Well-Child Visit - Children in New Hampshire

New Hampshire

The American Academy of Pediatrics recommends that all infants, toddlers and children receive routine preventive visits, known as well-child visits. Younger children require more frequent visits due to their rapid development.

The benefits of well-child visits include:

• Preventing illness through routine immunizations. 
• Tracking growth and development. 
• Having opportunities to discuss parental concerns about child development, behavior, sleep and eating.
• Developing a strong patient-provider relationship.
• Lower use of emergency care services.

As individuals enter adolescence, they experience a number of transitions that may require unique health care solutions and conversations. During this stage, adolescents experience rapid physical growth, changing hormones and sexual maturity. Social factors and behaviors that lead to morbidity and mortality are often initiated in adolescence, which makes it a critical time for education, prevention and early intervention.

According to data from the National Survey of Children’s Health, the prevalence of having one or more preventive visits in the last year is higher among:

• Children ages 0-5 years compared with those ages 6-17.
• White children compared with Asian, Hispanic and Black children.
• Children who come from higher-income households.
• Children from households where an adult has a higher level of education.
• Children who were consistently insured throughout the year.

There are several alternative methods of delivering cost-effective well-child visits that may improve access and use, including:

• Group well-child visits.
• Well-child visits in community settings, such as schools and day care centers, and via home visit.
• A health care team approach involving alternative providers, such as physician assistants, nurse practitioners, child development specialists and school counselors.

Expanding the options for well-child visits also gives physicians greater availability to care for children with complex medical problems. These alternative approaches may also be more efficient at serving low-income populations. Under the Affordable Care Act, insurance plans must cover well-child visits. Depending on the insurance plan, well-child checkups may be available at no cost.

When surveyed, adolescents identified more and different barriers to receiving well-child visits than their parents, and minimizing those barriers could increase their use of well-child visits. Forgetting an appointment or failing to schedule one is a common barrier, and modern tools such as text message reminders can help increase primary care usage. The implementation of the Affordable Care Act resulted in a moderate increase in preventive care use by adolescents, particularly Black, Hispanic and low-income adolescents.

Healthy People 2030 has several objectives regarding preventive visits, including:

• Increasing the proportion of adolescents who received a preventive health care visit in the past year.
• Increasing the proportion of adolescents who speak privately with a physician or other health care provider during a medical visit.

Aalsma, Matthew C., Amy Lewis Gilbert, Shan Xiao, and Vaughn I. Rickert. “Parent and Adolescent Views on Barriers to Adolescent Preventive Health Care Utilization.” The Journal of Pediatrics 169 (February 1, 2016): 140–45. https://doi.org/10.1016/j.jpeds.2015.10.090.

Adams, Sally H., M. Jane Park, Lauren Twietmeyer, Claire D. Brindis, and Charles E. Irwin. “Association Between Adolescent Preventive Care and the Role of the Affordable Care Act.” JAMA Pediatrics 172, no. 1 (January 2018): 43–48. https://doi.org/10.1001/jamapediatrics.2017.3140.

Bergman, David, Paul Plsek, and Mara Saunders. “A High-Performing System for Well-Child Care: A Vision for the Future.” The Commonwealth Fund, October 2006. https://www.commonwealthfund.org/publications/fund-reports/2006/oct/high-performing-system-well-child-care-vision-future.

Coker, Tumaini R., Candice Moreno, Paul G. Shekelle, Mark A. Schuster, and Paul J. Chung. “Well-Child Care Clinical Practice Redesign for Serving Low-Income Children.” Pediatrics 134, no. 1 (July 1, 2014): e229–39. https://doi.org/10.1542/peds.2013-3775.

Enlow, Elizabeth, Molly Passarella, and Scott A. Lorch. “Continuity of Care in Infancy and Early Childhood Health Outcomes.” Pediatrics 140, no. 1 (July 2017): e20170339. https://doi.org/10.1542/peds.2017-0339.

Kipping, R. R., R. M. Campbell, G. J. MacArthur, D. J. Gunnell, and M. Hickman. “Multiple Risk Behaviour in Adolescence.” Journal of Public Health 34, no. suppl_1 (March 1, 2012): i1–2. https://doi.org/10.1093/pubmed/fdr122.

O’Leary, Sean T., Michelle Lee, Steven Lockhart, Sheri Eisert, Anna Furniss, Juliana Barnard, Doron Shmueli, Shannon Stokley, L. Miriam Dickinson, and Allison Kempe. “Effectiveness and Cost of Bidirectional Text Messaging for Adolescent Vaccines and Well Care.” Pediatrics 136, no. 5 (November 2015): e1220–27. https://doi.org/10.1542/peds.2015-1089.