Content and Emphasis of Well-Child Visits

The content and emphasis of well-child visits conducted by nine randomly selected pediatricians was compared with those of five experienced pediatric nurse practitioners. Twenty one nurse visits and 43 pediatrician visits with 1-year-old to 2-year-old children were monitored. The nurses discussed developmental and child behavior topics in significantly (P less than .05) greater depth, they asked more open-ended questions, made more specific recommendations, provided more maternal support, and the parents spoke a greater proportion of the time during the nurses' visits. Efficiency (number and depth of topics considered per unit time) of both groups was similar. Nurse visits were more time-consuming (mean, 25.5 vs 17.6 minutes for pediatricians). A subgroup of four pediatricians conducted visits much like those of the nurses, scoring as well in less time. The other five pediatricians conducted shorter visits, with little emphasis on child development and provided less time for the parent to talk. Overall, after five years in practice, these nurses were in no way less complete in child health supervision than a representative sample of pediatricians and were considerably more comprehensive in their approach than the average pediatrician.