Well-Child Visit - Children in Pennsylvania

Pennsylvania

The American Academy of Pediatrics recommends that all infants, toddlers and children receive routine preventive visits, known as well-child visits. The benefits of well-child visits include:

• Preventing illness through routine vaccinations. 
• Tracking growth and development. 
• Having opportunities to discuss parental concerns about child development, behavior, sleep and eating.
• Developing a strong patient-provider relationship.
• Lower use of emergency care services.

Younger children require more frequent well-child visits due to their rapid development, but it is important to continue yearly visits as they grow older as well. As children enter adolescence, they experience a number of transitions that may require unique health care solutions and conversations. During this stage, adolescents experience rapid physical growth, changing hormones and sexual maturity. Social factors and behaviors that lead to morbidity and mortality are often initiated in adolescence, which makes it a critical time for education, prevention and early intervention.

According to America’s Health Rankings analysis, the prevalence of having one or more preventive visits in the last year is higher among:

• Children ages 0-2 compared with children ages 3-17.
• Multiracial and white children compared with Hawaiian/Pacific Islander children.
• Children with a caregiver who graduated from college compared with those who had caregivers with less than a high school education.
• Children with special health care needs compared with children who do not have special health care needs.

There are several alternative methods of delivering cost-effective well-child visits that may improve access and use, including:

• Group well-child visits.
• Well-child visits can occur in community settings, such as schools and day care centers, as well as through home visits.
• A health care team approach involving alternative providers, such as physician assistants, nurse practitioners, child development specialists and school counselors.

Expanding the options for well-child visits also gives physicians greater flexibility to care for children with complex medical problems. These alternative approaches may also be more efficient at serving low-income populations. Under the Affordable Care Act, insurance plans are required to cover well-child visits. Depending on the insurance plan, well-child checkups may be available at no cost.

When surveyed, adolescents identified more and different barriers to receiving well-child visits than their parents, and minimizing those barriers could increase their use of well-child visits. Forgetting an appointment or failing to schedule one is a common barrier, and modern tools such as text message reminders can help increase primary care usage. The implementation of the Affordable Care Act has resulted in a moderate increase in preventive care use by adolescents, particularly Black, Hispanic and low-income adolescents.

Healthy People 2030 has several objectives regarding preventive visits, including:

• Increasing the proportion of adolescents who received a preventive health care visit in the past year.
• Increasing the proportion of adolescents who speak privately with a physician or other health care provider during a medical visit.

Aalsma, Matthew C., Amy Lewis Gilbert, Shan Xiao, and Vaughn I. Rickert. “Parent and Adolescent Views on Barriers to Adolescent Preventive Health Care Utilization.” The Journal of Pediatrics 169 (February 1, 2016): 140–45. https://doi.org/10.1016/j.jpeds.2015.10.090.

Adams, Sally H., M. Jane Park, Lauren Twietmeyer, Claire D. Brindis, and Charles E. Irwin. “Association Between Adolescent Preventive Care and the Role of the Affordable Care Act.” JAMA Pediatrics 172, no. 1 (January 2018): 43–48. https://doi.org/10.1001/jamapediatrics.2017.3140.

Bergman, David, Paul Plsek, and Mara Saunders. A High-Performing System for Well-Child Care: A Vision for the Future. Commonwealth Fund, October 2006. https://www.commonwealthfund.org/publications/fund-reports/2006/oct/high-performing-system-well-child-care-vision-future.

Coker, Tumaini R., Candice Moreno, Paul G. Shekelle, Mark A. Schuster, and Paul J. Chung. “Well-Child Care Clinical Practice Redesign for Serving Low-Income Children.” Pediatrics 134, no. 1 (July 1, 2014): e229–39. https://doi.org/10.1542/peds.2013-3775.

Enlow, Elizabeth, Molly Passarella, and Scott A. Lorch. “Continuity of Care in Infancy and Early Childhood Health Outcomes.” Pediatrics 140, no. 1 (July 2017): e20170339. https://doi.org/10.1542/peds.2017-0339.

Kipping, R. R., R. M. Campbell, G. J. MacArthur, D. J. Gunnell, and M. Hickman. “Multiple Risk Behaviour in Adolescence.” Journal of Public Health 34, no. suppl_1 (March 1, 2012): i1–2. https://doi.org/10.1093/pubmed/fdr122.

O’Leary, Sean T., Michelle Lee, Steven Lockhart, Sheri Eisert, Anna Furniss, Juliana Barnard, Doron Shmueli, Shannon Stokley, L. Miriam Dickinson, and Allison Kempe. “Effectiveness and Cost of Bidirectional Text Messaging for Adolescent Vaccines and Well Care.” Pediatrics 136, no. 5 (November 2015): e1220–27.https://doi.org/10.1542/peds.2015-1089.