Prenatal visits offer pediatricians an opportunity to create a foundation for a relationship with patient families that could last 20 years.
The updated AAP clinical report The Prenatal Visit acknowledges the centrality of the long-term parent relationship in buffering adversity and promoting resilience. The report, from the AAP Committee on Psychosocial Aspects of Child and Family Health, also includes objectives for the visit, recommendations on what should be covered and links to parenting and child development resources for families. It is available at https://doi.org/10.1542/peds.2018-1218 and will be published in the July issue of Pediatrics.
Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, 4th Edition, recommends a pediatric prenatal visit early in the third trimester for all expectant families. The visit provides an opportunity to introduce a new family to the concept of the pediatric medical home for both health and developmental/behavioral concerns.
During the visit, pediatricians can gather basic information from expectant parents, offer information and advice regarding the baby, and identify psychosocial risks and high-risk conditions that may require special care.
Although 78% of pediatricians offer prenatal visits, only 5%-39% of expectant parents and less than 5% of urban poor mothers attend. In the hope of reducing disparity in pregnancy outcomes, encouraging nonresident prospective fathers and teen mothers to attend these visits may be particularly important, albeit challenging.
While a comprehensive prenatal visit with both parents is recommended during the third trimester, less formal contact may be an alternative to meet the preferences of expectant parents.
One of the goals of a prenatal visit is to provide guidance to parents so they can become more competent caregivers, while acknowledging their cultural beliefs and family values. Parents can discuss their responsibility for providing basic needs, and pediatricians can highlight how playing, reading, singing and talking to children from birth have a central role in fostering the development of trust and resilience.
Parents can be informed of the importance of observing and acknowledging individual differences in infants’ personalities from birth and that universal parenting techniques may not work the same for all infants. Discussions about feeding and the value of breastfeeding also can be emphasized.
The clinical report recommends improved communication with obstetricians and internists particularly regarding the importance of referring and coordinating care for parents, especially those with perinatal depression.
Bright Futures and this clinical report provide evidence to support payment for full prenatal visits. State chapters are encouraged to advocate that insurance companies and Medicaid pay for prenatal visits by pointing to the short- and long-term benefits for the health of infants and their parents.
Recommendations
- A prenatal visit can help expectant families (especially first-time parents) establish their child’s medical home and build a relationship with the pediatric practice. It also provides an opportunity for parents and the provider to share information.
- Pediatric practices can incorporate prenatal visits into their office routine but should be flexible to meet the needs of expectant parents. A full prenatal visit is preferred.
- The clinical report and Bright Futures support payment for full prenatal visits. AAP chapters and pediatric practices can advocate that payers cover these visits, pointing to evidence that they benefit health outcomes of infants and their parents.
- Pediatric residents can be taught about what should be covered during prenatal visits and their importance.
- Pediatricians should partner with obstetricians/gynecologists to optimize postpartum family care.
Dr. Yogman is a lead author of the report and chair of the AAP Committee on Psychosocial Aspects of Child and Family Health.
