November 2001 • POST-ASSEMBLY EDITION
Childhood screenings keep pace with increasing patient diversity
BY JODY McAULAY GLOOR
When it comes to childhood growth and development screening, pick the screening program that best fits your practice and -- more important -- your patients, Jeffrey Quinlan, M.D., said Oct. 3 during a clinical seminar at the Scientific Assembly.
Those young patients are becoming increasingly diverse, he said. The result? The latest screening information is likely to be outdated soon, and much of the information you learned in medical school and residency is probably obsolete. In fact, Quinlan, associate director of the family practice residency at the Naval Hospital in Jacksonville, Fla., said he decided to teach this course in order to re-educate himself on the topic.
His research turned up many answers, plus new and revised growth charts and developmental screening tools for today's family physician.
Older growth charts focused on weight for age, height for age, head circumference for age and weight for height.
However, the CDC last year introduced the first major overhaul of growth charts in more than 20 years. Weight-for-age, height-for-age and head-circumference-for-age charts were revised. But the weight-for-height chart was tossed out and replaced with one indicating body mass index for age.
Even more helpful, Quinlan said, are new charts created by other organizations for genetically diverse populations. These new tools in-clude ethnicity-specific charts and syndrome- or disease-specific charts.
"Because I see military families in my practice, many of my patients are Filipino," he said. "And you can't use classic American growth charts for children who naturally may be shorter or weigh less."
What's more, technology has greatly increased access to these charts as well as curbed costs for them. In fact, many can be downloaded free from Web sites. (See box below for more information.)
When choosing a child's screening tool, always consider its reliability, validity, application and appropriateness, Quinlan said. Most often in family practice, he said, "that means it's got to be quick and easy to perform. But it also needs to be relatively inexpensive." This is especially true for comprehensive screening programs.
Some tests, such as the Denver Developmental II, take at least 30 minutes to administer, yet the Denver Prescreening Questionnaire (a shorter version of DDII) takes only 5 10 minutes to complete. Ages and Stages screenings take about 15 minutes to administer, he said, but now they are available in many languages such as Spanish, French, Mandarin Chinese, Russian and Arabic -- making them invaluable to family physicians who care for ethnically diverse patient populations.
Several comprehensive screens require physicians to buy expensive kits with dozens of parts, while others require only pencils, crayons and/or blocks. A little more than a year ago, Quinlan said, he was introduced to Bright Futures, a comprehensive program for children's health and development that was created with input from several organizations, including the AAFP.
"I've seen little knowledge of (Bright Futures) in the medical community so far, but I highly recommend it," Quinlan said. Information can be downloaded free from the program's Web site, offering a new, affordable way to get the tools to properly screen and diagnose young patients, he said. Go to http://www.brightfutures.org for more information.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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