Primary Care Pediatrician's Experiences Caring for Children With Disabilities

Pediatricians have raised concerns about the time and resources needed to support children with disabilities (CWD). This study examines the experiences of pediatricians who provide services for CWD, including relationships between pediatrician characteristics, practice characteristics, and barriers to providing care.

This study analyzes American Academy of Pediatrics (AAP) 2023 Periodic Survey data (33.0% response rate; data weighted to account for nonresponse bias). Respondents reported experiences and barriers to caring for CWD. In addition to descriptive and bivariate statistics, we used multivariable logistic regression to examine pediatrician and practice characteristics associated with prescribing practices and reported barriers.

Survey respondents included 323 primary care pediatricians. While most pediatricians reported providing care for children with a range of disabilities (80.1% gross motor disability, 72.3% fine motor, 88.2% communication) more than half of pediatricians reported CWD made up a small portion (≤6%) of their patient panel. Most respondents reported prescribing physical therapy (78.1%), occupational therapy (78.4%), and speech therapy (88.6%) "often/very often," with few prescribing mobility aids (13.7%). Common barriers to caring for CWD included time limitations (74.9%), inadequate payment (63.3%), and lack of formal education/training (45.5%). Pediatricians with access to care coordinators were significantly less likely to identify inadequate payment and lack of formal education/training as barriers to care.

Most pediatricians provide care to CWD, but much of the care for CWD may be congregating among a small number of pediatricians. Equitable care access for CWD may entail medical home initiatives that combine support, consultation, and payment strategies.