Primary care interventions for early childhood development: A systematic review

Abstract

CONTEXT: The pediatric primary care setting offers a platform to promote positive parenting behaviors and the optimal development of young children. Many new interventions have been developed and tested in this setting over the past 2 decades. OBJECTIVE: To summarize the recent published evidence regarding the impact of primary care-based interventions on parenting behaviors and child development outcomes; to provide recommendations for incorporation of effective interventions into pediatric clinics. DATA SOURCES: A literature search of PubMed and PsycINFO was conducted from January 1, 1999, to February 14, 2017. STUDY SELECTION: Publications in which primary care-based interventions and reported outcomes regarding the child's development or parenting behaviors associated with the promotion of optimal child development are described. DATA EXTRACTION: Forty-eight studies in which 24 interventions were described were included. Levels of evidence and specific outcome measures are reported. RESULTS: Included interventions were categorized as general developmental support, general behavioral development, or topic-specific interventions. Two interventions resulted in reductions in developmental delay, 4 improved cognitive development scores, and 6 resulted in improved behavioral intensity or reduction in behavioral problems. Interventions used a variety of theory-based behavior change strategies such as modeling, group discussion, role play, homework assignment, coaching, and video-recorded interactions. Three interventions report the cost of the intervention. LIMITATIONS: Community or home-based interventions were excluded. CONCLUSIONS: Although several interventions resulted in improved child development outcomes for children aged 0 to 3 years, comparison across studies and interventions is limited by use of different outcome measures, time of evaluation, and variability of results.