Clinical Review Evidence based paediatrics

Evidence based well child care

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7317.846 (Published 13 October 2001) Cite this as: BMJ 2001;323:846
  1. Eugene Dinkevich, assistant professor of paediatricsa,
  2. Jordan Hupert, assistant professor of paediatricsb,
  3. Virginia A Moyer (Virginia.A.Moyer@uth.tmc.edu), associate professor of paediatrics and epidemiologyc
  1. a Department of Pediatrics, State University of New York at Brooklyn, Brooklyn, New York, NY11203, USA
  2. b Division of General Pediatrics, University of Illinois at Chicago, Chicago, IL 60612, USA
  3. c Center for Population Health and Evidence Based Medicine, Department of Pediatrics, University of Texas at Houston, TX 77030, USA
  1. Correspondence to: V A Moyer

    This is the first in a series of five articles

    THE CASE

    Your primary care paediatric practice has recently decided to review its preventive care practices before deciding which to include in a new computerised record system. You know that these practices vary considerably among group members, even as to how many check ups a child really needs. The value of some specific manoeuvres, such as the Adams forward bend test for scoliosis, for which adolescents are often referred from school, is doubted. You determine to find the best evidence for common preventive health interventions for children.

    Summary points

    Fewer visits than in the standard schedules for children up to age 2 years are sufficient to detect physical abnormalities and psychosocial and developmental outcomes

    Group care is as effective as individual care for routine checks

    The Adams forward bend test is not accurate enough for screening for idiopathic scoliosis

    Proving the value of check ups for healthy children and finding new and more effective ways to provide preventive care to all children remain major challenges

    Background

    Routine checks on apparently healthy children are an important part of preventive services available for children. In developed countries outside the United States, paediatricians are trained to practise as hospital based specialists providing clinical care, while general practitioners and public health nurses are responsible for preventive care, including care of healthy children.1 In the United States, general paediatricians provide both preventive and clinical care and spend as much as 40% of their time checking healthy children.2

    The major objective of these check ups is maintenance of health and prevention of disease. This is traditionally accomplished by repeated evaluations of healthy children under five heads: screening, health promotion, disease prevention, patient management, and follow up.

    A routine check up includes history taking, physical examination, observation of parent-child interaction, …

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