The routine "well child" examination: a study of its value in the discovery of significant psychological problems

The practice of well child care by pediatricians has been a subject of increasing controversy. Previous reports in the literature have indicated a low yield of significant organic or psychological findings. In the present study, three post-residency pediatricians, working in the general pediatric unit of an HMO setting at different times, evaluated the developmental and psychological problems of patients seen in consecutive well child examinations. The nature of their problems was measured by the actual degree of intervention required of the pediatrician, rather than by standard mental health terminology or diagnosis. The combined results of these evaluations (with close individual agreement among the three examiners) contradicted previous pediatric reports by indicating that 38 per cent of the children seen had definable developmental or psychological problems requiring some action or intervention by the pediatrician. Eleven per cent of the cases required major intervention--either 3 or more visits or referral to a mental health facility. These results indicate a wide prevalence of significant developmental and/or psychological problems in children and demonstrate the capability of general pediatricians working in a standard pediatric setting to detect them.