How has your child’s health care been going this past year?
 

This could be a difficult question to answer if you’re not sure what you should expect. For example, do you expect a prescription medication to relieve congestion or coughing for a particular episode of illness, or do you expect a treatment plan to reduce recurring symptoms so that your child and you miss less school and work days throughout the year?

 

According to the United States Agency for Health Care Research and Quality (AHCRQ), you should expect both the right treatment at the right time, as well as an ongoing partnership to manage your children’s health conditions or problems.

 

The Right Treatment at the Right Time

 

Despite the fact that physicians’ guidelines for the management of common childhood conditions have been developed based upon scientific evidence and concomitant expert consensus, our children are not receiving this state-of-the-art care. 

 

According to the most recent member survey of the American Academy of Pediatrics (AAP), the majority of general pediatricians are not incorporating clinical practice guidelines into their practices. And studies show that pediatricians who see more patients use guidelines less. Many physicians have responded to modern health care financing mechanisms by setting "productivity" goals that call for seeing a greater number of patients in a given time frame. But, contrary to popular opinion, managed care does not force physicians to abandon their professional integrity.

 

Instead, scientific and health services research offer specific findings about how pediatricians are not keeping up with advancements in medical knowledge and practice. The first five things your pediatrician won’t tell you pertain to these gaps between state-of-the-art and actual pediatric practice:

 

1. The National Institutes of Health updated the Guidelines for the Diagnosis and Management of Asthma in 1997. Contrary to guidelines recommendations:

 

* Pediatricians and family physicians do not conduct the recommended tests to confirm a diagnosis of asthma in school-age children.

 

* Pediatricians and family physicians do not evaluate symptom combinations as recommended to diagnose childhood asthma.

 

*  And, although written treatment plans have been shown to reduce the odds of hospitalization for asthma, half the primary care doctors don't use them.

 

2. Antibiotics are still being prescribed inappropriately for colds, upper respiratory tract infections and bronchitis in infants and young children, according to a study conducted by Harvard Medical School.

 

In another study, the following medical decision and practice errors were documented:

 

· 69% of physicians considered green or yellow nasal discharge a diagnostic indicator for sinusitis. It is normal for the mucus to get thick and change from clear to yellow or green during a viral cold.

 

· 86% prescribed antibiotics for bronchitis, regardless of cough duration. Bronchitis is a viral infection. Antibiotics do not kill viruses. A prolonged cough indicates further diagnostic assessment is warranted to consider other conditions such as asthma or infection.

 

· 42% prescribed antibiotics for the common cold. The common cold is caused by viruses. Antibiotics do not kill viruses.

 

3. Over-diagnosing middle ear infections and inappropriate treatment results in the overuse and misuse of antibiotics and, consequently, increased drug resistance. A child treated with unnecessary antibiotics may develop a bacterial infection that is resistant to that antibiotic, and may require hospitalization. Sometimes, there is no treatment for an antibiotic resistant bacterial infection.

 

Despite recommendations detailed in the Agency for Health Care Quality and Research’s Practice Guideline for Managing Otitis Media With Effusion in Young Children, studies found that variations exist among physicians regarding when to refer patients for surgery (tube placement). Some refer later than recommended, and put the child at risk for hearing loss with associated poor expressive language skills, difficulty paying attention, and reading delays.

 

4. Physicians are not following current standards of practice for the treatment of gastroenteritis (diarrhea) and dehydration, according to the AAP’s Practice Guideline for The Management of Acute Gastroenteritis in Young Children. The following practice variations from current standards of care for oral rehydration (fluid replacement) therapy have been identified in the recent medical literature:

 

· Using oral rehydration solutions for children who are not dehydrated or only mildly dehydrated. These children do not need oral rehydration solutions.

 

· Administering intravenous rehydration fluids to children who are moderately dehydrated. These children's care should be managed with oral rehydration solutions.

 

· Withholding oral rehydration solutions or other feeding for children with vomiting. Instead, these children need adequate fluids and nutrition.

 

5. A study comparing contamination rates of urine specimens obtained by "clean-voided" bag method versus catheterization found that the inaccuracies of bag urine culture result in risks that outweigh the benefits. Yet, contrary to the AAP Practice Guideline for The Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children, pediatricians are still collecting bag specimens for culture, largely due to a lack of training and experience for doing catheterization.

 

An Ongoing Partnership to Manage Your Child’s Health Problems

 

Physician leaders advocate redesigning the way physicians practice so that a parent-provider partnership is the driving force behind each child’s health care. However, pediatricians’ resistance to change results in their adherence to the status quo. This reduces the likelihood of your pediatrician telling you the next five things about the continuity of care and collaboration that you should expect from your child’s healthcare:

 

6. It is your pediatrician’s professional obligation to follow-up on past health problems.

 

7. Your pediatrician should understand how any health problem your child has affects her and your family’s day-to-day life.

 

8. Your pediatrician should effectively teach you how to manage your child’s condition at home.

 

9. You have a right to be involved as much as you want in decisions about your child’s health care.

 

10. It should not be a problem getting your child’s physician to agree with you on the best way to manage your child’s health condition or problem.

What Can Parents Do?

 

Parents can take the following actions:

 

· Get informed about your child’s condition, whether she has the common cold, allergies, asthma or any other condition,

 

· Keep a symptom diary to communicate the type, frequency and duration of your child’s symptoms,

 

· Target goals you want to achieve, such as optimal symptom reduction to enable your child to enjoy his regular activities, and

 

· Prompt your pediatrician for information on how to achieve these goals and ask for a management plan that provides detailed instructions for home care.

 

A practical and medically sound way to accomplish this is to use two traditional tools of medicine: the patient symptom history and the treatment or, management, plan.

 

Parents can keep a diary of their child’s symptoms to provide their pediatrician with information necessary for accurate diagnosis. For some conditions, such as allergies or asthma, professionally-developed management or, action, https://pediatriccare.solutions.aap.org/Pediatric-Care.aspx offers health care information, patient symptom diaries and management plans for you to print and use in partnership with your child’s physician or nurse practitioner. Another useful site for pediatric health care information is the AAP’s site: www.aap.org.

 

The information and tools available at https://pediatriccare.solutions.aap.org/Pediatric-Care.aspx  have been developed based upon published scientific evidence and corresponding  medical expert consensus about optimal pediatric care. Their use can help you better prepare for your pediatric office visit, make yourself heard, and activate state-of-the-art clinical practice guidelines for your child.

 

Expect nothing less.