Health Guidelines for Kids Are Skipped

Study Shows Children May Not Always Get Up-to-Date Treatment

Medically Reviewed by Louise Chang, MD on October 10, 2007

Oct. 10, 2007 -- Less than half of the outpatient medical care delivered to American children is in line with recommendations for the best treatment, concludes a study released Wednesday.

The results, which researchers called "shocking," show that 47% of the care delivered to children in doctors' offices and clinics meets professional recommendations or is up to date scientifically.

The study -- conducted among 1,536 children in 12 cities -- comes four years after similar research showing American adults receive recommended care 55% of the time.

"No one anywhere is immune to the risk of poor-quality care," says Elizabeth A. McGlynn, PhD, a researcher at RAND Corp. who worked on the study.

Two-thirds of children being treated for acute illnesses received appropriate care, the researchers found after reviewing medical records.

But proper care for chronic conditions like asthma and diabetes was delivered just half the time, while 41% of the children received recommended preventive care, the study showed.

Researchers guessed that the results may actually underestimate the problem because the study participants were primarily white and from wealthier families.

"I want to emphasize that the results of this study are the best-case scenario," says researcher Rita Mangione-Smith, MD, MPH.

Mangione-Smith told reporters that just 31% of 3-year-old children in the study received routine height and weight measurements at the pediatrician's office. "As a pediatrician I was shocked by some of our findings," she said. "I even rescreened some of the charts because I couldn't believe some of the results we were getting."

Busy Doctors

The researchers in part blame doctors' overly tight schedules, which often allow for 10-minute doctor visits that can crowd out needed care. They also say pediatrician residency training tends to focus on treating serious illnesses in the hospital, and not enough on prevention.

Joseph Hagan, MD, a co-author of soon-to-be released practice guidelines from the American Academy of Pediatrics, says he disagrees with some of the study's methods. But he also calls the conclusion that children receive recommended care less than half the time "abysmal."

"I see this report as a little bit of a face slap, but we know there's been a problem and this helps us get a sense of how to go and fix it," says Hagan, a pediatrician in private practice in Burlington, Vt.

Hagan acknowledges that many pediatricians do not keep up to date on the latest recommendations and findings. But he also blames insurance company policies that pay doctors primarily for treating diseases and not for patient education or disease screenings.

Researchers suggest that parents not rely on doctors to remember every point of recommended screenings. Mangione-Smith urges parents to take a checklist culled from the American Academy of Pediatrics web site or other sources to the doctor's office.

"Parents do need to be quite proactive about their child's health care," Mangione-Smith says.

(Do you feel your child has good health care? Why or why not? Talk with others on WebMD's Parenting: Preschoolers and Grade Schoolers message board.)

Show Sources

SOURCES: Mangione-Smith, R. New England Journal of Medicine, Oct. 11, 2007; vol 357: pp 1515-1523. Elizabeth A. McGlynn, PhD, RAND Corp. Rita Mangione-Smith, MD, MPH, University of Washington, Seattle. Joseph Hagan, MD, co-author, Bright Futures Guidelines, American Academy of Pediatrics.

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