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Family talks to doctor

Unscheduled visits may signal higher risk for developmental concerns

November 1, 2021

Children who visit a pediatric primary care office without an appointment may be at higher risk for developmental delays than those with scheduled visits, according to a recent study.

Some pediatric practices offer walk-in visits for well-child and/or sick care to accommodate parents with nonstandard or irregular work schedules. Previous studies have shown that parental nonstandard work schedules are associated with adverse developmental outcomes in some children. In addition, irregular work hours might prevent parents from bringing their child to well visits, which may delay developmental screening.

The authors of this study aimed to determine if children who present for unscheduled care are at higher risk for developmental concerns than those who have appointments.

They analyzed electronic health record data for 11,169 children ages 6-66 months who had well or sick visits at a large pediatric primary care clinic from 2013-’19 and whose parents had completed the Ages & Stages Questionnaire, Third Edition (ASQ-3). The screening instrument assesses communication, gross and fine motor, problem-solving and social skills.

Fifty-one percent of the children were male, 70% were Black and 80% had public insurance. Eight percent of the visits (n=848) were unscheduled.

Developmental concerns were more prevalent in children with walk-in visits than those with scheduled visits (28% vs. 18%), in White children than Black children (24% vs. 17.4%) and in children whose parents reported that they rarely read to their children than those whose parents read to them regularly (24.8% vs. 18.2%). 

The authors said Black parents may be less likely to report developmental delays than White parents due to concerns regarding prejudice, negative stereotypes and distrust in the health care system. 

In adjusted models, children with unscheduled visits had twice the odds of having developmental concerns than those who had appointments.

“These findings suggest that developmental screening outside of scheduled well-child checks may be an opportunity for practices to identify children with potential developmental delays who might otherwise be missed,” the authors wrote.

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