2019-20 TOW #2: Early Childhood Well Child Care

We are moving on to the fun and challenge of early childhood WCC (ages 1-4). I’ve attached some cases to stimulate discussion, the link to the Bright Futures materials, and a review article that has some helpful tables about incorporating development-behavioral teaching in primary care. The cases are a way to introduce resources/concepts, and I’ve noted that we will also have more on several topics later in the year.

Materials for next week:

Key take-home points

  1. How do we prioritize what to cover in early childhood well child checks? Again, the most important element in providing patient-centered care is to ask about the parents’ concerns and priorities first. We hone in on the ongoing dramatic developmental and behavioral changes of these years, and the challenges those can bring for caregivers. There is a critical influence that environment plays in nurturing children’s development that affects their behavior, communication, nutrition and activity.
  2. What are the Bright Futures anticipatory guidance topics for early childhood? For toddlers/preschoolers, the major 5 areas vary somewhat by age, but general priorities are family support, routine (including sleep and nutrition), development (with discipline and response to tantrums important in year 2, and school readiness becoming a bigger emphasis for preschool years), oral health, and safety.
  3. What are the most important evidence-based components of early childhood visits? In addition to immunizations, there’s a bigger role for developmental screening and appropriate referral in this age group. There is great evidence for the benefit of literacy programs like Reach Out and Read and early childhood education programs like Head Start, so we have an important role in promoting these. Evidence also shows that our efforts to provide continuity and have ongoing relationships with parents helps with early child outcomes and lowers use of emergency care.
  4. What are the recommended screenings for early childhood visits? It varies some by age, but during this time we should screen for anemia and lead screening in year 2, vision starting at age 3, and hearing at age 4. In addition, we should do formal autism screening (at age 18 months-2 years). We continue to screen for social determinants of health (poverty, education, legal issues, housing and food security).
  5. How can we build rapport with parents and children for early childhood visits?  Again, we can acknowledge the really hard work parents are doing and how exhausting it can be to care for toddlers. Children at this age are also amazing in their rapid change and new skills, so we can help parents connect with that joy and wonder. In our family we joked that this required “advanced parenting,” as you’re trying to negotiate with little ones that can behave like demanding tyrants. It requires a ton of patience and awareness of the child’s experience to be empathic. As always, noticing parent strengths and the qualities they bring helps build those relationships.

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