Parents whose children are at risk for child abuse and
neglect may be reluctant to follow injury and illness
prevention advice from pediatricians with whom they don't
have a good working relationship, say researchers at the
Johns
Hopkins Children's Center, the Johns Burns University
of Hawaii School of Medicine and the Hawaii State Health
Department.
"While it may seem basic, this practical advice could
prove life-saving to children whose home and family
situations already make them vulnerable to unintentional
injury, the leading cause of death of children over 1 year
of age in this country," said the study's lead author,
Catherine Nelson, a general pediatrics fellow at the Johns
Hopkins Children's Center.
In the study, published in the January issue of
Pediatrics, researchers asked such parents about
their relationship with their children's pediatrician and
whether the doctor talked to them during well-child visits
about the presence of smoke alarms in the home, use of baby
walker and car seats, safe hot water heater temperatures
(120 degrees F or less), use of stair guards and sunscreen,
presence of guns in the home and bottle propping at
bedtime.
Not surprisingly, Nelson said, families who had good
relationships with their pediatricians reported receiving
more advice on injury prevention issues.
Parents in the study who trusted their children's
pediatrician were more likely to follow the doctor's advice
and change their behavior. The group of parents who trusted
their pediatricians the most changed their behavior on 72
percent of topics discussed by the doctor, while the group
who trusted their pediatrician the least changed behavior
on 54 percent of topics discussed by the doctor. In
particular, the use of car seats was the advice most often
followed among parents.
Researchers say that overall, while pediatricians
recognize the importance of injury- and illness-prevention
counseling, time constraints during well-child visits and
the need to address other pressing health matters during
the visit often stop them from discussing all aspects of
injury prevention with parents. Time constraints also can
impede a pediatrician's ability to take the time during
well-child visits to really establish a good relationship
with a family.
"The medical community recognizes that the
clinician-parent relationship is the centerpiece of primary
care. As we observed in our study, this relationship is
especially important for clinicians dealing with families
at risk of child abuse and neglect. Not only are their
children more likely to experience illness or unintentional
injury, but also [the families] often face other issues,
such as partner violence or substance abuse, which may make
them wary of doctors," Nelson said. "If we can earn their
trust and establish a good relationship with them, they may
be more willing to trust and follow our advice."
"Good relationships between pediatricians and parents
are developed through mutual understanding of the 'medical
home' concept — primary care physician services that
are accessible, family-centered, coordinated,
comprehensive, continuous, culturally effective and
compassionate," added Calvin C.J. Sia, professor of
pediatrics at the John Burns University of Hawaii School of
Medicine and a co-author of the study.
In the study, researchers surveyed 402 at-risk
families with newborns enrolled in the state of Hawaii's
Healthy Start Program. Mothers were interviewed when their
children were 1 year old. Nelson noted that because the
study was limited to at-risk families, the findings may
not be applicable to the general population of parents of
infants.
The study was funded by the Robert Wood Johnson
Foundation, Annie E. Casey Foundation, David and Lucile
Packard Foundation, Hawaii State Department of Health and
the U.S. Maternal and Child Health Bureau. In addition to
Sia, of the University of Hawaii, co-authors were Susan M.
Higman, Elizabeth McFarlane and Anne K. Duggan, all of the
Johns Hopkins Children's Center; and Loretta Fuddy, of the
Hawaii State Department of Health.