How accurate is the health history of pediatric patients?

Parents may be unreliable about accurately reporting the health history of their children at the dental office, according to a study of more than 800 patients ages 17 and younger that was published on September 1 in the Journal of the American Dental Association.

As research is increasingly demonstrating a link between oral health and systemic health, it is especially important that dental care professionals obtain thorough documentation about a patient's medical history. In the study, a retrospective chart review was conducted on 863 pediatric patients in which parent-reported histories were compared with subsequent physician-to-dentist consultations.

Sensitivity varied widely among six health conditions that were included in the research analysis, with the highest sensitivity involving mental and behavioral disorders. Researchers speculate that parents may be unreliable in reporting children's health histories and that dentists should not solely rely on parents when obtaining health histories.

"To ensure up-to-date and accurate documentation of patients' health histories, dentists should obtain medical consultations before providing dental treatment for patients with incomplete medical histories of special health care needs," the study authors wrote, led by Dr. Christine Chiao, MPH, of Boston University.

The study's findings indicate varying accuracy of parental reports of pediatric patients' health histories. The sensitivity of parental reporting was highest for mental and behavioral health disorders (75.1%) followed by nervous system diseases (63%), respiratory conditions (47.9%), congenital conditions (46.3%), and cardiovascular conditions (25%). The lowest sensitivity was for hematologic conditions (12.2%).

Previous research has suggested a number of reasons why inaccurate reporting of a child's history may occur, including forgetfulness and poor recall, lack of communication between parents, confusion, lack of knowledge, shame and stigma, and intentional concealment so that desired outcomes are more likely.

Further, there may have been a lack of cultural and linguistic services at both dental and medical offices that hindered clear communication between patients and providers. This provides a potential explanation for an additional discovery from this study which was that the parents of children ages 6 and older and parents who had private insurance had significantly higher sensitivity for reporting mental and behavioral conditions.

"Known barriers experienced by low-income populations, such as language barriers and low health literacy, may contribute to unclear communication between clinician and patient," wrote the study authors. These barriers in combination with the complexity of achieving accurate diagnoses in children may explain why sensitivity of identifying mental and behavioral conditions was higher for older children.

"In advocating for patient safety, especially those with special needs and complex medical conditions, this study supports the use of medical evaluation before dental treatment and for the integration of dental and electronic health records," Chiao and colleagues concluded.