Gaps in the evidence for well-child care: a challenge to our profession

Article Outline

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Moyer VA, Butler M. Pediatrics 2004;114:1511-21.

Given the focus in this section on the current best evidence, it makes sense to review this article that highlights many of the gaps in the evidence for well-child care. This systematic review examined the interventions recommended by seven major North American organizations. Forty-two interventions (noted by two or more organizations) related to behavioral counseling, screening, and prophylaxis were reviewed in more detail. Although not surprising to those of us in practice, the evidence supporting the recommended interventions is generally lacking, especially for common screening interventions. Some evidence exists for the effectiveness of behavioral counseling, particularly for injury prevention. There also is evidence that prophylaxis with folate prevents neural tube defects and iron supplementation can prevent iron deficiency. This article should be read in its entirety, especially by general pediatricians and health services researchers, as we strive to provide high-quality care for children.