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Good parent-doctor relationships may improve the advice parents receive

January 04, 2005

Parents whose children are at risk for child abuse and neglect may be reluctant to follow injury and illness prevention advice from pediatricians with whom they don't have a good working relationship, say researchers at the Johns Hopkins Children's Center, the Johns Burns University of Hawaii School of Medicine, and the Hawaii State Health Department.

"While it may seem basic, this practical advice could prove life-saving to children whose home and family situations already make them vulnerable to unintentional injury, the leading cause of death of children over one year of age in this country," says the study's lead author, Catherine Nelson, M.D., M.P.H, a general pediatrics fellow at the Johns Hopkins Children's Center.

In the study, published in the January issue of Pediatrics, researchers asked such parents about their relationship with their children's pediatrician and whether the doctor talked to them during well-child visits about the presence of smoke alarms in the home, use of baby walker and car seats, safe hot water heater temperatures (120ºF or less), use of stair guards and sunscreen, presence of guns in the home, and bottle propping at bedtime.

Not surprisingly, Nelson says, families who had good relationships with their pediatricians reported receiving more advice on injury prevention issues.

Parents in the study who trusted their children's pediatrician were more likely to follow the doctor's advice and change their behavior. The group of parents who trusted their pediatricians the most changed their behavior on 72 percent of topics discussed by the doctor, while the group who trusted their pediatrician the least changed behavior on 54 percent of topics discussed by the doctor. In particular, the use of car seats was the advice most often followed among parents.

Researchers say that overall, while pediatricians recognize the importance of injury-and-illness-prevention counseling, time constraints during well-child visits and the need to address other pressing health matters during the visit often stop them from discussing all aspects of injury prevention with parents. Time constraints can also impede a pediatrician's ability to take the time during well-child visits to really get to establish a good relationship with a family.

"The medical community recognizes that the clinician-parent relationship is the centerpiece of primary care. As we observed in our study, this relationship is especially important for clinicians dealing with families at-risk of child abuse and neglect. Not only are their children more likely to experience illness or unintentional injury, but also they often face other issues, such as partner violence or substance abuse, which may make them wary of doctors," Nelson says. "If we can earn their trust and establish a good relationship with them, they may be more willing to trust and follow our advice."

"Good relationships between pediatricians and parents are developed through mutual understanding of the 'Medical Home' concept - primary care physician services that are accessible, family centered, coordinated, comprehensive, continuous, culturally effective, and compassionate," adds Calvin C.J. Sia, M.D., FAAP, Professor of Pediatrics at the John Burns University of Hawaii School of Medicine and a co-author of the study.

In the study, researchers surveyed 402 at-risk families with newborns enrolled in the state of Hawaii's Healthy Start Program. Mothers were interviewed when their children were one year old. Nelson notes that because the study was limited to at-risk families, their findings may not be applicable to the general population of parents of infants.

The study was funded by the Robert Wood Johnson Foundation, Annie E. Casey Foundation, David and Lucile Packard Foundation, Hawaii State Department of Health, and the U.S. Maternal and Child Health Bureau.

Study co-authors were Susan M. Higman, Ph.D., Elizabeth McFarlane, M.P.H., and Anne K. Duggan, Sc.D. from the Johns Hopkins Children's Center; Calvin Sia, M.D. from the John Burns University of Hawaii School of Medicine; and Loretta Fuddy, L.C.S.W., M.P.H. from the Hawaii State Department of Health.
Founded in 1912 as the children's hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children's Center offers one of the most comprehensive pediatric medical programs in the country, from performing emergency trauma surgery, to finding causes of and treatments for childhood cancers, to delivering a child's good bill of health. With recognized Centers of Excellence in 20 pediatric sub-specialties including cardiology, transplant, psychiatric illnesses and genetic disorders, Children's Center physicians, nurses and staff provide compassionate care to more than 90,000 children each year. For more information, please visit:

Nelson CS, Higman SM, Sia C, McFarlane, Fuddy L, Duggan AK. Medical homes for at-risk children: parental report of clinician-parent relationships, anticipatory guidance, and behavior changes. Pediatrics 2005; 115(1): 48-56.

Johns Hopkins Medicine

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