The importance of discussing parents' concerns about development: Do Parents Express Concerns Spontaneously?

 It is the recommendation of the American Academy of Pediatrics Committee on the Psychosocial Aspects of Child and Family Health1 and the authors of Bright Futures2 that at each health supervision visit, pediatricians discuss parents’ psychosocial concerns. The value of this recommendation is supported, in part, by research showing that in response to a standardized protocol for eliciting and interpreting parents’ concerns, parents can provide highly accurate indicators of childhood disabilities.3–7

Nevertheless, little is known about how parents express concerns outside of research settings. Pediatricians may use varying methods for eliciting concerns or they may depend on parents to raise concerns spontaneously. These approaches may alter the content of discussions or affect referral decisions. For example, Sharp et al. showed that despite readily engaging parents in discussions of psychosocial issues, pediatric residents had difficulty responding appropriately to parents’ concerns – often ignoring concerns or failing to explore them further.8 Another study showed that fewer than 50% of patients with psychiatric disturbance were referred even when parents raised concerns.9

Thus there are a number of research questions to be answered about the actual use and impact of parents’ concerns about children’s development on provider referrals. These include:

• Are parents more likely to seek health care when they have concerns about their children?
• How likely are parents to discuss concerns about development with health care providers?
• What kinds of concerns are discussed?
• Do parental socioeconomic status and other family characteristics affect the likelihood of raising concerns?
• What happens after concerns are discussed?

The goal of this study is to provide preliminary answers to these questions. The results should have implications for the use of parents’ concerns in developmental surveillance and promotion as well as for future research.