Hughes Evans

Compliance With Vision-Screening Guidelines Among a National Sample of Pediatricians

OBJECTIVE The American Academy of Pediatrics (AAP) recommends vision screening from birth through adolescence, with visual acuity testing and binocular screening to begin at age 3 years. The 1996 AAP guidelines advised referral for visual acuity worse than 20/40 for children aged 3 to 5 years and worse than 20/30 for children aged 6 years and older. Our objective was to describe vision-screening and referral practices in a national sample of primary care pediatricians. METHODS We mailed a survey to a random sample of US pediatricians. Initial nonresponders were mailed up to 3 additional surveys. All mailings occurred between May and October 1998. Analyses focused on primary care pediatricians and consisted of descriptive statistics and regression analyses. The main outcome measure was compliance with 1996 AAP recommendations for vision screening. RESULTS Of the 1491 surveys mailed, 888 (60%) were returned, including 576 (65%) from primary care pediatricians. Vision-screening methods included visual acuity testing (92%), cover test (64%), red reflex test (95%), fundoscopic examinations (65%), and stereopsis testing (32%). Respondents routinely performed visual acuity testing at 3 years (37%), 4 years (79%), 5 years (91%), 6 years (80%), 7-12 years (82%), and 13-18 years (80%). Visual acuity thresholds for referring 3- and 4-year-olds were 20/40 (47%, 51%), 20/50 (36%, 32%), or worse than 20/50 (14%, 12%). The majority of pediatricians referred children aged 5 years and older at 20/40, although thresholds worse than 20/40 were reported commonly (18%-33%). Logistic regressions were done to identify factors associated with higher likelihood of performing specific screening tests. Although no factor was consistently associated with use of all screening tests, size of the practice was significant in several regression models. CONCLUSIONS Many pediatricians do not follow AAP guidelines for vision screening and referral, especially in younger children. Two thirds of pediatricians do not begin visual acuity testing at age 3 years as recommended, and about one fifth do not test until age 5 years. In addition, one fourth do not perform cover tests or stereopsis testing at any age.

A longitudinal study of parental discipline of young children

Objective: To determine how discipline practices changed over time for young children. Methods: A cohort of parents with young children were interviewed in clinic about a broad array of disciplinary practices at two points in time. Results: A total of 182 parents were interviewed at Time 1, and 94 were interviewed at Time 1 and 2. Mean age of the child was 16.2 months at Time 1 and 35.8 months at Time 2. Monitoring, verbal communication, and distracting were the most common types of discipline when the children were one year old. Corporal punishment (P < 0.05), verbal communication (P < 0.001), timeout (<0.0001), removing privileges (<0.0001), negative demeanor (<0.0001), and sternness (<0.0001) increased significantly from Time 1 to Time 2. Distracting (<0.001) decreased significantly and positive demeanor also decreased. Conclusions: Most discipline practices increased in frequency over the 20 months of this study. The increase in parental negative demeanor seems particularly important and worthy of further study.

Factors that affect parental disciplinary practices of children aged 12 to 19 months.

Background: Physicians are encouraged to provide counseling regarding parental discipline. Quality counseling requires knowledge of disciplinary practices and factors that affect these practices. Methods: One hundred and eighty two parents of 12- to 19-month-old children from general pediatric clinics in North Carolina and Alabama were interviewed regarding discipline using the Discipline Survey. Measures of contextual factors were analyzed to see which predicted disciplinary practices. Results: Ninety-two percent of the participants were mothers; 6% were fathers; participation rate: 78%. Monitoring was the most common type of discipline used and time out was the least common. Parent, child, and family characteristics were all importantly associated with a broad array of disciplinary practices and modes of administration. However, the situation in which discipline occurred was found to be significant for most disciplinary practices even after controlling for other factors. Our study found that the specific misbehavior was most likely, and the presence of the other parent was least likely, to affect the type of discipline which was utilized. Conclusions: When counseling families about discipline, practitioners should incorporate the fact that misbehavior happens in various contexts.

The Discipline Survey: A New Measure of Parental Discipline

OBJECTIVES To develop a new measure of parental discipline of children encompassing a broad array of types of discipline and modes of administration. METHODS Parents of 12- to 19-month-old children were interviewed using a new 45-item structured survey about discipline in general pediatric clinics in North Carolina and Alabama. Demographic data describing the population studied were linked from another study in which these families were participating. Principal component analysis and confirmatory reliability analysis were used to define subscales and determine which items were retained in the survey. RESULTS One hundred eighty-two parents were interviewed about disciplinary practices. Disciplinary subscales were robust for a number of disciplinary types (monitoring, verbal communication, modeling behavior, corporal punishment, and ignoring) and modes of administration (follow-through, consistency, positive demeanor, negative demeanor). CONCLUSIONS The Discipline Survey is a promising new measure of parental discipline. A survey instrument to assess disciplinary practices like the one developed fills a gap and can enhance research methodology for those interested in the effects of interventions on parental discipline.

Pediatric discourse on corporal punishment: A historical review

Corporal punishment is a commonly used, but controversial disciplinary technique. This article reviews the pediatric professional response to corporal punishment over the past century. We focus predominantly on the discourse written to educate pediatricians, for the most part, textbooks. Using the sociologic construction of deviance proposed by Conrad and Schneider, we show how corporal punishment has moved from a condoned behavior to a socially deviant behavior. Based on our review of this literature, we delineate three distinct pediatric professional attitudes toward corporal punishment over this century:(a) corporal punishment as morally sanctioned behavior, (b) corporal punishment as atool for controlling behavior, and (c) corporal punishment as abusive. We show how each of these stances developed and demonstrate how these stances inform paradigms that are still operative today. By reviewing changes in pediatric thought toward corporal punishment, this article provides a useful framework for child health professionals struggling with the appropriateness of corporal punishment as a disciplinary technique.

Hearing Screening Practices Among a National Sample of Primary Care Pediatricians

The objective of this study was to describe variations in hearing screening using a survey mailed to a national sample of primary care pediatricians prior to the 2003 American Academy of Pediatrics (AAP) hearing screening guidelines. Of the 390 primary care respondents, only 303 (78%) performed audiometry, routinely beginning at age 3 (32%), 4 (44%), or 5 (17%); 81% defined abnormal audiometry primarily as failure to hear at a specified decibel level: 15 dB hearing level (HL) (<1%), 16 to 20 dB HL (10%), 21 to 25 dB HL (23%), 26 to 30 dB HL (44%), 31 to 40 dB HL (16%), and more than 40 dB HL (6%). This study serves as a baseline for comparison with postguideline practices.