Many Children Make Too Few Health Care Visits, HRSA Study Finds

A substantial proportion of children in the United States do not receive the professionally recommended number of preventive health and dental care visits, according to new HRSA research.

The study, “Factors that Influence Receipt of Recommended Preventive Pediatric Health and Dental Care,” published in December’s Pediatrics (www.pediatrics.org), was conducted by HRSA epidemiologists Stella Yu and Michael Kogan, researchers from the Maternal and Child Health Information Center in Washington, D.C., and the University of California at Los Angeles.

Researchers used the 1999 National Survey of America’s Families, including 35,938 children younger than 18, to examine sociodemographic and economic factors associated with children who made “well-child” and dental visits during 1998.

The study used as a guide the recommendations of the American Academy of Pediatrics (AAP) that children ages 3 to 18 make one well-child visit each year, skipping annual visits at ages 7 and 9, and of the American Academy of Pediatric Dentistry (AAPD) and HRSA’s Bright Futures guidelines, that parents take children to the dentist twice annually.

Study findings include:

• Overall, more than 23 percent of children did not receive AAP’s recommended number of well-child visits in the year prior to the survey. Children least likely to receive the recommended preventive health visits were non-Hispanic whites, in fair or poor health, from families with incomes between 200 percent and 300 percent of the federal poverty level, and without health insurance.

• Nearly half of the children did not receive AAPD’s recommended two annual dental visits, with very young children the least likely to receive dental care. Twenty-one percent of all children did not even make a single dental visit. Uninsured children, those living in or near poverty, children with young parents or parents with less than a college education, and Hispanic and black children were also least likely to get recommended dental care.

Slightly more than two-thirds of all children received recommended well-child care visits and at least one yearly dental visit, which researchers say indicates families’ interest in preventive care. Children with public health insurance were more likely to receive recommended well-child care than those uninsured or privately covered. But there is much need for improvement, researchers contend, among public programs in providing recommended dental care, especially among adolescents and children in poor general health.

Barriers to preventive dental care may be based on lack of knowledge or resources, according to researchers. They suggest increasing outreach to educate parents about the benefits of dental care and to encourage pediatricians to give families preventive dental guidance and make dental referrals.

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