Overweight kids have more social problems; Well-child visits to screen for mental health last only minutes

Two studies last week in Pediatrics gave us more knowledge about  mental health and wellness in young children.

The first study in Pediatrics found that the heavy kids were up to 20 percent more likely at age eight or nine to be described by their parents as having social difficulties and by teachers as having emotional problems.

The researchers surveyed the parents and teachers of 3,363 Australian children participating in a large national health study.  At ages four and five, 222 boys (13 percent) and 264 girls (16 percent) were determined to be overweight, while 77 boys (4.5 percent) and 87 girls (5.2 percent) were obese.

Those kids with a body mass index (BMI — a measure of weight relative to height) at least 1.6 points greater than their normal-weight peers at a young age were more at risk of having social problems, including isolation or teasing, later on.  The researchers also found out that the heavier kids were about 20 percent more likely, by the age of eight or nine, to experience social difficulties and emotional problems, as described by their parents and teachers, respectively.

The study points to the need to comprehensively screen more children earlier for all sorts of issues during well-child visits including eating and activity habits in addition to asking about developmental and mental health issues. 

Unfortunately, a second study in the same issue of Pediatrics found that most well-child visits last less than 20 minutes and pediatricians are getting even more time-crunched as health care systems look to cut extra expenses any way they can. 

In 2000, the researchers conducted a phone survey of about 1,700 parents across the U.S. with a child between four months and three years old. They asked parents how much time they had spent with a doctor at their last well-child visit and whether the doctor had talked with them about issues such as breastfeeding, the child’s sleeping position and sources of family support.

About one-third of parents said their most recent appointment lasted 10 minutes or less. Only one in five had a visit lasting more than 20 minutes.  Interestingly, parents also reported how satisfied they had been with the visit.      

During longer visits, doctors gave a more thorough developmental assessment and discussed more health and safety issues with parents, and more parents said they’d had enough time to ask questions. Still, parents said they didn’t get any guidance about issues including child care, toilet training and emotional support at more than half of the longest visits. 

Prior research has reported and practice guidelines have suggested for some time that enhanced screening efforts by pediatricians are necessary and will help us save health care costs long-term.  But in spite of those calls the most recent statistics show that less than half of those pediatricians surveyed do so and this is in part at least theorized to be because of reimbursement issues; although many of those reimbursement issues appear to be solved. 

I also think it is “behavior” and “habit”—it is difficult to get healthcare providers to change their practices voluntarily unless we as consumers start asking for changes or the federal government mandates those changes.  It’s time for comprehensive change in our system of care for little kids.   We know what works and that it will save money—what is keeping us from implementing those changes?  Please visit www.projectskip.com for more information on screening.