Parents want their kids to grow up healthy, happy, and thriving. Routine check-ups and preventive health care services are an important part of achieving this. But too many California kids are not getting these key services.  

Children Now’s Preventive Services Chartbook reveals that less than half of the infants and toddlers enrolled in Medi-Cal are receiving essential check-ups at a time in their lives when healthy development is so critical. Well-child visits are not just routine appointments. They are also vital touchpoints for families in understanding developmental milestones, creating healthy habits and behaviors, and connecting with other programs, services, and community resources. 

This alarming statistic should be a wake-up call for all of us. 

The Importance of Well-Child Visits as Family Touchpoints 

For any caregiver who has taken their kid to the pediatrician, they know that well-child visits are much more than just a time for vaccinations and physical exams. During these visits, pediatricians assess a child’s physical and emotional needs, support their growth and development, and refer for additional care if issues arise. These visits also provide an opportunity for parents to discuss concerns and receive guidance on topics such as nutrition, sleep safety, and age-appropriate development and behavior. This is true for dads too, not just moms: 

During a well-child visit, a pediatrician might also identify a need for additional supports and refer the family to other programs or services to meet the child and their caregivers’ needs. These referrals coming from a trusted source like pediatric primary care providers and practices is crucial – parents are more likely to enroll in food assistance programs if pediatricians inform them about their eligibility. This demonstrates the power of these visits as touchpoints for connecting families to a broader network of resources. Given the important connection parents have with their pediatricians, there is a lot of opportunities for healthcare providers to support the overall well-being of families, including through referrals to nutrition and food programs. 

Focusing on Equity in Improving Well-Child Visit Rates 

Before the pandemic, many kids, especially those from communities of color, were already missing out on essential check-ups and preventive services. Structural barriers to accessing healthcare, including transportation issues, language differences, lack of childcare, and financial constraints, played a role.  

COVID-19 then made things even worse. Parents of young children shared that the pandemic made it harder to access prenatal care, educational resources, and other support services. Research shows that these challenges only made existing disparities in child healthcare worse,  so the racial disparities in well-child visit attendance and infant health care widened. As a result, Black, American Indian/Alaska Native, and Native Hawaiian/Other Pacific Islander children in California still have the lowest rates of preventive care visits. 

On top of the harm the pandemic had on access to preventative services, it is important to recognize that historical and ongoing experiences of discrimination and bias in the healthcare system have led to a lack of trust among some communities of color. This mistrust can result in reluctance to seek care, even for preventive services. It is important for families to feel heard and supported to gain trust, and to achieve this, cultural competency – the ability to understand, appreciate and interact with people from cultures or belief systems different from one’s own – is key.  

For healthy development, culturally competent providers are critical in ensuring effective and proactive well-child visits. Implicit bias among healthcare providers or a failure to identify cultural distinctions in kid’s behavior can lead to underdiagnosis or misdiagnosis of developmental delays in Black children. Studies have shown that Black children are less likely to be diagnosed with conditions like autism compared to their White peers, and when they are diagnosed, it often occurs later, delaying critical early interventions.  

It’s more important than ever to address this racial disparity issue with a focus on equity. We need to ensure that all children, regardless of their background, have access to the healthcare they need to thrive. By tackling these disparities head-on, we can help build a healthier future for all our kids. 

Transforming Health Care for Kids 

The Medi-Cal program – the cornerstone of coverage for California children – is undergoing a number of transformations to improve children’s preventive services and bridge divides between public health and social services sectors, as well as the communities they serve. Primary care is a central point where transformation can occur through “closed loop referrals” and “warm handoffs” that ensure families get connected to and actually receive the care and services they need beyond primary care.  

As Dr. Palav Babaria, Chief Quality Officer and Deputy Director of Quality and Population Health Management at the California Department of Health Care Services, said in a recent podcast (20:18) regarding the goals of the Medi-Cal transformation initiatives, the state is “really thinking about underutilization—who’s not showing up at our front door? We know so much of that drives a lot of the racial and ethnic disparities we see. How do we think about re-engaging primary care as the front door of our delivery system?”  

Since there are many kids – roughly half of all children and youth with Medi-Cal – who never show up to the “front door” of the health care system, they end up missing out on timely preventive care services like screenings, immunizations, connection to dental care, and referrals to other supports, specialists, or services they may need. Transformational efforts to eliminate structural barriers so that children have continuous access to culturally-competent primary care providers will be necessary to close the health equity gap and ensure all children have the opportunity to grow up healthy and strong.