Jan 05, 2015

Childhood and prevention-—think immunizations, brushing teeth, car seats-—seem like natural partners. But the data show we could be doing a lot better. As we start the 2015 year, it is a good time to think about how greater focus on prevention measures can improve child safety and health. 140092155(1) A recent Centers for Disease Control and Prevention report shows that millions of U.S. children are missing out on important opportunities for better health. Nearly all newborns are screened for possible hearing loss; but only half of those identified have a documented follow-up audiology exam. A majority of children don’t get all the preventive dental care they need. Of teens who report using tobacco, only one in five get counseling or medication to help them quit. That’s just a partial list of shortfalls among 11 highlighted services.

Prevention, like dieting or exercise, is one of those concepts that reliably elicits plenty of nods, but which often falters somewhat between idea and execution. Why? Evolutionarily speaking, we humans were primed to respond preferentially to the saber-tooth tiger in front of us, rather than to the one we might encounter next month. Additionally, the health care system’s payment structures tend to reinforce a bias toward treatment over prevention.

Rationality certainly favors prevention: it’s been demonstrated multiple times that addressing problems early on (or avoiding them altogether), rather than waiting until they’re in full bloom, is less costly in time, money, and suffering. Of course, this is true not just in health, but education, social-emotional development, and any number of motor skills (throwing a football, playing the piano).

Where children are concerned, we need trustworthy “gatekeeper” systems that assure (to the extent possible) that early problems don’t go unnoticed, un-responded to, and left to spiral into serious trouble. The pediatric “well-child” visit is one model of such a system. According to the updated Child Trends DataBank, we’ve made notable progress in convincing parents that children don’t have to be sick or injured to benefit from a periodic check-up. As of 2013, 91 percent of children younger than six received a well-child visit; that’s improved from 84 percent in 2000.

But the aggregate data obscure some worrisome disparities. Among children lacking health insurance, only two out of three had a well-child visit. Among Hispanic children, 86 percent had such a visit, compared with 92 percent among white and black children.

Now, these data are just about getting in the door; as the data cited earlier show, even for those children receiving a well-child visit, there may be inadequate follow-through.

We’re making progress; but it will be a while before society truly catches on that “well begun is half done.”

David Murphey, senior research scientist