Pediatric and adolescent health care in the United States may be in need of an overhaul, according to a report released in April by the Commonwealth Fund, a private foundation. While notable advances have been made in children's health, such as declines in infant and child mortality rates and the dramatic improvement in childhood cancer survival rates, there remains much room for improvement.

"When as many as three-quarters of children and adolescents aren't receiving recommended, effective preventive care, and only one in five is receiving necessary treatment, it's clear that the quality of the care isn't what it should be," says Douglas McCarthy, coauthor of the report, Quality of Health Care for Children and Adolescents: A Chartbook.

Taking data from dozens of separate studies, McCarthy and coauthor Sheila Leatherman found that as many as a quarter of all young children were not up to date on their recommended vaccines; fewer than 50% of adolescents ever discussed important health risk topics-including sexually transmitted diseases, pregnancy prevention, and alcohol usage-with a health care practitioner; as many as three-quarters of sexually active teenage girls aren't being screened for chlamydia infection; a third of children with persistent asthma aren't getting appropriate controller medications; and as many as a third of parents are never asked by a clinician about their children's speech and language development.

For many children, the authors say, health care still isn't easily accessible. As many as one in five has difficulty obtaining needed care, and about 25% don't see a dentist for a yearly check-up. Of the estimated 7.5 million children who're in need of a mental health evaluation, nearly 80% don't receive one.

Numerous disparities in care persist. Uninsured, poor, urban-dwelling, and minority children are less likely to complete their immunizations or to receive adequate dental care. And even when African-American, white, and Latino children have comparable insurance, nonwhite children are less likely to receive appropriate medications for asthma.

"We also found many good examples of improvements in quality," says McCarthy. "But in many cases, the nation is failing to apply these proven strategies to improving health care for children."-Roxanne Nelson, BSN, RN