Primary Care

Primary care providers often fail to cover the most significant injury prevention issues during well-child visits

Injuries are the primary cause of death among those 19 years of age and younger. Given the limited time doctors have to counsel parents and children about injury prevention, they tend to select only certain topics. Although two-thirds of primary care providers counsel parents of children age 5 and younger on how to prevent car-crash related injuries (66 percent) and ingestion of poisons (62 percent), few counsel them on drowning prevention (32 percent) and firearm injuries (16 percent). Unfortunately, attitudes about certain injuries rather than knowledge about the prevalence of particular childhood injuries affect the prevention counseling topics that doctors and pediatric nurse practitioners address.

Use of the Injury Prevention Program developed by the American Academy of Pediatrics could help to ensure that the most significant injury prevention issues are discussed consistently during well-child examinations, concludes a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00046). Shari Barkin, M.D., M.S.H.S., currently of Wake Forest University, and her colleagues at the University of California, Los Angeles, surveyed a random sample of 465 pediatricians, family physicians, and pediatric nurse practitioners in Los Angeles County. They asked clinicians about the injury prevention counseling they provided during well-child examinations on motor vehicle crashes, toxic ingestion, drowning, and firearm injuries.

When asked to rank order the four injury topics, most providers were clear that they would discuss motor vehicle crash injury prevention first and knew that these crashes were the primary cause of death and disability for young children. However, they generally disagreed about which injury prevention topic was next in importance, and were unclear about the relative prevalence of the other three types of injuries. Attitudes were more predictive of their counseling topics. Believing that it was less important to counsel on drowning and firearm injury prevention (even though childhood drowning injury was a significant problem in Los Angeles County) significantly decreased the likelihood that clinicians would do so.

More details are in "Predicting clinician injury prevention counseling in young children," by Dr. Barkin, Arlene Fink, Ph.D., and Lillian Gelberg, M.D., M.S.P.H., in the December 1999 Archives of Pediatric and Adolescent Medicine 153, pp. 1226-1231.

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