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Obesity in children is a rapidly growing problem and may be underrecognized by pediatricians. We reviewed 473 consecutive well child visits to assess frequency of correctly identifying overweight children. Of children with a body mass index greater than the 95th percentile for gender and age, only 27 (29%) were diagnosed as overweight by the physician. Our results suggest that the frequency of diagnosing children as overweight at well child visits is critically low.

The purpose of this study was to determine whether anticipatory guidance at well-child visits (WCV) that included early literacy development and the provision of books by the examining physician changed family literacy practices. It was conducted in an inner-city pediatric clinic that serves as the continuity practice site for pediatric and pediatric/internal medicine residents. There were 352 children (181 treatment: 171 control), aged 2 to 24 months, enrolled in this prospective, controlled study. The health care providers underwent training on literacy and on how to incorporate this information during WCV. Anticipatory guidance on safety, development, and early literacy was given to all parents. Additionally, the treatment group received an age-appropriate book at each WCV. There were 1,263 visits made (686 treatment, 577 control). Questionnaires were completed by parents on physician helpfulness and by physicians on parental receptiveness. Parental ratings on physician helpfulness were higher in the treatment group than in the control group (p

Urban, poor, preschool children are noted for having low immunization rates. To determine factors related to completion of immunization, vaccine records of 479 3-year-old children from an inner-city pediatric clinic were reviewed. Complete immunization was defined as four diphtheria-tetanus-pertussis doses, three oral polio vaccine doses, one measles-mumps-rubella dose, and one Haemophilus influenzae type b vaccine dose. Seventy percent of our patients were up-to-date by 2 years of age. The administration of all age-appropriate vaccines at a single visit for patients 15 months and older, the establishment of a continuous primary-care relationship, earlier age at first immunization, and lower birth weight were significantly associated with higher immunization levels in our study.

The objective of this prospective study was to determine the impact of early literacy anticipatory guidance (AG) with provision of books on language development in 3-year-olds in an early literacy program at a University-affiliated inner-city pediatric clinic. The Peabody Picture Vocabulary Test (PPVT-III) and the Expressive One Word Picture Vocabulary Test (EOWPVT-R) were administered to 33-39-month-old children exposed to an early literacy program, which included AG and provision of an age-appropriate book at each well-child visit starting at 2 months old. Children with developmental delays were excluded. Parental surveys on literacy and demographic data were obtained. Univariate and multivariate analyses were performed. Sixty-four children were evaluated; 88% African American, 89% Medicaid recipients. Fifty-eight percent of families reported familycentered literacy orientation. The PPVT-III scores directly correlated with the number of AG visits with book given x number of books purchased (r2 = 0.025, p = 0.0006). Higher scores in EOWPVT-R were predicted by race and the number of visits with books given x number of books purchased (r2 = 0.182, p = 0.0009). All families reported reading together, half reporting positive familycentered literacy. Given the same number of books purchased for each child, the outcome scores were higher the greater the number of clinic visits wherein AG included early literacy and provision of books.

Obesity is a common nutritional problem among children. Using the Futrex 5000A method of bodyfat measurement, this prospective study determined the percentage bodyfat in a self-selected, indigent, predominantly black population and the accuracy of perceived body image. Bodyfat exceeded the optimal range in 39% and 67% of female and male children, respectively. Females tended to view themselves as fatter and males perceived themselves as thinner than their actual composition. Parents were more accurate in their perception of obesity in their daughters (88%) than in their sons (52%). Children did not recognize the importance of exercise in preventing obesity. Bodyfat measurement and counseling should be done at an early age to improve this remarkable lack of perception about obesity.

Use of the Emergency Department (ED) for nonurgent conditions results in increased cost and discontinuous health care. This prospective study evaluated a program (KenPAC) that required 24-hour access to a primary care physician (PCP) with ED gatekeeping responsibility. Following established criteria, medical records were reviewed for appropriateness of ED use by an urban indigent pediatric population. Emergency Department visits declined (10% to 7.6% (P=0.00005) and inappropriate visits dropped (41% to 8%) (P