USA today Article about Well Child visits

[Guest guest]

'Well child' visits revisited

Updated 8/6/2006 6:38 PM ET

Pediatricians are busy. Parents are, too. So fitting one more thing into a

" well child " visit - in addition to the weighing, measuring, poking and

prodding - is tough.

But when that one thing is assessing an infant's or toddler's development -

all the outward signs that his brain, mind and body are working together as

they should - it's worthwhile. That's because catching the early signs of

problems ranging from mild speech delays to mental retardation can make a

huge difference in the lives of children and families.

" We just know that if we get kids in early, they do so much better, " says

Frances Glascoe, an adjunct professor of pediatrics at Vanderbilt University

in Nashville.

The problem: making routine developmental screening happen in a world where

a well-child visit lasts less than 15 minutes and insurers don't pay doctors

to indulge in long chats with worried parents.

The American Academy of Pediatrics published its latest policy in July. It

calls for pediatricians to:

..Ask parents questions about their children's development and look for signs

of trouble at every well-child visit up to age 3.

..Use formal, proven developmental screening tests at 9 months, 18 months and

again at either 24 or 30 months (the group favors the later check but says

children aren't always seen at that age).

..Screen every child for autism at 18 months (a first-time call for formal

autism screening).

..Offer additional, formal screening any time a parent or doctor becomes

concerned about a child.

..Refer children who fail screening tests to public early-intervention

programs and to specialists who can evaluate the child fully, both for

developmental disorders and related medical problems.

The mix of periodic formal screening, less formal checks in between and

prompt responses to parents' concerns should work for time-pressed doctors

but minimize chances that children in trouble will go months or years

without help, says Lipkin, director of the Center for Development and

Learning at the Kennedy Krieger Institute in Baltimore and head of the panel

that wrote the policy. " Once a parent expresses a concern around a child's

development, that in and of itself is significant, " he says. " We'd like to

get 'wait and see' taken out of the vocabulary of the well-child visit. "

Wiseman of Merrimac, Mass., would like that, too. Doctors told her to

" wait and see " when she first expressed concerns about her toddler

daughter's poor language, communication and play skills - warning signs of

an autism-related disorder that was diagnosed months later. Today, her

daughter is 10 and doing well, but Wiseman says too many doctors still fail

to respond when a child falls behind.

" I'd like to see screening at every visit, " says Wiseman, founder of First

Signs, which promotes early diagnosis and treatment of developmental

disorders and author of Could It Be Autism? A Parent's Guide to the First

Signs and Next Steps. (Full disclosure: I was a paid contributor to that

book.)

The warning signs of many disorders, including autism, can be seen in the

first two years of life. Yet the federal Centers for Disease Control and

Prevention says children with autism are diagnosed at an average age of 5.

Meanwhile, about 2% of children under 3 are enrolled in federally mandated

early-intervention programs for children with developmental delays, Glascoe

says. But, she says, 8% likely qualify.

D. Wiseman

Founder and President

First Signs, Inc.

Dedicated to early identification and intervention

of children with autism and other developmental disorders

Phone: (978) 346-4380

Fax: (978) 346-4638

Email: <mailto:nwiseman@...> nwiseman@...

www.firstsigns.org <http://www.firstsigns.org/>