Preventive care for children is a fundamental aspect of healthcare. Its primary goal is to maintain and improve the health and wellbeing of paediatric patients. It encompasses a wide range of interventions and strategies aimed at averting illness, identifying health concerns early, and promoting healthy lifestyles.

Well-Child Visits

Regular well-child visits with a healthcare provider are a primary form of preventive care. These visits vary by age group but typically include:

Developmental Screening:

Early identification of developmental delays is vital for a child's wellbeing. Routine use of developmental surveillance and regular screening for behavioural problems, allow paediatricians to detect issues early, and provide interventions that can lead to more favourable outcomes.

Standardised tests like the Ages and Stages Questionnaires and Modified Checklist for Autism in Toddlers are some of the tools employed for this purpose. For children younger than four years: General developmental screening is provided at 9, 18, 24 and 30-month visits, and screening for autism spectrum disorder at 18 and 24-month visits. At 4 years of age, the focus of the screen becomes school readiness and motor skills. For children 5 and older, periodic behavioural, social and emotional screen at each health maintenance visit is recommended.

Nutrition and Physical Activity:

Proper nutrition is essential for the physical and cognitive development of children. Preventive care in this area includes promoting breastfeeding, providing nutritional counselling, and addressing issues like childhood obesity. Research underscores the importance of balanced diets and regular sports.

Infants need at least 30 minutes of “tummy time” and other interactive play, spread throughout each day. Children aged 3 to 5 need at least three hours of physical activity per day, or about 15 minutes every hour they are awake. Children 6 and older need 60 minutes of moderate to vigorous physical activity most days of the week.

Screening Tests:

These may include hearing and vision tests, blood lead level tests (in population at risk), and other screenings to detect conditions like anaemia or high cholesterol.

General Counselling:

Paediatricians play a crucial role in providing guidance and counselling to parents and caregivers on a wide range of issues. This includes discussions on child safety, injury prevention, mental health, and the importance of a nurturing environment.

Preventive Services for Adolescents:

As children transition into adolescence, preventive care must adapt to address the unique needs of this age group. Topics such as mental disease awareness, substance abuse and sexual health become more prominent. Such comprehensive care typically includes education, screenings, and access to resources.

Dental Care:

Good oral health starts early. Dietary fluoride supplements is recommended for all children living in communities with non-fluoridated water. All children need access to a dentist for regular care that includes regular teeth check-ups, cleaning, X-rays and further care as needed. The American Academy of Paediatrics recommends a first dental visit by the age of one year.

Immunisation:

Immunisation are a cornerstone of paediatric preventive care. Vaccines have significantly reduced the incidence of infectious diseases such as measles, polio, and influenza. Evidence-based vaccination schedules, like the one from the US Centres for Disease Control and Prevention, are supported by extensive research, and ensure that children are protected from potentially life-threatening diseases.

In recent years, there have been widespread myths about the negative effects of immunisation, including disinformation about increased risk of autism related to some vaccines. The origin of these myths was in two publications by the same medical group, of a handful of cases that turned out to be fabricated. Ultimately, these two studies were retracted and the main author prohibited from practicing medicine. Despite that, these myths are still circulating, and the consequent decline in vaccination rate noted in some communities has lead to the emergence of new cases of polio, pertussis and measles.

Is Paediatric Prevention Based on Evidence?

Yes, effective paediatric preventive care is heavily reliant on evidence-based medical practices. Research studies have clearly established the positive impact of preventive care in this age group on reducing infant mortality, incidence of childhood diseases, and improved overall children's health.

Additionally, preventive care contributes to reducing healthcare costs by averting the need for more extensive medical interventions later in life.

Challenges in paediatric preventive care include addressing health disparities, ensuring access to care for all children, and keeping up with evolving healthcare guidelines.

Future directions may involve advancements in technology, telemedicine, and personalised preventive care plans tailored to each child's unique needs.

• Nisrine Atieh, MD is an American board-certified paediatrician and Obesity Medicine specialist