Showing posts with label preventive health. Show all posts
Showing posts with label preventive health. Show all posts

Monday, August 3, 2015

Sources for Infant Care Advice: What Are They and How Well Is That Advice Received?

By: Lewis First, MD, MS; Editor-in-Chief       

          A key component of every health maintenance visit is the advice we provide to parents who bring their infants and children to us.  In fact as pediatricians, we pride ourselves on making sure that advice is evidence-based and individualized for each patient and family under our care.  That being said, parents seek advice not just from pediatricians, but from birth hospital nurses, family and the media—at least according to a new study by Eisenberg et al. (2015-0551) being released this week. 
     The authors surveyed more than 1000 mothers from across the country regarding five key advice topics—immunization, breastfeeding, sleep position, sleep location and pacifier use. While the good news is that pediatricians are the most prevalent source of advice, mothers self-reported that they got no advice on sleep location or pacifier use, and about 1/5 of the sample stated they got no advice on breastfeeding or sleep position.  To find out how the other sources of advice performed, read the study yourself—although be ready to learn just how popular or unpopular family members and the media can be in also offering advice to your patients.   
     So do you agree with the findings in this study and are you surprised how often key areas of advice are not being received by families from pediatricians?  Does this mean the advice is not given, or it just doesn’t register given everything else a family wanted to learn during a visit?  To provide some further input on this study and what it means to all who practice, Drs. Scott Krugman and Carolyn Fowler provide their interesting opinion in an accompanying commentary (doi: 10.1542/peds.2015-1826).   
      Take my advice—and read this study and commentary and share the findings with families of infants as you provide your anticipatory guidance that will help insure they stay healthy in that important first year of life.

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Friday, May 9, 2014

An Ounce of Prevention: Factors Associated With Dental Care Utilization in Early Childhood

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our June issue. To learn more about Dr. Schulte and her work in general pediatrics and preventive medicine, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH

Seven unlucky years ago, Deamonte Driver was 12 years old. He died in Maryland in 2007 after infection from a cavity that became an abscessed tooth spread to his brain. An $80 extraction would have saved him, but his family had lost their Medicaid coverage, was homeless and couldn't find a dentist.

Photo by David Mulder via Flickr
Other children, both in Canada and the USA, share his experience of not having access to dental care. A study we’re early-releasing this week from the June issue of Pediatrics by Denise Darmawikarta and colleagues (doi: 10.1542/ peds.2013-3752) found that less than one percent of the 2,505 Toronto children in the TARGet Kids! Practice network had seen a dentist by their first birthdays. The cross-sectional study, which was done between September 2011 and January 2013, found that low family income, prolonged bottle use and higher intake of sweetened drinks were associated with no dental visit. Among the children who had seen a dentist in Toronto, dental cavities were more likely among those children whose families were low-income, were older and whose mothers were of East Asian maternal ethnicity.

Ms. Darmawikarta and her co-authors noted that Canada and the USA both share poor access to dental care. Dental care is not covered as part of Canada’s universal health care system. In the USA, most dental care is provided in private-practice settings on a fee-for-service basis. In the US, only 21 states get any kind of funding from the US Centers for Disease Control and Prevention (CDC) to provide oral health funding that helps provide dental care for poor children according to a study done by the Pew Charitable Trusts. According to the CDC, dental disease is the most common chronic condition among US children.

Dental and pediatric organizations, including the AAP, have set standard that says a child should see a dentist every six months. Federal data available through the Pew website shows that more than 14 million children enrolled in Medicaid did not receive any dental service in 2011.

It’s not much comfort to know that at least some Canadian children and their USA counterparts share the same bad boat with a big bite in it when it comes to accessing dental care. Sinking in cavities is not a good thing. That’s what went wrong in Deamonte Driver’s mouth seven unlucky years ago. Maybe it’s time to bite into the funding sources and draw out some dollars, both US and Canadian.

Related Reading: