphasis in most North American communities has appropriately shifted from infection management and malnutrition to developmental screening, wellness promotion, and anticipatory guidance. 17 The heaviest burdens of adult disease are also predicted by epigeneticallymediated determinants, most of which have their roots in early life: developmental origins of health and disease. 18,19,20,21 The World Health Organization, the Public Health Agency of Canada, and the Office of Disease Prevention and Health Promotion in the United States all emphasize the importance of determinants of health, all of which are interwoven with others, underscoring the importance of addressing health from a multifactorial perspective. ...
... The possibilities and limitations of well-child care within a multidimensional health system have been the focus of a spirited and enduring discussion within the pediatric community. 88,90,91 Over more than half a century, this dialogue has focused on the need for family-centered, community-based, culturally competent care for children with developmental disabilities, behavior problems, and chronic health impairments, as well as the need for a broader contextual approach to the challenges of providing more effective interventions for children living under conditions of poverty, with or without the additional complications of parental mental illness, substance abuse, and exposure to violence. 10 As the debate has continued, the gap between the call for comprehensive services and the realities of day-to-day practice has remained exceedingly difficult to reduce. ...
... The importance of children's social-emotional wellbeing for later life has been widely recognized. [1][2][3] As a consequence, multiple studies have focused on the identification of socialemotional problems in children [4][5][6], because children and their families may benefit from early intervention if social-emotional problems occur. [7][8][9] However, the early identification of social-emotional and psychosocial problems in children could be improved. ...
Objective
Family-centered care (FCC) has been related to positive healthcare outcomes in pediatric care. Our aim was to assess whether an FCC approach also leads to better and earlier identification of social-emotional problems and less child psychosocial problems at age 18 months.
Methods
In a quasi-experimental study within routine well-child care in the Netherlands, we compared those regions in which an FCC approach was implemented (FCC-JointStart) to those regions with “care-as-usual” (CAU), including all children. In all regions, professionals performed well-child visits (2–18 months) and assessed social-emotional problems, or risks developing these, by rating outcomes of assessments as “not optimal” or as “a problem.” We compared FCC-JointStart and CAU regarding the rates of newly identified (risks for) social-emotional problems, the pace of identification over time, and the child’s psychosocial wellbeing at eighteen months as measured by the Child Behavior Checklist (CBCL). For participants that received extra care, we compared FCC-JointStart and CAU regarding the severity of parent-reported problems. Parents were blinded, professionals were not.
Results
5658 parents (68%) agreed to participate in the study. In the FCC-JointStart group, risks were identified more frequently, though differences were small (24.7% versus 22.0%, odds ratio (95%-confidence interval) adjusted for confounders: 1.44 (0.96; 2.18), Phi = .03). Risks were also identified earlier (p = .008), and additional care was provided to more severe cases than in CAU. Effect sizes r ranged from 0.17 (PSBC) to 0.22 (FAD). CBCL scores at 18 months did not differ between groups.
Conclusions
FFC-JointStart may contribute to more and earlier identification of risks for social-emotional problems and of families that need additional care, but not to fewer child psychosocial problems at age 18 months.
Trial registration
Netherlands Trial Register NTR2681
... Fathers have positive experiences and find satisfaction in health care visits when questions are sufficiently answered and needs are met (Garfield & Isacco, 2006). However, within the context of a busy practice, pediatric providers clearly need to consider optimal ways in which to target parenting-related anticipatory guidance to fathers (Schor, 2007). Although fathers in this study stated that they had obtained information from their child's health care provider, they implied that physicians' busyness during clinical encounters hindered the ability to adequately deliver health and other information. ...
Fathers play a critical role in children's development; similarly, fatherhood positively affects men's health. Among the larger population of fathers relatively little is known about the parenting knowledge of urban, African American fathers. Focusing on urban, African American fathers, the objectives of this study were to (1) understand the primary sources from which fathers learn about parenting, (2) determine where and how fathers prefer to receive future parenting education, and (3) explore the information perceived as most valuable to fathers and how this compares with the recommended anticipatory guidance (Bright Futures-based) delivered during well visits. Five focus groups, with a total of 21 participants, were conducted with urban fathers at a community-based organization. Study eligibility included being more than18 years old, English speaking, and having at least one child 0 to 5 years old. During the focus groups, fathers were asked where they received parenting information, how and where they preferred to receive parenting information, and what they thought about Bright Futures parenting guidelines. Fathers most commonly described receiving parenting information from their own relatives rather than from their child's health care provider. Most fathers preferred to learn parenting from a person rather than a technology-based source and expressed interest in learning more about parenting at community-based locations. Although fathers viewed health care providers' role as primarily teaching about physical health, they valued Bright Futures anticipatory guidance about parenting. Fathers valued learning about child rearing, health, and development. Augmenting physician counseling about Bright Futures with community-based parenting education may be beneficial for fathers.
... One of the main challenges is that most chronic illnesses among youth are not preventable by lifestyle changes, although socially related co-morbidities can be targeted to increase the overall quality of life (Lindsay et al. 2013). The course of chronic illnesses is mutually influenced by multiple factors including physical, psychological, and social factors (Schor 2007). These various factors demonstrate how interventions should be designed as comprehensive and multidimensional in nature in order to improve the overall quality of life of youth with chronic illnesses (Pendley et al. 2002). ...
Youth with chronic illnesses are at risk for decreased overall quality of life. A key component to enhancing quality of life is recognizing that comprehensive care addressing psychosocial factors is critical. Therefore, health professionals, parents/guardians, teachers, and other supportive adults should aim to incorporate strategies presented in this review in existing treatment plans. This review addresses specific strategies health professionals can use to improve the quality of life of youth with chronic illnesses. Specifically the following questions were explored: 1) What are hospital-based strategies that can enhance the overall quality of life of youth with chronic illnesses? 2) What are school-based strategies that can enhance the overall quality of life of youth with chronic illnesses? 3) What are community-based strategies that can enhance the overall quality of life of youth with chronic illnesses? This review outlines effective strategies for ensuring youth with chronic illnesses receive the proper care they need in hospital, school, and community settings.
... This ultimately forecasts finishing high school, especially in disadvantaged populations (16). School readiness should also be concerned with preparedness to adopt healthy lifestyle skills and habits because disparities in educational attainment often translate into disparities in healthy lifestyle habits, well-being, and family social support (17,18). ...
... Such numbers indicate not only the potential for dropout but also a life course of difficulties in social and occupational functioning (16). Therefore, ensuring that all children are prepared for school entry has become an important societal goal given the eventual socioeconomic and health implications of underachievement, lifestyle risks, and social maladjustment (15)(16)(17)(18). ...
... Early child development and school performance have long been considered integral components of clinical practice and assessment in the realm of community health care regarding children (18). Identifying modifiable factors that identify a lack of readiness for the transition to formal schooling represents an important goal for social pediatrics (17). Using a population of typically developing children followed from birth, the current study sought to verify the findings from a handful of independent studies addressing the influence of early childhood televiewing on distinct school readiness outcomes (25)(26)(27) and offers a singular and consistent approach to the television exposure predictor, outcomes, and statistical controls. ...
Background:
Using a large population-based sample, this study aims to verify whether televiewing at 29 mo, a common early childhood pastime, is prospectively associated with school readiness at 65 mo.
Methods:
Participants are a prospective longitudinal cohort of 991 girls and 1,006 boys from the Quebec Longitudinal Study of Child Development with parent-reported data on weekly hours of televiewing at 29 mo of age. We conducted a series of ordinary least-squares regressions in which children's scores on direct child assessments of vocabulary, mathematical knowledge, and motor skills, as well as kindergarten teacher reports of socioemotional functioning, were linearly regressed on early televiewing.
Results:
Every SD increase (1.2 h) in daily televiewing at 29 mo predicted decreases in receptive vocabulary, number knowledge scores, classroom engagement, and gross motor locomotion scores, as well as increases in the frequency of victimization by classmates.
Conclusion:
Increases in total time watching television at 29 mo were associated with subsequent decreases in vocabulary and math skills, classroom engagement (which is largely determined by attention skills), victimization by classmates, and physical prowess at kindergarten. These prospective associations, independent of key potential confounders, suggest the need for better parental awareness and compliance with existing viewing recommendations put forth by the American Academy of Pediatrics (AAP).
