Millions of US Children Losing Out on Preventive Care

Yael Waknine

September 15, 2014

Millions of children and teenagers are not receiving the basic preventive care needed to ensure their long-term health and well-being, according to a new report from the Centers for Disease Control and Prevention (CDC).

Published as a supplement to the September 12 issue of the Morbidity and Mortality Weekly Report, the findings are based on data collected before or shortly after implementation of the Affordable Care Act. As such, the data provide a baseline assessment for 11 key services, including immunizations, dental care, screenings for developmental delays and hearing/vision loss, and counseling for tobacco use and reproductive health.

"Children have distinct health-care needs that are different than those of adults. They undergo rapid and constant physical, physiological, and developmental changes from infancy through adolescence," write Lorraine F. Yeung, MD, from the Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDC, and colleagues. They note that each stage is associated with unique preventive health needs that often remain unmet.

Whereas early interventions can mitigate long-term disability, 2007 data show that only 21.1% of parents with young children between the ages of 10 and 47 months were offered comprehensive screening for developmental delays, such as autism, by a healthcare provider. Also, about 50% of infants failing a hearing screen during 2009-2010 had not received routine testing to detect hearing loss, and 67% of children aged 1 to 2 years in 2010 had not been screened for lead poisoning.

Screenings during early and middle childhood can identify the emergence of major chronic disease/lifestyle risk factors. Yet during 2009 to 2010, 22% of 5-year-olds had never had a vision check, and 24% of clinic visits for children aged 3 to 17 years did not include blood pressure measurements. Dental care was also sorely lacking, as only 44% of children in 2009 visited a dentist and only 14% received a dental sealant or topical fluoride application.

During adolescence, screening for and addressing risky behaviors (smoking, alcohol use) remains of key importance. However, tobacco use status remained undocumented in 31% of office visits made by patients aged 11 to 21 years during 2004 to 2010. Among those who screened positive for tobacco use, only 20% received cessation assistance such as counseling and/or medication.

With respect to reproductive health among sexually active teenagers aged 15 to 19 years, data from 2006 to 2010 showed that 24% of girls and 37.5% of boys did not receive a reproductive health service from a healthcare provider in the previous year. In addition, nearly half (47%) of girls and 90% of boys aged 13 to 17 years in 2011 had not received their first HPV vaccination dose, and 60% of sexually active girls aged 15 to 21 years during 2006 to 2010 had not been screened for chlamydia during the last year.

According to the report, access to preventive care is particularly low among certain racial, ethnic, and socioeconomic minorities. Uninsured children were less likely to receive services than those with coverage, and Hispanic children had lower rates of vision screening than non-Hispanics.

"We must protect the health of all children and ensure that they receive recommended screenings and services," Stuart Shapira, MD, PhD, associate director for science in the CDC's National Center on Birth Defects and Developmental Disabilities, said in a CDC news release. "Increased use of clinical preventive services could improve the health of infants, children, and teens and promote healthy lifestyles that will enable them to achieve their full potential."

The Affordable Care Act, passed in 2012, aims to expand insurance coverage with a special emphasis on preventive care.

"Parents need to know that many clinical preventive services for their children, such as screening and vaccination, are available for free with many health plans," Dr. Yeung emphasized in the news release.

Morb Mortal Wkly Rep. 2014;63:99-107. Full text

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