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Review of the Literature

Michael Regalado, MD; Neal Halfon, MD, MPH

Arch Pediatr Adolesc Med. 2001;155:1311-1322.

Objective  To examine the evidence base for primary health care services promoting the optimal development of typically developing children aged birth to 3 years.

Data Sources  Peer-reviewed publications addressing clinical evaluations of primary care services from the MEDLINE and PsychINFO databases.

Study Selection  Criteria for selection were as follows: (1) publication between 1979 and 1999; (2) evaluation of efficacy or effectiveness of education, intervention, and care coordination services or validation of assessment approaches; (3) services applicable to an office practice setting; (4) target population including children aged birth to 3 years; and (5) publication in English.

Data Extraction  A total of 312 publications were abstracted and reviewed by both of us; 47 were selected for inclusion.

Data Synthesis  Assessments of parental concerns and psychosocial risk factors using validated approaches seem to be more accurate in identifying developmental problems than clinicians' appraisals. In general, study results support the efficacy of (1) primary care educational efforts toward promoting optimal parent-child interaction, parents' understanding of child temperament, book-sharing activities, and approaches to healthy sleep habits and (2) office interventions such as counseling for the management of excessive infant crying and sleep problems.

Conclusions  The literature suggests that many primary care activities promoting the optimal development of children are efficacious. Evaluations of developmental assessment and services in primary care should be expanded in depth and breadth. The implications for clinical practice, training, and health care policy are discussed.

From the Department of Pediatrics (Dr Regalado) and the Center for Healthier Children, Families, and Communities (Dr Halfon), University of California–Los Angeles Schools of Medicine and Public Health.

Corresponding author and reprints: Michael Regalado, MD, Cedars Sinai Medical Center, 8700 Beverly Blvd, MOT 475W, Los Angeles, CA 90048 (e-mail: Michael.Regalado{at}cshs.org).

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