Maternal depressive symptoms are common in early infancy and contribute to unfavorable parenting practices.

ROVIDING QUALITY PEDIATRIC care for young children involves matching the needs and expectations of families with the organizational structure and clinical practices of pediatric providers. There is growing evidence of deficiencies in the quality of health care for children, including low rates of preventive services, 1 persistent disparities in health status, 2 and lack of a usual source of care among ethnic and racial minorities and children in low-income families. 3 Specific limitations have been noted in the quality of care related to developmental and behavioral services for children in the first 3 years of life, 4-7 particularly regarding gaps between recommended and actual care received. 8,9 In a national survey, only 23% of 2017 parents of young children discussed discipline and early learning with their child's clinician, and over half Author Affiliations are listed at the end of this article.

The study findings suggest that concurrent maternal depressive symptoms have stronger relations than earlier depressive symptoms, with mothers not initiating recommended age-appropriate safety and child development practices and also using harsh discipline practices for toddlers. Our findings, however, also suggest that for parenting practices that are likely to be established early in the life of the child, it may be reasonable that mothers with early depressive symptoms may continue to affect use of those practices by mothers. The results of our study underscore the importance of clinicians screening for maternal depressive symptoms during the toddler period, as well as the early postpartum period, because these symptoms can appear later independent of earlier screening results. Providing periodic depressive symptom screening of the mothers of young patients has the potential to improve clinician capacity to provide timely and tailored anticipatory guidance about important parenting practices, as well as to make appropriate referrals.