Children's Health

Limited direct evidence supports the many recommendations for preventive care during well-child care visits

Well-child care visits, which account for one-third of visits to pediatricians, are intended to prevent disease or injury and to promote the health of children and adolescents. Professional organizations, government agencies, and other groups have made extensive and sometimes conflicting recommendations about what should be included in well-child visits. These recommendations should be based on the strongest possible evidence. Yet, there is limited direct evidence to support 42 commonly recommended preventive interventions, according to a study supported in part by the Agency for Healthcare Research and Quality (contract 02-R00012801D).

Virgina A. Moyer, M.D., M.P.H., and Margaret Butler, B.A., of the University of Texas-Houston Health Science Center, tabulated the well-child care recommendations of seven major North American organizations such as the U.S. Preventive Services Task Force and the American Academy of Pediatrics. They found a total of 42 preventive interventions that were recommended by two or more organizations. These fell into three categories: behavioral counseling to reduce risky behavior or increase healthy behavior, screening (for example, growth monitoring, routine blood pressure measurement, and scoliosis screening), and prophylaxis (such as vitamin supplementation). They did not consider immunizations, which have been reviewed elsewhere.

The researchers sought evidence of effectiveness for the recommendations based on systematic reviews of the research literature and clinical trials. Limited clinical trials showed that counseling can change some health risk behaviors (such as seat belt and car seat use and use of smoke alarms), and that repeated intensive counseling is most likely to be effective. Rigorous evidence in support of screening was very limited. Trials supported the use of folate to prevent neural tube defects, trials of iron supplementation did not address developmental outcomes, and none addressed other prophylactic approaches such as oral fluoride treatment.

More details are in "Gaps in the evidence for well-child care: A challenge to our profession," by Dr. Moyer and Ms. Butler, in the December 2004 Pediatrics 114(6), pp. 1511-1521.

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