This study examines the effects of having an uninsured parent on access to health care for low-income children. Using data from the 1999 National Survey of America's Families, we find that having an uninsured parent decreases the likelihood that a child will have any medical provider visit by 6.5 percentage points, and decreases the likelihood of a well-child visit by 6.7 percentage points. Estimates for low-income children who have insurance but have an uninsured parent indicate a 4.1 percentage-point reduction in the probability of having any medical provider visit, and a similar 4.2 percentage-point reduction in the probability of having a well-child visit relative to those with insured parents. The effects of having an uninsured parent are smaller in magnitude than the effects of a child being uninsured. Efforts to increase insurance coverage of parents, either by extending eligibility for public insurance or through other policy interventions, will have positive spillover effects on access to care for children. Although the magnitude of these effects is small relative to the direct effect of providing insurance to either the child or parent, they should be considered in analyses of costs and benefits of proposed policies.
This new chart is an easy-to-use reference covering important areas in the pediatric well-child visit: developmental and social-emotional milestones, adolescent development, mental health, behavioral concerns, toxic stress and resilience, physical activity, sleep, and more.
https://shop.aap.org/aap-healthy-development-and-well-child-support-chart-paperback/
The Centers for Disease Control (CDC) recently recommended that the vaccines usually given at the 15- and 18-month visits could be given simultaneously at 15 months, thereby omitting the 18-month well-child visit.
There is little doubt that measles-mumps-rubella (MMR) immunization, now recommended by the American Academy of Pediatrics to be given at 15 months of age, and the diphtheria-tetanus-pertussis (DTP) and oral polio booster immunizations, now recommended to be given at 18 months of age, could be given together with no problem at 15 months. But this is not a good enough reason to abandon the 18-month well-child visit. Although I will not argue that we have solid evidence for the effectiveness of any well-child procedures other than immunizations, I believe that the 18-month visit is one of the more important ones and should not be discontinued for all children.
In a pediatric office setting, car safety counseling was provided to 16 primigravida women during a prenatal pediatric interview. A control group of 19 women received no counseling during a similar interview. Forty-two percent of noncounseled mothers and 69% of counseled mothers were using a safe infant restraint system at the six-week well-child visit.
Preventive counseling in car safety is an important role for the pediatrician.
To the Editor.—
Dr Dworkin raises many good points in his review, "British and American Recommendations for Developmental Monitoring: The Role of Surveillance." However, I am skeptical that the concept of "surveillance" is actually different from what physicians have practiced in the past. Dr Dworkin acknowledges "that mild mental retardation is not typically identified until the child is confronted with the cognitive demands of school...," especially when physicians rely on subjective impressions. With the concept of "surveillance," "eyeball" estimates will continue to be made of a child's development; and with each well-child visit and frequently each acute illness visit being of relatively brief duration, I strongly suspect that the overwhelming majority of mildly retarded children will continue to elude detection.
Parental Perceptions of Culturally Sensitive Care and Well-Child Visit Quality
