*"It doesn't matter if the cat is black or white as long as it catches
mice."*

Deng Hsaio P'ing 1904-1997

This a page for sharing "what works" as seen in the published literature
as well as what is done at sites that care for American Indian/Alaskan
Native children. If you have any suggestions, comments or questions
please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics
at sholve@tcimc.ihs.gov

IHS Child Health Notes

February 2005

# Quote of the month

*" If we knew what we were doing it wouldn't be called research, would
it?"*

Albert Einstein

**Articles of Interest**

Rethinking well-child care.\
Pediatrics. 2004 Jul;114(1):210-6.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15231930

-   Well child care visits were initially set up to mesh with the
    vaccination schedule.

-   Well child care needs may no longer be congruent or fit best with
    vaccination schedules

-   Well child care should be scheduled to meet developmental needs

-   The author speculates that much of current well child care is
    inefficient and much that is needed, especially in child
    development, is left out.

Gaps in the evidence for well-child care: a challenge to our
profession.\
Pediatrics. 2004 Dec;114(6):1511-21.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15574609

-   Almost one third of visits to pediatricians are for well child care

-   Aside from vaccinations; there is virtually no evidence to support
    what is done in office based well child physical exams, screening
    and counseling are effective

-   The authors do not deny that screening and counseling are important,
    only that evidence of their effectiveness is lacking and that this
    evidence needs to be obtained through well designed clinical trials.

**Editorial Comment**

Two thought provoking articles that demonstrate that we have little
evidence to justify what we do for well child care. The authors don't
feel that health maintenance is useless, but that it lacks the rigorous
evidence we would normally ask for in any other medical intervention.
They challenge pediatrics to come up with the data to show "what works"
and to then discard what doesn't work, or worse, cause harm.

**Recent literature on American Indian/Alaskan Native Health**

Intervention-related bias in reporting of food intake by fifth-grade
children participating in an obesity prevention study.\
Am J Epidemiol. 2004 Dec 1;160(11):1117-21.

[**http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed**](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed)

-   A follow-up to the Pathways study that looked at trying to prevent
    obesity in American Indian school children.

-   The Pathways program increased knowledge about diet and exercise but
    failed to demonstrate any change in increased physical activity,
    better diet or less weight gain.

-   The authors believe that children in the intervention group under
    reported their caloric intake. They point out that this may be an
    issue in children being counseled on weight loss.

# Meetings of Interest for Child Health

April 29-May 1, 2005\
Seattle, WA

Join the American Academy of Pediatrics and the Canadian Paediatric
Society, in cooperation with the Indian Health Service, for the first
International Meeting on Inuit and Native American Child Health.
Pediatricians, family physicians, residents, other health care
professionals, clinical researchers, state and federal public health
employees, child advocates, and other professionals and family
representatives dedicated to working with First Nations, Inuit, and
American Indian/Alaska Native (AI/AN) children should attend.
Participants will have the opportunity to share ideas on culturally
effective health care delivery models, present research findings, and
dialogue about strategies to improve the health of First Nations, Inuit,
and AI/AN children and communities.

http://www.aap.org/nach/InternationalMeeting.htm

This is the first international meeting on Indian/Inuit health with
sponsorship by both countries pediatric societies. It should be an
excellent forum for education and sharing of ideas.