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When Should Children Assume Responsibility for Managing Their Health?

William L. Cull, Steven G. Federico, Mariana Glusman, Shalini Forbis, Barbara Bayldon. AAP, Elk Grove Village, IL; Denver Health Medical Center, Denver, CO; Feinberg School of Medicine, Northwestern University, Chicago, IL; Wright State University, Dayton, OH.

Presented at the May 2010 Pediatric Academic Societies Annual Meeting.

Background: There is much variability in the age when U.S. children begin to manage daily tasks related to conditions such as asthma or diabetes. Pediatricians are often looked to for guidance about when children should begin assuming responsibility for various aspects of their health.

Objective: Examine pediatricians' opinions about the age when children should assume primary responsibility for managing various health conditions and examine physician and practice characteristics predictive of these age estimates.

Design/Methods: A national random sample of AAP members was surveyed through the AAP Periodic Survey of Fellows in 2007 (N=1605; 56% response rate). Pediatricians were asked when they think a developmentally normal child can assume primary responsibility for several chronic conditions (asthma, diabetes, ADHD) and several preventive care topics (oral health, physical activity, nutrition). A repeated measure multivariate regression model was conducted to compare the age estimates for the chronic versus preventive topics and to examine other physician characteristics and practice characteristics (8 control variables).

Results: For the chronic conditions, the majority of pediatricians thought that children should take primary responsibility for asthma by age 12, for diabetes by age 13, and for ADHD by age 14. For the preventive topics, the majority thought children should take responsibility for oral health by age 8, for nutrition by age 12, and for physical activity by age 12. There was considerable variation in pediatricians' age estimates, as standard deviations were greater than 2.5 yrs for all conditions. In multivariate modeling, age estimates were younger for the preventive care topics than for the chronic conditions (11.1 yrs versus 13.4 yrs, p < .001). The only other significant predictor in the multivariate model showed pediatricians with more limited-English-proficiency (LEP) families provided lower age estimates (B = -.74 yrs, p = .003).

Conclusions: Pediatricians vary in their opinions concerning when children should assume health responsibility. Pediatricians provided lower age estimates for preventive topics, especially oral health, and when they have more LEP patients. Communication difficulties with LEP parents may lead pediatricians to think children in these families should take earlier responsibility for their health management.
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