Original Article: Well-Child Visits for Infants and Young Children

Issue Date: September 15, 2018

See additional reader comments at: https://www.aafp.org/afp/2018/0915/p347.html

To the Editor: The article by Dr. Turner on well-child visits for infants and young children is well written and comprehensive, highlighting the various aspects of anticipatory guidance that family physicians need to address for parents of young children.

An additional area of guidance that family physicians can provide is the assessment of maternal behavioral risk factors. The impact of maternal health on the health of children is well understood, so these interventions fit naturally into the context of well-child care because these risks affect the child's health and the health of future pregnancies.¹

Based on this premise, the Family Medicine Education Consortium's Interventions to Minimize Preterm and Low Birthweight Infants through Continuous Quality Improvement Techniques Network (www.fmec.net/implicit) developed a proactive approach to interconception care. As a quality initiative project, the interconception care model uses this opportunity to specifically target four maternal behavioral risk factors—tobacco use, depression, family planning, and multivitamin use—by screening current actions, reinforcing desired behaviors, and offering interventions during well-child visits. After an initial pilot phase, the project is now incorporated as an essential part of routine well-child care for infants younger than two years.

At the time of this letter, nearly 14,000 mother-child dyads have been followed at our 19 participating network sites. Our demographic data show this model of interconception care especially reaches low-income minority women who are at the greatest risk of having preterm and low birth weight infants. Data collected demonstrate that mothers accompanied their babies to 93.5% of visits, making well-child visits an opportune time to reach women.² The model can also be adaptable to a variety of practice settings; any site in which women and babies are seen together is an ideal situation for delivering interconception care, including family medicine, pediatrics, health departments, community health centers, and public health programs. We believe that this brief but powerful assessment has the potential to lead to healthier mothers and babies.