A survey of 2,000 parents soliciting their views on preventive care for infants and toddlers revealed information significant to the field of holistic pediatrics. The survey was a project of the UCLA Center for Healthier Children, Families and Communities and the American Academy of Pediatrics. Although the survey evaluated parents' opinions of their care in allopathic as opposed to holistic settings, it does reveal parents' unmet needs in these settings. The Holistic Pediatric Association (HPA) would assume that these needs are better addressed by holistic practitioners whose stated goal is to view the child within a broad context of emotional and environmental factors that influence health. However, a look at the specific concerns parents expressed may help us establish a dialog to improve well-child care.

A place for your feedback

The HPA recommends periodic well-child visits. We are in the process of developing guidelines for the content of holistic pediatric well-baby care. To this end the HPA would like to hear feedback from parents. Specifically, what aspects of well-child care are most important to you, especially your concerns that have not been addressed at well-baby visits by your practitioners in the past. To post your feedback, go to http://www.hpakids.org, click on the Parent Forums button and then the Community Bulletin Boards in the upper left corner. Enter your suggestions in the Preventive Care section.

Topics you might want to address include your thoughts on nutritional counseling, environmental concerns, breastfeeding, attachment parenting, vaccinations, injury prevention, developmental assessment, learning styles, and safety.

Parents' Unmet Needs

This survey revealed that some issues were frequently or almost universally discussed in well-child visits. Over 90 percent of parents indicated that vaccination and feeding-related issues were discussed with their clinician, though feeding discussions decreased to 73 percent in the 19-35-month-old group.

The survey found that parents of children 4-9 months wanted more discussion of reading, child care settings, night waking and fussing, how a child communicates needs, and burn prevention. These unmet needs can be separated into parenting subjects and symptoms. The parenting issues involved communication and interaction, specifically reading to children to stimulate development and ways to better communicate with babies at this age when they are first starting to reach out into the world and establish relationships. The symptoms that concerned parents, waking and fussiness, have specific forms of treatment within a holistic pediatric setting. Both homeopathy and herbal medicine can address these symptoms of distress and imbalance, and holistic practitioners would therefore be especially interested in hearing about these symptoms.

Parents of 10-18 month-old children felt a lack of attention to toilet training, child care settings, discipline, reading, words and phrases, and weaning. These subjects can be separated into parenting issues (weaning and discipline) and developmental concerns (language and toilet training). Parents were clearly interested in discussing more about child development and learning, which shows a significant interest in educational goals.

Unaddressed topics in the 19-35 month age group included similar issues (toilet training, discipline, and child care), with the addition of new social concerns (avoiding dangerous situations and getting along with others). Children at this age are exploring communication. It is only natural that parents often need advice at this time concerning their children's social skill development as well as their acquisition of new skills.

Child development is a theme that runs through these various parental concerns and additional needs. It is interesting that the survey also showed that only 42 percent of parents of children 10-35 months recalled ever having been told that a developmental assessment was being conducted. However, nearly all pediatricians reported that they routinely perform developmental assessments at these ages. This indicates a significant gap in perception and in communication between provider and parent. At best, pediatricians are doing informal assessments of developmental milestones at well-baby visits, and parents are unaware of their perceptions. At worst, pediatricians are not assessing development except when obvious abnormalities or delays are evident. In any case, it is clear that parents want to discuss their child's development, learning skills, and interpersonal intelligence.

The fact that parents of children in each of these age groups wanted more discussion of child care points to a significant need that is unmet in our culture where often both parents must work outside the home. Although the ideal child care at this age is with a parent or other family member at home, the reality is that parents must seek a child care setting that is developmentally appropriate. Pediatricians are often ill-equipped to counsel parents in this community referral realm, but making these types of referrals could be a useful service of pediatric offices.

Some glaring deficiencies in pediatric counseling were also noted in the survey. For example, more than one-third of parents indicated they had never discussed reading to their children with their pediatric clinician. Reading to children has been identified as important for early brain development, yet only about half of parents reported reading to their child every day. Discussion of reading with a pediatric clinician is significantly correlated with reading. Similarly, parents felt that pediatric clinicians should ask about parents' well-being and financial concerns, but less than 40 percent of parents reported being asked about their own health or emotional support for parents, and only 12 percent had been asked about their financial situation. In this survey, 89 percent of parents were in favor of asking parents about alcohol and drug use in the home, but only 44 percent of parents recalled their own pediatric clinician inquiring about substance use.

Reference:

The National Survey of Early Childhood Health: Parents' Views on Preventive Care for Infants and Toddlers, June 2004

http://pediatrics.aappublications.org/cgi/content/full/113/6/S1/1907