Special needs children more likely to receive preventive health counseling and screening than heal

Amy J. Houtrow, MD, MPH -----

Children with special needs are more likely than their healthy peers to receive preventive health care screening and counseling from their physicians, a national study led by researchers at UCSF Children’s Hospital has found.

The results of the survey analysis contradict anecdotal evidence that special needs children receive less preventive health care than their healthy peers because of the complexities of such children’s health conditions and the shortness of doctors’ office visits, the researchers say.

The study, published in the April issue of the journal “Pediatrics,” suggests that a mitigating factor may be that special needs children see their doctors more frequently than healthy children and so may have more opportunities to receive preventive screening and the health counseling that doctors call “anticipatory guidance.”

“Based on our findings, children with special health care needs receive significantly more health counseling and screening than other children, which we conclude may in fact be due to an increase in the number of encounters with health care providers,” says lead author Amy J. Houtrow, MD, MPH, assistant professor of pediatrics at the University of California, San Francisco, and medical director of the Spina Bifida Program and Pediatric Rehabilitation at UCSF Children’s Hospital.

However, she added, there are clear gaps in the delivery of preventive health care services to both children with and without special health care needs. “We are not providing enough health screening and anticipatory guidance to children across the board,” Houtrow said. Why that is the case, and how it can be improved, is an area that deserves further research, she said.

Of particular concern, Houtrow said, are children with special health care needs who also are low-income and uninsured. The study found that those children were less likely than other special needs children to receive screenings and guidance.

The study found that, when compared with those who were living above 400 percent of the federal poverty level, caregivers of special needs children who were living below 200 percent of the federal poverty level were significantly less likely to recall having had any of the health screening measures checked.

Four hundred percent of the federal poverty level is an annual household income of $82,600 a year for a family of four. Two hundred percent of the federal poverty level is $41,300 a year for a family of four.

Anticipatory guidance and preventive screenings, including height, weight and blood pressure checks, along with immunizations, are the cornerstones of well-child health care for children of all ages. Anticipatory guidance includes discussion of such subjects as growth and developmental assessments and patient and parent counseling about health, nutrition and safety. The goal of anticipatory guidance is to help parents understand what to expect during current and future developmental stages.

Both the American Academy of Pediatrics (AAP) and the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services have established guidelines for anticipatory guidance for all children at all developmental stages, from infants to teens.

More than 21 percent of the children in the study between the ages of 3 and 17 years old were diagnosed with special health care needs. The authors defined children with special health care needs as those with “chronic physical, developmental, behavioral or emotional conditions who also require health and related services of a type or an amount beyond that required by children generally.”

To determine the frequency of anticipatory guidance and screening for special needs children versus healthy children, the researchers reviewed data from the 2002 and 2003 Medical Expenditure Panel Surveys (MEPS). MEPS is a set of large-scale, nationwide surveys of families and individuals, their medical providers and employers. In MEPS, an adult caregiver—usually a parent—responds to telephone survey questions that identify what health services their child has received. MEPS is considered one of the most complete source of data on the cost and use of health care and health insurance coverage in the United States.

The study examined whether patients received a variety of health screenings, including whether or not their height, weight and blood pressure were checked during the previous year and whether they had ever had their vision checked. It also examined whether caregivers received anticipatory guidance about six topics: advice about dental checkups and oral health; advice about healthful eating; advice about exercise; advice about the use of car seats, booster seats and seat belts; advice about wearing a bicycle helmet; and advice about second-hand smoke exposure. 

The MEPS data used in the study represented a total of 18,279 children aged 3 to 17 years old. Of that number, 21.6 percent had special health care needs. Based on caregiver reports, 87.5 percent of the special needs children had one or more health screening measures checked during the previous year; only 73.1 percent of healthy children received one or more health screenings. Nearly 70 percent of children with special needs received more than one anticipatory guidance discussion with their health care provider during the previous year, compared with 55.2 percent of children without special health care needs. 

Other study researchers include Sue E. Kim, PhD, MPH and Paul W. Newacheck, DrPH of UCSF and Alex Y. Chen, MD, MSHS of the University of Southern California and UCLA Children’s Hospital.

Chen’s research is supported by a grant from the National Institutes of Health. Newacheck and Kim are supported in part by the Maternal Child Health Bureau and Services Administration of the U.S. Department of Health and Human Services.

UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.