Public Release: 

Pediatricians don't often refer patients to community resources for childhood aggression

Wake Forest Baptist Medical Center

WINSTON-SALEM, N.C. - Training pediatricians to recognize the signs of aggression and make a referral to an appropriate community organization may help prevent future violence. However, providers don't often do this, according to a new study by a pediatrician at Brenner Children's Hospital, part of Wake Forest University Baptist Medical Center.

Shari Barkin, M.D., says making pediatricians aware of local resources and encouraging them to make referrals early is vital, yet even after training, providers do not often do this, according to her research presented at the Pediatric Academic Society Meeting in San Francisco, Calif. on Saturday, April 29.

"We know that aggression in children is a predictor of violence later in life," Barkin said. "We must train pediatricians to identify aggression early and use the resources in their local communities, such as parenting classes and Boys and Girls Clubs."

In a recent study of 1,100 parents nationwide with children ages two to 11, 12 percent said they worry that their child is more aggressive than children in their peer group. But only 3.7 percent received a referral to an appropriate community agency by their pediatrician.

"When we asked pediatricians about this, they said it was hard to identify resources in their community," Barkin said. "In addition, physicians said they were concerned about insurance issues and long wait lists at some referral agencies."

Of the 3.7 percent of parents who had received a referral, 38 percent had asked for the referral directly. Other times, referrals were made when physicians noticed signs of a possible mental health issue, there was high parental stress or they observed an abnormal interaction between the parent and child in the office.

"We must work to dismantle these barriers and get children the services they need early," she said.

Physical aggression is defined as using your body to push, shove hit or bite to express frustration. The rate of childhood aggression is increasing and it occurs more frequently with boys than girls. Parents often turn to their pediatricians for help, Barkin said.


Forty-seven clinicians in practices affiliated with the Pediatric Research in Office Settings Network (PROS) in 22 states and Puerto Rico and Canada were interviewed for this research project, which is part of the Randomized Controlled Trial to Prevent Child Violence study - a larger $2.5 million study looking at the effectiveness of an office-based violence prevention intervention during well-child visits of children ages two to 11. The study is funded by the National Institute of Child, Health and Human Development; the Agency for Healthcare Research and Quality; the Robert Wood Johnson Foundation; the Friends of Children of the American Academy of Pediatrics; the Maternal Child Health Bureau; and the Wachovia Foundation.

Media Contacts: Rae Bush,, or Shannon Koontz,, at 336-716-4587.

Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital, Wake Forest University Health Sciences and Brenner Children's Hospital. The system comprises 1,187 acute care, rehabilitation, psychiatry and long-term care beds and is consistently ranked as one of "America's Best Hospitals" by U.S. News & World Report. Brenner Children's was named one of the top children's hospitals in the nation by Child magazine.

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