Introduction: results from a new national survey of children's health.

Health supervision visits for infants and toddlers are core to the work of primary care pediatrics. Pediatricians provide the majority of the well-child visits to children who are younger than 3 years. Data from the American Academy of Pediatrics (AAP) show that the typical pediatrician provides 35 health supervision visits a week to children 35 months and younger.1 Increasingly, pediatricians are asked to address not only traditional issues in these visits, such as immunizations and physical growth, but also developmental needs and psychosocial issues in the family. Professional guidelines (AAP Guidelines for Health Supervision III, Bright Futures),2,3 innovative programs (eg, Healthy Steps),4 and recent policy studies (eg, National Academy of Science’s From Neurons to Neighborhoods)5 point to the importance of anticipatory guidance for child health and development. Physicians, particularly pediatricians, are the professionals who see virtually all US children in the first few years of life. Through these unique contacts, pediatricians play an important role in identifying potential problems and helping parents to promote their children’s healthy development. Despite the importance of these visits, little is known about the process, content, and quality of health supervision, particularly from the perspective of parents. This supplement to Pediatrics reports results of a new national survey, the 2000 National Survey of Early Childhood Health (NSECH), which was designed to address this information gap. The NSECH is a unique survey of parents of infants and toddlers, developed to monitor the health of young children, assess child health service delivery, and inform child health policy. The NSECH provides critical national-level information about the content and quality of preventive health care for young children, as well as parenting practices in early childhood that can affect the cognitive, emotional, and social development of children. Many of the specific measures included in the NSECH have not previously been used in a national survey of child health. The NSECH is a new tool to provide national benchmarks about quality of health supervision provided to children in the context of family needs and their child-rearing environments. Assessing the content and quality of anticipatory guidance and other services that are part of routine well-child care has always been a difficult task because there have been fewer studies and less conclusive evidence on the effectiveness of interventions than what might be desired. This lack of evidence may be viewed as the glass being half full or half empty. Although the evidence base is deficient, it is growing.6,7 In the absence of robust evidence, health care guidelines and quality measurements have relied on expert panels that use best available evidence to make practice recommendations. All of the measures included in the NSECH were derived from guidelines that meet or exceed this latter standard. The NSECH also responds to the growing interest in parenting and the critical role that well-child care potentially plays in promoting optimal health and development of children. Recent release of the National Academy of Science’s report From Neurons to Neighborhoods has made assessing and addressing the developmental needs of young children even more salient in the minds of policy makers, health care providers, and parents. Several other recent research studies suggest that parents are in fact not receiving the health care that professional guidelines call for and that parents say that they need. At the same time, pediatricians struggle with deciding, in the limited time available in office visits, which health supervision topics to cover from a growing list of potentially useful topics. The NSECH project began as a partnership between the AAP and the Center for Healthier Children, Families & Communities at UCLA with primary funding from the Gerber Foundation. Supplemental funding was later obtained from the Maternal and Child Health Bureau (MCHB) and the AAP Friends of Children Fund. As the project evolved, the original 2 partners developed a number of additional strategic partnerships to ensure the highest quality of data and to maximize the application of the information. This project would not have been possible without the substantial contributions of many groups. The National Center for Health Statistics was engaged to produce a methodologically rigorous and high-quality survey. The NSECH was conducted as a survey module of the State and From the *UCLA Center for Healthier Children, Families and Communities, UCLA Schools of Medicine, Public Health, Public Policy, and Social Research, Los Angeles, California; and ‡Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, Illinois. Received for publication Oct 20, 2003; accepted Jan 13, 2004. Reprint requests to (N.H.) 1100 Glendon Ave, Ste 850, Los Angeles, CA 90095-6939. E-mail: [email protected] PEDIATRICS (ISSN 0031 4005). Copyright © 2004 by the American Academy of Pediatrics.