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“Well-child” pediatric visits to promote good health and development are recommended for all children. In 2013, 68 percent of children younger than six who were not covered by health insurance had received a well-child check-up in the past year, compared with 92 percent of children who were covered by health insurance.

Importance

During a well-child visit, a pediatrician provides preventive care by assessing a child’s physical, behavioral, developmental, and emotional status. A well-child visit is a critical opportunity to detect a possible developmental delay or disability, early treatment of which can lessen the future impact on both the child and family.[1]

In addition, well-child visits allow physicians to promote behaviors conducive to healthy development, and to give age-appropriate counseling, or anticipatory guidance.[2],[3] Research shows that parents want more information in basic areas of childrearing, such as discipline or how to encourage learning; one study found that more than half (53 percent) of parents surveyed reported that they could use more guidance in at least three of six areas.[4],[5] Anticipatory guidance given during a well-child visit can change parenting practices (for example, by encouraging the use of time-outs instead of harsher forms of discipline[6]), and increase knowledge of injury prevention practices and infant sleep patterns.[7]Physician guidance has also been found to increase the likelihood that parents will read to their child, and that a child will be breastfed.[8]

The American Academy of Pediatrics’ age-specific recommendations for preventive pediatric care cover the following areas: medical history, measurement (such as height, weight, blood pressure), sensory screening (vision and hearing), developmental/behavioral assessment, physical examination, immunizations, anticipatory guidance (in such areas as injury prevention and nutrition counseling), and dental referral.[9],[10] As infectious childhood diseases become less prevalent, guidelines have become increasingly focused on encouraging pediatricians to address the parent/child relationship and other psychosocial aspects of development.[11],[12]

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Trends

93_fig1The proportion of children under age six who received a well-child check-up in the past year was 91 percent in 2013, an increase from 84 percent in 2000. Most of the increase has been since 2006, when the proportion reached a low of 83 percent. (Figure 1)

Differences by Health Insurance Coverage

93_fig2In 2013, children without health insurance coverage were significantly less likely than children with coverage to have received a well-child check-up in the past year (68 versus 92 percent, respectively). (Figure 2) However, this gap has been shrinking since 2007, when only 57 percent of uninsured children received a well-child check-up. (Appendix 1) Of those who had health insurance, children covered by public health insurance were less likely to have received a well-child visit than those with private insurance (89 and 94 percent, respectively). (Figure 2)

Differences by Race and Hispanic Origin[13]

Hispanic children are less likely than white and black children to receive a well-child check up. In 2013, 86 percent of Hispanic children received a well-child check up, compared with 92 percent of white and black children, each. (Appendix 1)

Differences by Parental Education

93_fig3Children with parents who have more education are more likely to receive a well-child check-up. In 2013, children whose parents had a bachelor’s degree or more were most likely to have received a well-child check-up in the past year (96 percent), followed by those whose parents had some college and children whose parents had only a high school diploma (91 and 86 percent, respectively), and children of parents with less than a high school degree (79 percent). (Figure 3)

Differences by Immigrant Status

Children under age six with at least one foreign-born resident parent were less likely than children with no foreign-born parent to have received a well-child check-up in the past year (86 compared with 92 percent, respectively, in 2013). (Figure 1)

Differences by Age

93_fig4Although in the past younger children were more likely than older children to have received a well-child check-up, in 2013 they were equally likely to have received one. (Figure 4)

State and Local Estimates

The Data Resource Center for Child & Adolescent Health provides state-level “NSCH medical home profiles”. A medical home is a source of care where the child has a personal doctor or nurse, and receives family-centered care that is comprehensive, coordinated, and culturally sensitive.

They also provide state-level data on preventive medical visits for all children under the age of 18.

International Estimates

None available.

National Goals

The American Academy of Pediatrics (AAP) recommends that children visit their pediatrician for a well-child check-up as a newborn; at 3 to 5 days post-partum; by one month; at two, four, six, nine, twelve, fifteen, eighteen, twenty-four, and 30 months; and once a year between the ages of three and 21 years. The AAP has published “Guidelines for Health Supervision III,” which includes recommendations for each well-child visit from birth to 21.

A one-page summary of recommendations from the AAP entitled “Recommendations for Preventative Pediatric Health Care” is also available.

The federal government, through their Healthy People 2020 initiative, has set a goal that all children younger than 18 will have a specific source of ongoing care by 2020.

More information is here. (see goal AHS 5.2)

What Works to Make Progress on This Indicator

A Well-Visit Planner, based on recommendations from the American Academy of Pediatrics, offers guidance to parents and guardians on what to expect from a well-child visit, how to prepare for it ahead of time, and how to ensure their top-priority questions are addressed. More information is available here.

Related Indicators

Definition

In the context of this indicator, a child received a well-child check-up in the past year if his or parent answered “yes” to the question, “During the past twelve months, did {sample child} receive a well-child checkup- that is a general checkup when {he/she} was not sick or injured?”

Data Source

Data for 2000-2013: Original analyses by Child Trends of the National Health Interview Survey.

Raw Data Source

National Health Interview Survey
http://www.cdc.gov/nchs/nhis.htm

Appendix 1 – Percentage of Children under Age 6 Who Received a Well-Child Check-Up in the Past Year, 2000-2013

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Total 84.3 84.5 84.5 84.1 85.0 84.9 82.5 83.0 87.0 88.3 89.6 89.0 89.7 90.5
Gender
Male 84.2 83.0 84.0 82.7 85.5 84.3 82.9 82.5 85.2 88.2 89.5 88.1 89.6 90.7
Female 84.4 86.0 85.1 85.4 84.5 85.6 82.1 83.4 86.6 88.4 89.7 90.0 89.9 90.2
Race/Ethnicity
Non-Hispanic white 85.6 86.1 86.4 88.3 87.4 87.7 84.5 85.0 85.3 89.8 91.8 91.8 91.6 92.0
Non-Hispanic black 86.3 87.1 88.8 88.0 87.5 86.0 87.2 86.6 90.8 88.3 90.6 90.2 92.5 92.0
Hispanic1 77.3 77.2 76.6 83.6 76.5 77.6 74.1 76.0 83.5 85.2 85.1 82.7 84.6 85.6
Non-Hispanic Other 87.9 84.9 79.8 86.2 85.8 80.4 84.1 80.9 88.1 88.9 88.4 87.3 89.2 93.6
Age group
Under 2 88.9 89.3 87.8 87.7 87.7 89.2 86.0 86.5 90.1 91.0 91.9 91.3 90.5 91.5
Ages 2-3 83.0 83.7 84.3 84.1 85.4 84.9 80.1 81.2 87.0 87.3 88.7 88.8 90.2 90.7
Ages 4-5 81.1 80.5 81.5 80.9 82.0 80.5 81.6 81.2 81.0 86.8 88.3 87.1 88.6 89.3
Poverty Status
Under 100 percent of poverty 77.0 80.3 83.7 78.9 79.9 81.0 80.1 78.8 82.8 84.1 87.7 86.0 86.6 86.0
100-199 percent of poverty 81.9 82.6 80.7 81.9 83.3 80.6 80.0 78.5 82.9 88.1 86.4 87.1 88.8 89.0
At least 200 percent of poverty 88.6 88.1 87.5 88.1 89.9 89.6 87.0 87.5 90.1 90.7 92.9 91.5 92.3 93.4
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Parental Education2
Some high
school or less
75.0 73.0 77.3 74.3 71.2 71.2 73.5 70.7 71.5 78.3 84.1 80.0 82.4 78.5
High
school graduate/ GED
81.5 83.1 82.6 80.5 83.6 84.0 81.3 79.3 83.3 85.5 86.2 86.9 86.3 86.5
Some
college, no degree /AA degree
86.5 87.4 86.0 86.3 87.1 86.0 82.0 84.0 88.0 89.9 91.5 90.5 90.2 91.3
Bachelor’s
degree or higher
89.0 87.9 88.2 89.1 90.3 90.7 88.7 90.0 91.8 92.6 92.6 92.9 93.9 95.8
Insurance Coverage
Not insured 66.6 62.0 70.6 67.3 66.3 62.4 61.2 57.4 59.2 69.7 70.2 68.4 73.8 68.4
Insured 86.6 86.7 86.0 85.4 86.5 86.8 84.3 84.7 88.3 89.6 91.0 90.1 90.5 91.7
Private insurance 87.8 87.3 87.4 86.5 89.0 88.9 86.6 86.2 89.8 91.5 92.9 92.7 92.8 94.0
Public insurance 83.8 84.9 83.9 83.7 82.5 83.4 81.4 82.7 87.3 87.1 89.2 87.4 88.4 89.2
Immigrant
Status of Parents
At least one foreign born resident parent 79.8 80.0 79.1 77.8 77.6 77.2 78.4 77.3 84.0 84.7 84.5 84.1 85.6 82.5
No foreign born resident parent 85.8 85.8 86.4 86.0 87.5 87.6 83.9 84.9 86.5 89.8 91.9 91.0 91.2 91.5
Welfare/TANF Receipt3
Received income from welfare/TANF 84.9 89.6 87.9 83.5 83.9 82.1 91.6 84.9 89.1 91.4 85.8 90.5 91.3 88.4
Did not receive income from welfare/TANF 84.3 84.2 84.3 84.4 85.2 85.1 81.7 82.8 85.7 88.1 89.9 88.9 89.6 90.6
Food Stamps/SNAP Receipt3
Authorized to receive food stamps/SNAP 84.2 86.4 84.3 82.5 83.0 85.5 82.9 85.3 87.0 87.6 89.4 86.7 89.0 89.6
Not authorized to receive food stamps/SNAP 84.3 84.1 84.6 84.3 85.4 84.7 82.5 82.4 85.6 88.5 89.7 90.1 90.0 90.8
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Region
Northeast 92.6 91.2 91.0 91.8 91.2 91.7 90.8 88.1 90.7 93.4 94.6 91.4 91.9 93.1
Midwest 86.6 87.5 88.5 85.1 87.5 87.1 85.7 83.7 82.2 88.8 91.9 91.2 91.0 91.7
South 81.9 84.1 81.6 82.9 83.6 83.3 80.4 81.4 86.1 85.9 87.3 88.3 90.1 88.9
West 78.7 77.3 79.7 79.0 80.1 79.9 76.2 81.3 86.4 87.9 88.0 86.4 86.6 90.1
1Persons of Hispanic origin may be of any race.2Parental education reflects the education level of the most educated parent in the child’s household.3At least one family member receives benefit.Source: original analysis by Child Trends of National Health Interview Survey data 2000-2013.

Endnotes


[1]American Academy of Pediatrics. (2002). Developmental surveillance and screening of infants and young children. Pediatrics, 109(1), 144-145.

[2]Committee on Psychosocial Aspects of Child and Family Health. (2001) The new morbidity revisited: A renewed commitment of the psychosocial aspects of pediatric care. Pediatrics, 108(5), 1227-1230.
Available at http://pediatrics.aappublications.org/content/108/5/1227.full.

[3]Regalado, M.& Halfon, N. (2001). Primary care services promoting optimal child development from birth to age three years: Review of the literature. Archives of Pediatrics and Adolescent Medicine, 155(12), 1311-1322.

[4]Young, K. T., Davis, K., Schoen, C., Parker, S(1998). Listening to parents. A national survey of parents with young
children . Archives of Pediatric and Adolescent Medicine, 152(3), 255-62.

[5]Schuster, M. A., Duan, N., Regalado, M., & Klein, D. J. (2000). Anticipatory guidance: What information do parents
receive? What information do they want?”Archives of Pediatric and Adolescent Medicine, 154(12), 1191-8. Available at: http://archpedi.ama-assn.org/cgi/content/abstract/154/12/1191.

[6]Sege, R. D., Perry, C., Stigol, L. et al. (2002). Short-term effectiveness of anticipatory guidance to reduce early childhood risks for subsequent violence. Archives of Pediatrics and Adolescent Medicine, 156(1), 62-66.

[7]Child Trends and Center for Child Health Research. (2004). Early childhood development in social context: A chartbook. Available at: http://www.cmwf.org/publications/publications_show.htm?doc_id=237483

[8]Young, K. T., Davis, K., Schoen, C., Parker, S(1998). Op. cit.

[9]American Academy of Pediatrics. (2000). Recommendations for preventative pediatric health care. Pediatrics, 105(3),
645-646. Available at: http://brightfutures.aap.org/pdfs/AAP_Bright_Futures_Periodicity_Sched_101107.pdf

[10]Other organizations have published guidelines as well. For other examples see Green, M. and Palfrey, J. S., Eds. (2002).
Bright futures: Guidelines for health supervisions of infants, children, and adolescents. 2nd ed., rev. Arlington, VA: National Center for Education and Maternal Health. Available at: http://www.brightfutures.org/bf2/about.html

[11]Blumberg, S. J., Halfon, N., & Olson, L. M. (2004). National Survey of Early Childhood Health. Pediatrics, 113(6),
1899-1906.

[12]Committee on Psychosocial Aspects of Child and Family Health. (2001). Op. cit.

[13]Hispanics may be of any race. Estimates for whites and blacks in this report refer to non-Hispanics only.

Suggested Citation:

Child Trends Databank. (2014). Well-child visits. Available at: https://www.childtrends.org/?indicators=well-child-visits

Last updated: October 2014