487 - Caregivers' Perceptions of Flourishing among Children 5-12 Years Old Receiving Well Child Care at an Urban Safety-Net Pediatric Clinic

Publication Number: 4478.487

Neha Bharadwaj, University of Colorado School of Medicine, Aurora, CO, United States; Abigail S. Steiner, Denver Health, Denver, CO, United States; Eamon Nussbaum, University of Notre Dame, South Bend, IN, United States; Joshua T. Williams, Denver Health, Denver, CO, United States

Background: Flourishing is a holistic measure of well-being gaining increasing attention. Limited data describe the extent to which children who receive care in safety-net health systems flourish, including what modifiable factors clinicians can promote to foster flourishing.

Objective: To describe caregivers' perceptions of child flourishing and factors associated with child flourishing in a safety-net pediatric clinic.

Design/Methods: A cross-sectional, observational study in 1 urban safety-net pediatric clinic (7/22/25 to 8/29/25). Eligible caregivers spoke English or Spanish and had children 5-12 years old presenting for well care. Caregivers completed a survey about their perceptions of their child's flourishing, factors associated with flourishing (i.e., family meals, extracurricular activities), demographic variables, and health-related social needs. Child-level data were collected via chart review.

The primary outcome was child flourishing, defined per the National Survey of Children's Health (NSCH) as "Always"/"Usually" responses to: "How often does your child (1) show interest and curiosity in learning new things, (2) work to finish tasks they start, and (3) stay calm and in control when faced with a challenge?" Descriptive analyses with Chi-square or Fisher exact tests compared caregiver- and child-level covariates by flourishing status. Unadjusted and adjusted logistic regression analyses tested associations between flourishing (as a binary outcome), the number of flourishing factors present in the home (as a continuous variable), and categorical variables (child: age, race and ethnicity, preferred language, medical complexity; caregiver: health-related social needs).

Results: Overall, 350 of 351 (99.7%) caregivers participated (Table 1); 163 perceived their children (46.6%) as flourishing, with varying agreement per NSCH item (Figure 1). Flourishing differed by child race and ethnicity, child medical complexity, caregiver education, and health-related social needs (Table 1), as well as by 6 pro-flourishing factors, including exercise frequency, family meals, screen time, and extracurricular activities (Table 2). In adjusted analyses, the odds of child flourishing tripled (aOR 3.53; 95% CI:2.62,4.74) for every flourishing factor present.

Conclusion(s): In a convenience sample of children aged 5-12 years at one urban safety-net clinic, fewer than half of children were perceived to be flourishing. Yet, flourishing was strongly associated with modifiable factors on which clinicians routinely counsel. Future work should explore the implementation of flourishing screening tools in safety-net care settings.

Table 1
Table 1.pdfDemographic and Household Characteristics of Surveyed Caregivers and their Children, with Categorical Comparisons among Characteristic Levels by Child Flourishing Status (N = 350 unless otherwise noted).

Figure 1
Figure 1R.pdfNational Survey of Children’s Health flourishing questions with caregivers’ responses, stratified by response option (N = 350).

Table 2
Table 2R.pdfFactors Associated with Child Flourishing among Surveyed Caregivers and their Children, with Categorical Comparisons among Factor Levels by Child Flourishing Status (N = 350 unless otherwise noted).