Well child office appointments are conducted jointly or sequentially by a team consisting of a physician/pediatric nurse practitioner and a Healthy Steps Specialist. The visits are designed to answer questions mothers and fathers may have about their children's upcoming developmental stages, as well as to administer physical exams and developmental checkups. The Healthy StepsSM team is also responsible for identifying family health risks, such as maternal depression, household smoking, substance abuse, and domestic stress.
Physicians/pediatric nurse practitioners and Healthy Steps Specialists are trained to take advantage of "teachable moments" to help mothers and fathers observe and understand their child's temperament and development. Early literacy activities are also provided as part of the Reach Out and Read program.
Click here to view or download the protocol for Enhanced Well Child Care.
Teachable Moments
Each visit is likely to offer several "teachable moments," when physicians/pediatric nurse practitioners and Healthy Steps Specialists can draw on their observation of the child and the parents’ natural interest in their baby's health and development to communicate information effectively about behavior, temperament, and "goodness of fit." The guidelines for implementing a teachable moments strategy are simple: use what happens in the office as a compelling experience, shared by the Healthy Steps team and the parents to help mothers and fathers understand that experience in a way that furthers their insights into their child and themselves as parents. Although the child's behavior initiates the teachable moment, it is up to the Healthy Steps team to capitalize on it.
These strategies allow for a spontaneous, unforced dialogue, as the focus moves from the child to the parents and back to the child, facilitating a blend of action, observation, and information-sharing. If health care professionals shift their orientation, any interaction with a parent or child can be seen as a potential teachable moment. There are few limitations on where discussions of teachable moments may go, given the health care professional's use of shared experiences in the office, understanding of mothers' and fathers’ attitudes and concerns, and sensitivity to their past history and current circumstances.
Using such incidents to promote discussion and provide information throughout the well child visit is both more effective and more time-efficient than reserving the last few minutes of the visit for a discussion of "psychosocial issues." In addition, using teachable moments can help strengthen the crucial relationship between mothers and fathers and health care professionals.
Promoting Early Literacy
Because parents' reading to and talking with their young children are crucial factors in their children's readiness to learn and language development, early literacy activities (as part of the Reach Out and Read program) are an integral part of the Healthy Steps approach. Looking at books also gives children a pleasurable and positive way to elicit parental attention. Although many mothers and fathers know that reading aloud to children is important, some are not sure how to proceed. Many don't realize that they should begin to support their child's literacy in infancy. Reach Out and Read introduces age-appropriate children's books into the well child visit, starting at six months. The physician/pediatric nurse practitioner gives the child a book, comments on the child's response to the book in the examination room, and offers information on the child's cognitive development--for example, pointing out how the child can turn the pages of a cardboard book or can point to a named object in the book. The child is then invited to pick out a book to take home. For many mothers and fathers, the very fact that the book comes from the physician/pediatric nurse practitioner communicates the importance of reading more effectively than any amount of explanation would do.