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Pediatric visits during pregnancy may have health benefits for the children of low-income women. Researchers randomly assigned 156 first-time, low-income, inner-city mothers to a prenatal visit with a pediatrician or not. Nearly half of the mothers who breastfed decided to breastfeed after study enrollment versus 14% of the no-visit group. By seven months old, women in the visit group had averaged 0.58 emergency room visits for their child versus one emergency room visit in the no-visit group. Half the pediatricians in the prenatal visit group felt they knew the mother well versus 30% of the no-visit group., Background. Prenatal pediatric visits have been recommended by the American Academy of Pediatrics to allow the pediatrician to counsel parents on infant care issues, establish a supportive relationship, and provide pediatric practice information to parents. We hypothesized that prenatal pediatric visits would have an impact on breastfeeding decisions, health care behaviors, health care utilization, and the doctor-patient relationship. Methods. We conducted a randomized controlled trial of prenatal pediatric visits for urban, low-income families to measure the impact on breastfeeding decisions, infant car safety seat use, circumcision, health maintenance, and emergency room visits and the pediatrician's perception that he/she would know the mother better. Pregnant women were recruited prenatally from the obstetrics clinic. Outcomes were measured by maternal interview prenatally and when the infant was 2 months old, in addition to review of the nursery record. Physicians were interviewed after the 2-month visit. Health care utilization was measured by chart review at months. Results. A total of 156 pregnant women were enrolled and randomized, 81 to the intervention group and 75 to the control group. Of mothers who breastfed, 45% in the intervention group changed their mind in favor of breastfeeding after enrollment compared with 14% in the control group. Mothers in the intervention group compared with the control group were more likely to make fewer emergency room visits, 0.58 compared with 1.0. Pediatricians were more likely to think that they knew mothers in the intervention group well, 54% versus 29% in the control group, yet 67% of mothers in both groups agreed their pediatrician knew them well. There were no differences between groups in initiation or duration of breastfeeding at 30 or 67% days, infant car safety seat use, circumcision, or health maintenance visits. Conclusions. Prenatal pediatric visits have potential impact on a variety of health care outcomes. Among urban, low-income mothers, we found beneficial effects on breastfeeding decisions, a decrease in emergency department visits, and an initial impact on the doctorpatient relationship. We suggest urban practices actively promote prenatal pediatric visits., Prenatal pediatric visits are health care visits that give expectant parents the opportunity to meet their infant's future pediatrician and give that pediatrician the chance to know the family and [...]

Pediatricians should try to prevent gun violence among adolescents and even younger children by working with patients and their parents. Firearms are the second cause of injury death to children aged 10 to 14 and 15 to 19. Pediatricians should encourage parents not to keep guns at home or at least to lock them up, and to limit their children's exposure to gun violence in the media. The availability of guns may contribute to killings as an end result of violent behavior. Pediatricians should notice early indicators of aggressive behavior in children, as aggressive and antisocial behavior patterns develop before age 10, and should make referrals to mental health professionals when necessary. Reducing access to guns may prevent injury and death resulting from gun violence, and pediatricians should advocate gun control as a way of protecting children from violence., Summary recommendations for pediatricians. Adolescence is a developmental stage characterized by high rates of violent behavior. Increasingly, violent injury is involving preadolescent children. Evidence suggests that the availability of guns increases the lethality of violent acts. Because guns are ubiquitous in the United States and integral to the current epidemic of youth violence, pediatricians should participate in primary prevention of firearm injuries. Efforts should begin long before children reach adolescence. Pediatricians should: (1) Encourage parents to remove guns from the home, or at a minimum to keep guns unloaded and locked up; (2) Advise parents to limit viewing of gun violence in the media, and playing with toy guns and video games that involve shooting; (3) Be alert for early indicators of aggressive behavior; and (4) Become outspoken advocates for laws that restrict gun availability. Pediatrics 1994;94:617-622; firearm injuries, violence, injury prevention.

Mothers may talk more about their family's psychosocial issues to pediatricians who ask questions, make supportive comments and listen attentively. Researchers analyzed primary care visits for 234 children and their mothers and 52 physicians in residency training. Mothers discussed aggressive or overactive behavior in 60 (26%) visits, family disruption in 48 (21%), physical punishment in 41 (18%) and parental impairments in 18 (8%). Mothers who tested positive for adult psychosocial distress were more likely to talk about parental impairments and report family disruptions than those who tested negative. Doctors asked an average of 33 questions about psychosocial issues per visit, most concerning child development. They made an average of 24 supportive comments, most were compliments to the parent. They averaged 66 statements per visit indicating attentive listening including statements of agreement and clarifying questions., Objective. Primary care pediatricians play an important role in the detection, diagnosis, treatment, and referral of children with mental health problems. Some parents, however, are reluctant to discuss behavioral and emotional symptoms with their child's pediatrician. Studies of patient-physician communication suggest that specific aspects of pediatrician interview style (asking questions about psychosocial issues, making supportive statements, and listening attentively) increase disclosure of sensitive information. We hypothesized that disclosures of parent and child psychosocial problems would be more likely to occur during visits when pediatricians used these techniques. Design. Cross-sectional analysis of a systematic sample of pediatric primary care visits. Population. Two hundred thirty-four children ages 6 months to 14 years and their mothers or female guardians attending an inner-city hospital-based pediatric primary care clinic; 52 physicians in their second or third year of pediatric residency training. Methods. Visits audiotaped and dialogue coded using the Roter Interactional Analysis System. Independent variables included counts of pediatrician utterances in the following categories: (a) questions about psychosocial issues, (b) statements of support and reassurance, and (c) statements indicating sympathetic and attentive listening. Dependent variables were the disclosure of information about: (a) parental medical or emotional impairment, (b) family disruption, (c) use of physical punishment, and (d) aggressive or overactive child behavior. Results. Use of psychosocially oriented interviewing techniques was associated with a greater likelihood of disclosure for all four of the topic areas studied. Odds ratios for disclosure, adjusted for parental concerns and child age, ranged from 1.09 to 1.22 depending on the interview technique and outcome involved. Positive associations were observed both f or topics raised primarily in response to pediatrician questions (family and parent problems) and for topics raised primarily by mothers (behavior and punishment). Conclusions. Three simple communication skills were associated with disclosure of specific concerns relevant to child mental health. Training pediatricians to use these skills would help to better detect and diagnose children's mental health problems. Pediatrics 1994;93:289-295; mental health problems, pediatrician interview style, maternal disclosures.

Data were collected from parents bringing children to selected pediatric practices in Maryland using questionnaires and focus group discussions. Gun ownership ranged from 27% in the suburban practice to 53% in the rural practice. Unrealistic perceptions of children's capabilities and behavioral tendencies with regard to guns were common among gun owners. Half of all gun-owning parents believed that active strategies (eg, education, supervision) were the best method of preventing gun injuries to children older than 12 years of age. Nearly all gun owners indicated a willingness to follow their pediatrician's advice about gun storage, but only 19% of the mothers and 10% of the fathers said they would follow advice to remove guns from the home. Among parents who did not have a gun in the home, 40% said they would consider obtaining one if they felt threatened; however, 73% of these parents indicated they would be dissuaded from doing so by a pediatrician's advice about the risks of keeping guns in the home. Results suggested that pediatricians will be most effective if they recommend passive strategies (eg, removing guns from the home or storing guns unloaded and locked) on the basis of children's development capabilities and behavioral tendencies and make their recommendations part of general counseling about child safety. Pediatrics 1992;89:908-914

Members of the Maryland Chapter of the American Academy of Pediatrics completed a mail survey on their beliefs and counseling practices related to firearm injury prevention. Respondents were skeptical of the protective value of firearms in the home and most were supportive of gun control measures. Only a fifth believed that most families with handguns keep them inaccessible to children; however, many seemed to believe that the children at risk were in practices other that their own. Among those providing direct ambulatory care, 40% had a patient who had been shot. Seventy-four percent believed pediatricians have a responsibility to counsel families about firearms. Only 13% believed parents would be offended if guns were included in anticipatory guidance discussions. Even so, only 30% had ever provided such counseling. Just half of the respondents agreed that they knew what to tell families about firearms. Ninety percent were very likely to counsel parents to store guns unloaded and locked up, whereas 54% were very likely to advise parents to remove guns from the home. More than two thirds believed parents would heed their advice about storing firearms, and 30% believed parents would follow advice about having guns. Results suggest pediatricians are ready to counsel about firearm injury prevention, but are not yet doing so. Pediatrics 1992;89:902-907

Pediatricians will often visit a mother and newborn in the hospital within the first one to two days after childbirth to promote a supportive relation between the pediatrician and family, decrease anxiety of parents and improve parental self-confidence, provide information about infant care, and detect and treat diseases of the infant. Pediatricians may also maintain daily telephone contact with the parents shortly after childbirth. This practice of early contact between the pediatrician and mother is more common in private practice than in hospital-based clinics. Studies have shown that early contact between health care workers and mothers of newborns caused the mothers to be more receptive to advice offered by health care workers concerning infant care. The effects of visits by the pediatrician to mothers with newborns, in combination with telephone access shortly after childbirth, were assessed. It was anticipated that early contact between the mother and pediatrician would improve the use of health care services, the mother's recognition of the pediatrician as a source of information on infant care, and her knowledge of infant care, and would reduce anxiety and depression in the mother following childbirth. The study involved 251 mother-and-newborn pairs, including 122 pairs who were not exposed to early contact with a pediatrician and 129 pairs who were provided with early physician contact. The frequency of clinic visits within the first month following childbirth, the likelihood of seeking care at a clinic, and use of phone access to the physician were greater among mothers provided with the intervention of early physician contact and telephone access. However, this intervention had no effect on use of emergency services, rate of immunizations within the first month and a half of the newborn's life, knowledge about infant care, or upon anxiety and depression of the mother. These findings suggest that early communication with the pediatrician and telephone access to the pediatrician improve use of health care services and the relation between the mother and physician. (Consumer Summary produced by Reliance Medical Information, Inc.)

In 1990, the first regulation requiring the use of helmets for bicyclists younger than 16 years of age was passed in Howard County, Maryland. This unexpected injury control measure resulted from the convergence of multiple factors and efforts: the bicycle-related deaths of two children from the same middle school, creative students and teachers motivated by these deaths, a responsive legislator to introduce the legislation, available surveillance and research statistics supporting the need and efficacy for helmet use, increased national awareness of the importance of helmet use to prevent bicycle-related head injuries, and organized national and local public health groups to support the legislation. This case study of activism in injury control illustrates the importance of supporting research, of well-organized public health coalitions and groups, and of creative community activists motivated by local circumstances.

To the Editor.-- We appreciate the soundness and validity of the article by Bogen et al[1] and their interest in including a dietary survey in the context of well-child care. [...]

Abstract. Data were collected from parents bringing children to selected pediatric practices in Maryland using questionnaires and focus group discussions. Gun ownership ranged from 27% in the suburban practice to 53% in the rural practice. Unrealistic perceptions of children's capabilities and behavioral tendencies with regard to guns were common among gun owners. Half of ail gunowning parents believed that active strategies (eg, education, supervision) were the best method of preventing gun injuries to children older than 12 years of age. Nearly all gun owners indicated a willingness to follow their pediatrician's advice about gun storage, but only 19% of the mothers and 10% of the fathers said they would follow advice to remove guns from the home. Among parents who did not have a gun in the home, 40% said they would consider obtaining one if they felt threatened; however, 73% of these parents indicated they would be dissuaded from doing so by a pediatrician's advice about the risks of keeping guns in the home. Results suggested that pediatricians will be most effective if they recommend passive strategies (eg, removing guns from the home or storing guns unloaded and locked) on the basis of children's developmental capabilities and behavioral tendencies and make their recommendations part of general counseling about child safety. Pediatrics 1992;89:908-914; firearm injuries, injury prevention. INSET: LEAD HELPS TO GUARD YOUR HEALTH. [ABSTRACT FROM AUTHOR]