Adequacy of well-child care and immunizations in US infants born in 1988.

Objective: To determine adequacy of preventive care for US infants, including both well-child care visits and immunizations, and to identify risk factors for inadequate receipt of care.

Design: Analysis of the 1988 National Maternal and Infant Health Survey of the National Center for Health Statistics.

Sample: Nationally representative sample of all US children born in 1988.

Participants: A total of 7035 infants from a live-birth subsample who were at least 8 months of age and living with their mothers at the time of the survey.

Main Outcome Measures: Percentage of children receiving both adequate well-child visits and adequate immunizations by 8 months of age.

Results: Adequate visits were received by 82% of white infants and 75% of black infants; adequate immunizations were received by 46% and 34%, respectively. Forty-two percent of white infants and 29% of black infants received both. Sixty percent of infants who did not have adequate immunizations by 8 months of age had at least three well-baby visits. With adjustment for maternal education level, poor white children had a relative risk of 1.5 of receiving inadequate care compared with infants in families with income greater than 185% of the federal poverty level. Infants with Medicaid or other government assistance had significantly lower levels of adequate care than did infants with private insurance.

Conclusions: This study demonstrates a wide gap between actual immunization coverage levels and recommended levels among US infants born in 1988. Public health agencies, Medicaid programs, and primary care providers should explore ways to take better advantage of well-child visits that are already occurring to achieve appropriate levels of immunization coverage.