Child/Adolescent Health

Many children do not receive recommended well-child visits during the year, especially disadvantaged children

Compliance with recommended well-child visits has improved slightly since 1987. However, it remains low among U.S. children, with very low rates among certain disadvantaged groups, concludes a new study. Well-child visits are important because they help promote timely immunizations and present opportunities to screen for health conditions and normal development. They also offer clinicians the chance to answer parents' health-related questions and provide guidance, explains Thomas M. Selden, Ph.D., of the Agency for Healthcare Research and Quality (AHRQ).

Dr. Selden analyzed data from the 2000-2002 Medical Expenditure Panel Survey of U.S. households, which combines well-child care data over a 2-year period with a rich array of socioeconomic and health status measures. On average, 56.3 percent of all children up to 18 years of age had no well-child visits during a 12-month period, and 39.4 percent had no well-child visits over a 2-year period. The average rate of compliance with well-child visit recommendations from the American Academy of Pediatrics was 61.4 percent; however, compliance rates varied substantially among various subgroups. Groups with high compliance rates were infants (83.2 percent), children with special health care needs (86.6 percent), children with college-educated parents (74.3 percent), children with family incomes over four times the poverty level (71.6 percent), and children living in New England and the Middle Atlantic regions (94.6 and 83.2 percent, respectively).

However, uninsured children had low levels of compliance (35.3 percent), especially uninsured children eligible for public health insurance coverage (28.4 percent). Other groups with low compliance rates included teenagers (49.2 percent), noncitizen children (43.9 percent), and children in the West South Central (44.9 percent), East South Central (48.8 percent), and Mountain (49.7 percent) regions. Although experts dispute the optimal frequency of well-child visits, the disparities observed in compliance rates among population subgroups raise important public health concerns.

More details are in "Compliance with well-child visit recommendations: Evidence from the Medical Expenditure Panel Survey, 2000-2002," by Dr. Selden, in the December 2006 Pediatrics 118(6), pp. 1766-1778. Reprints (AHRQ Publication No. 07-R019) are available from the AHRQ Publications Clearinghouse.

Editor's Note: An AHRQ-supported article (HS10770) on a related topic found that children living in families with many other children or with other adults used less outpatient care and prescription medications than their peers. For more details, see Chen, A.Y. and Escarce, J.J. (2006, October). "Effects of family structure on children's use of ambulatory visits and prescription medications." HSR: Health Services Research 41(5), pp. 1895-1914.

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