Evidence based paediatrics: Evidence based well child care

Abstract

THE CASE Your primary care paediatric practice has recently decided to review its preventive care practices before deciding which to include in a new computerised record system. You know that these practices vary considerably among group members, even as to how many check ups a child really needs. The value of some specific manoeuvres, such as the Adams forward bend test for scoliosis, for which adolescents are often referred from school, is doubted. You determine to find the best evidence for common preventive health interventions for children. Summary points Fewer visits than in the standard schedules for children up to age 2 years are sufficient to detect physical abnormalities and psychosocial and developmental outcomes Group care is as effective as individual care for routine checks The Adams forward bend test is not accurate enough for screening for idiopathic scoliosis Proving the value of check ups for healthy children and finding new and more effective ways to provide preventive care to all children remain major challenges