Primary care services promoting optimal child development from birth to age 3 years - Review of the literature

Objective: To examine the evidence base for primary health care services pr omoting the optimal development of typically developing children aged birth to 3 years. Data Sources: Peer-reviewed publications addressing clinical evaluations of primary care services from the MEDLINE and PsychINFO databases. Study Selection: Criteria for selection were as follows: (1) publication be tween 1979 and 1999; (2) evaluation of efficacy or effectiveness of educati on, intervention, and care coordination services or validation of assessmen t approaches; (3) services applicable to an office practice setting; (4) ta rget population including children aged birth to 3 years; and (5) publicati on in English. Data Extraction: A total of 312 publications were abstracted and reviewed b y both of us; 47 were selected for inclusion. Data Synthesis: Assessments of parental concerns and psychosocial risk fact ors using validated approaches seem to be more accurate in identifying deve lopmental problems than clinicians' appraisals. In general, study results s upport the efficacy of (1) primary care educational efforts toward promotin g optimal parent-child interaction, parents' understanding of child tempera ment, book-sharing activities, and approaches to healthy sleep habits and ( 2) office interventions such as counseling for the management of excessive infant crying arid sleep problems. Conclusions: The literature suggests that many primary care activities prom oting the optimal development of children are efficacious. Evaluations of d evelopmental assessment and services in primary care should be expanded in depth and breadth. The implications for clinical practice, training, and he alth care policy are discussed.