What Is Well-Child Health Care and Why Is It Important? [Key Concepts, Background Information]

Well-child health care involves a partnership between Head Start families and community providers to ensure accessible, continuous medical services. This learning tool for health and other program staff presents key concepts related to well-child health care in Head Start programs.

The following is an excerpt from Well-Child Health Care: Making It Happen.

Key Concepts
Well-Child Health Care - What Is It and Why It's Important
The Components of Well-Child Health Care
     Documentation
     Screening
     Examinations
Head Start Responsibilities
Questions for Discussion/Reflection

Key Concepts

The cornerstone of well-child health care is establishing a partnership between children and families and a "medical home." The "medical home" provides an ongoing source of continuous accessible medical care.

Well-child health care consists of providing the child with regularly scheduled check-ups with a health care provider. It includes the following:

  • Health history of the child
  • Screening tests to identify health conditions that might need further assessment or treatment
  • Examination of the child
  • Treatments to prevent disease
  • Education and counseling to promote health

Well-child health care helps to keep children healthy. The earlier a child's health needs are identified and met, the better it is for the child and family.

It is important to read and understand each child's complete health record since existing health problems are interrelated with screening and exam results. All results and follow-up should then be clearly explained to parents.

Background Information

A. Well-Child Health Care—What It Is and Why It's Important

The cornerstone of well-child health care is a partnership of children and families with a system of health care that ensures families have a continuous, ongoing source of accessible medical care. This source of health care is termed the "medical home." The health care provider might be a physician, nurse practitioner, or traditional healer; the "medical home" might be located in an office, clinic, or other setting. The health care provider works in a collaborative partnership with the parents and Head Start staff. She or he gets to know the family and coordinates the child's health care during healthy times, illnesses, injuries, and other health conditions. Through linkage to a medical home, a child can be put on a program of regularly scheduled immunizations and early and periodic screenings. The medical home is important for all children, especially for those with health problems. The relationship between families and the medical home will hopefully continue after the child leaves Head Start.

Well-child health care begins before the child is born by helping pregnant women access comprehensive prenatal care. Prenatal care can prevent low birth weights, premature labor, birth defects such as spina bifida and other neural tube defects, and increase the chances of a healthy baby for HIV-positive women. Prenatal education helps women make healthy choices for themselves and their babies regarding smoking, diet and exercise. At birth, health experts recommend that children begin regular examinations, screenings and immunizations. Since the first few years of life are critical for a child's health and development, early and frequent visits to the medical home are crucial. ...

When health conditions are identified and treated early, the impact of many disabilities can be reduced. For example, lead poisoning can cause serious medical, behavioral, and learning problems in children. When lead screening identifies a child with lead poisoning, prompt intervention—removing the source of lead, educating the family, and getting medical therapy—can lessen the harmful effects of lead poisoning on the child. It may also help prevent poisoning of other family and community members.

B. The Components of Well-Child Health Care

  • Health History

    A brief summary of the child's health history is made from discussion with the parents and review of medical records. It addresses the health of the child within the context of the family. It covers pregnancy and delivery, illnesses, hospitalizations, chronic health conditions, allergies, and the child's physical, emotional, and social development. It also includes a family history of health problems and a description of the child's home environment. The health history highlights any special concerns about the child.

The health history should include a list of the child's primary health care provider, specialists, and other services that the child and family receive, such as a developmental center or Children's Protective Services.

  • Documentation

    Health records are essential for evaluating children's health needs and developing plans for intervention and follow-up. They are also important for communicating with families, health care professionals, and teachers/caregivers. Health records must be:

Accurate: Observations and screening and exam results should be carefully documented in objective terms. Vague terms and judgments should be avoided. For example, instead of stating "Jimmie's behavior has been very bad since he started school," it would be better to state, "Jimmie has gotten into fights with his classmates three or four times a week. He frequently screams, punches, and bites."

Complete: Results must be documented for all of the required screenings and exams. All "abnormal" screening and exam results must be followed up by further assessment and treatment, when needed. When children have specific health problems, it is important to get records of previous evaluations, diagnoses, and treatments. Ongoing consultation with the family and health care providers should also be carefully documented.

Confidential: Children and families have a right to have their health records kept confidential. Information should not be shared with other parents. Only staff who need to know the information should have access to the family's health records.

Shared Appropriately: The information can and should be shared with anyone who needs to know in order to care for the child, but only with the consent of the parent(s) or legal guardian. Key family members, health care providers, and staff need to be involved in family conferences to develop plans for intervention and follow-up to meet the child's needs. When the child changes programs or goes to kindergarten, the records should be forwarded, with the consent of the parent(s), in a complete, organized and confidential manner.

  • Screening

    Screenings are standardized, often quick, procedures to identify health conditions that might need further assessment and treatment.

Screening procedures include gathering information from the family, observing the child's behavior and skills, and doing certain tests. They include both objective, standardized procedures (e.g., developmental tests), and subjective observations (e.g., "Tina seems to have difficulty with fine motor tasks").

While Head Start requires screenings be completed within certain time limits after enrollment, screening also includes daily observations of children's appearance, behavior, and skills throughout the year. It is important for Head Start staff to be able to read and understand each child's health record since existing health problems can be related to screening results. Head Start should not duplicate services that have been conducted by other health professionals. Instead, Head Start works in partnerships with health care professionals to make sure children are receiving needed health services.

The trained professionals at the child's medical home will do some screening (e.g., hematocrit, tuberculosis, hereditary/metabolic, lead, and intestinal parasite screening). Other screenings may be done by Head Start staff, parents, or volunteers who are properly trained in the procedures (e.g., growth, vision, hearing, nutritional assessment).

Within 45 days of enrollment, the Head Start staff will screen to identify developmental, sensory, and behavioral concerns. Many screenings can be completed in the classroom or in the family's home where the child is most comfortable.

The child's screening results are assessed according to the "typical" or "normal" range among children that age. "Atypical" or "abnormal" screening results mean that the child may have a special health need. The child needs further evaluation by a health professional to determine if he has a specific condition or diagnosis and what treatment or services might help.

A relationship with the medical home will offer consistency of care. Diagnosis, treatment and follow-up can be closely followed.

Examinations

Examinations are in-depth physical assessments of the child, such as the medical/physical exam and the dental exam. Licensed health care professionals, such as a physician, nurse practitioner, or physician's assistant perform the medical exam; a dentist performs the dental examination. Professional standards require specific procedures and equipment. Staff work with parents and mental health professionals to address concerns over a child's mental health.

  • Preventive Treatments

    Public health research has shown that certain preventive treatments can reduce health problems among children. For example, immunizations can prevent many serious diseases such as polio and measles, and dental fluoride can help prevent dental cavities. The medical home will provide the child with regularly scheduled immunizations following the Centers for Disease Control and Prevention (CDC) guidelines.
  • Education and Counseling

    Working in partnership, health care providers and parents discuss many issues to promote the health of the child. They review the results of the screenings and exams, and discuss what further assessment and treatment may be needed. Parents are given guidance about the child's development, nutrition, dental care, and preventing illnesses and injuries. The parents' concerns are addressed and support is provided.

Note to Trainer/Coach:
For information on developing partnerships with parents, see the guide Partners in Decision Making in the Parent Involvement series of Training Guides for the Head Start Learning Community.

C. Head Start Responsibilities

The Head Start program works in partnership with parents and health care providers to ensure that every child entering Head Start is assisted with:

  • Identifying and accessing health care providers
  • Linking to a medical home: a source of ongoing and continuous health care
  • Receiving recommended screenings, examinations, and immunizations within specific time frames
  • Receiving follow-up evaluation, diagnosis, and treatment of health conditions that are identified

Head Start programs also provide the following:

  • Assistance to pregnant women in accessing comprehensive prenatal care, childbirth services and postpartum care
  • Health education for children and parents

Head Start services complement the services provided by other practitioners. Head Start programs do not duplicate services already given unless there is an explicit need to do...

Note to Trainer/Coach:
As medical information advances, health recommendations and requirements may change. Head Start programs must stay current on state and local recommendations of health authorities and state licensing requirements to determine the complete list of screenings, exams, and immunizations needed. For information about local recommendations for well-child health care and screening, contact your local or state Medicaid/Early and Periodic Screening, Diagnosis & Treatment program, your local Health Services Advisory Committee, and your local chapter of the American Academy of Pediatrics.

Questions for Discussion/Reflection

Preventive health care is not only important for children-it is also very important for adults. Thinking about your own health care practices can give you a greater understanding of some of the challenges Head Start families may face:

  • Do you have a "medical home" or a consistent health care provider?
  • Do you see your health care provider only when you are sick or also on a regular basis when you are well? Do you put off seeing your provider because you are anxious about what he or she may find?
  • Have you gotten the screenings and exams (e.g., blood pressure, breast exam, PAP smear, blood cholesterol level, eye exam, dental exam, tuberculosis test) and the immunizations that you need?

"What Is Well-Child Health Care and Why Is It Important? [Key Concepts, Background Information]." Well-Child Health Care: Making It Happen. Training Guides for the Head Start Learning Community. HHS/ACF/ACYF/HSB. 1998. English.

Last Reviewed: May 2009

Last Updated: August 26, 2015