Pediatric injury prevention counseling: an observational study of process and content
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L C Barrios1, C W Runyan, S M Downs
1The University of North Carolina Injury Prevention Research Center, Chapel Hill, NC, USA. lbarrios@cdc.gov
Insights
Pediatricians often discuss injury prevention topics prompted by checklists, but conversations about car seat safety remain superficial. Enhancing prompts may improve counseling depth and effectiveness for child injury prevention.
Area of Science:
- Pediatric medicine
- Public health
- Injury prevention
Background:
- Routine well-child visits offer opportunities for injury prevention counseling.
- Current counseling practices may lack depth, particularly regarding critical safety topics like car seat use.
Purpose of the Study:
- To characterize routine injury prevention counseling during well-child visits.
- To examine the influence of printed prompts, parent remarks, and parent behaviors on counseling.
- To detail the process and content of car seat safety discussions.
Main Methods:
- Videotaped 128 well-child visits for children under 7 months at a university pediatric clinic.
- Observed parent-physician interactions related to injury prevention.
Main Results:
- An average of three injury topics were discussed per visit.
- Physicians initiated most injury prevention topics (73%), often guided by prompts.
- Car seat counseling primarily focused on ownership/use (93%), with limited discussion on consistent application (11%).
Conclusions:
- Physician-led discussions are influenced by prompted topics.
- Current counseling on injury prevention, including car seat safety, is often superficial.
- Improved prompts addressing counseling process and content could enhance effectiveness.
Objectives:
To describe routine injury prevention counseling; to observe how three visit components - printed prompts, parent remarks, and parent behaviors - affect such counseling; to describe the process and content of discussions about car seats as an example of routine injury prevention.
Methods:
A total of 128 well-child visits of children under 7 months of age to a university pediatric clinic were videotaped (76% of eligible visits).
Results:
Three injury topics were mentioned, on an average, per visit. Parents or caregivers rarely introduced injury topics (5%). Physicians frequently introduced those topics listed on age-specific prompting sheets (73%). Car seat counseling typically began with a physician's question (82%). Most asked simply about ownership or use (93%). Few addressed difficult issues, such as consistency of use (11%).
Conclusions:
Physicians bring up the injury topics that are prompted. However, most discussion is superficial. Printed prompts that address counseling process as well as content might be beneficial.
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