[Pediatrician-parent interaction and early prevention : A review about the limits in addressing psychosocial risks during well-child visits].

BACKGROUND: Pediatricians can be a door opener to early prevention for families at risk. The German well-child program is well-established, but there is a gap between the structural possibilities and the observed placements.
OBJECTIVE: The aim of this review is to show how pediatricians and parents talk about psychosocial risks under the very structured conditions of well-child visits. The challenges and traps of the framed interactions will be described and options for early prevention will be shown.
METHODS: The review is primarily based on the work of conversational and ethnomethodological studies reconstructing the pediatrician's discussion with parents about psychosocial issues in the family.
RESULTS: Well-child visits are a highly routinized practice. Talking about family issues for both partners is a difficult task. Discussions about psychosocial issues are seldom and vague . Predominantly, they work cooperatively on reciprocal normalization of the child's development. Based on this shared orientation, pediatricians make an early, mostly general, prescription of parental tasks, supporting the child in the next developmental step. This kind of routine anticipatory counselling puts some pressure on the parents. Parents under unknown stress could be overburdened with this advice.
CONCLUSION: In the script of well-child visits, there are no slots that indicate to pediatricians and parents when, which, how and for what purpose psychosocial issues can be discussed and negotiated. For implementing such slots in well-child visits, three steps are necessary: a structured and regular assessment of psychosocial issues, a trained pediatrician in motivational interviewing and a social worker guiding the family in the network of early prevention.