Anticipatory guidance (AG) is age and developmentally appropriate health advice focused on improving the health, safety, and physical and emotional well-being of children and adolescents. This preventive advice, valued by parents, guardians, and patients, is dedicated to helping families understand what to expect during their child’s or adolescent’s current and approaching stage of development.¹ The continuity relationship between the physician and family makes this the ideal setting for AG discussions, because many of the topics are discussed longitudinally. To be effective, the AG should be patient specific and culturally relevant.²

The health education provided by pediatricians is intended to increase parent and patient knowledge, and hopefully it has a positive impact on behaviors that promote health and well-being and prevent disease and injury. The number of potential topics and their content are extensive. Although there are no mandatory issues to be covered, there are standard topics for consideration. These include:

Healthy eating

Prevention of illness and injury

Environmental health

Child development

Promotion of literacy

Media use

Nutrition

Oral health

Sexual health

Substance abuse

Social development

Family relationships

Parental health

Community interactions

Self-responsibility

School/vocational achievement

Most pediatricians recognize the importance of providing health advice but are challenged on how to cover the topics effectively and efficiently.^3,4 The best advice is given and received by the family when there is a strong doctor–patient–child relationship. To create a patient-focused visit, families find it helpful to receive personalized advice with a discussion reflecting their child’s age and developmental level, along with cultural traditions of the family. This avoids “running the list” and allows time to prioritize and focus the discussion on topics that are both interesting and relevant to the patient and family.

Environmental, cultural, and economic shifts have made AG more important than ever. For many, the support provided by extended family members is less available, and the demands of working outside the home have resulted in less parental time and less energy to learn independently about these topics. Parents want, need, and expect their pediatrician to provide them with child-rearing information and preventive advice. To enhance the parental response to AG it is important to learn what families already know and are currently doing to promote health and then select topics to clarify misconceptions, reinforce healthy family practices, and introduce new information.¹

Physicians report that limited time and lack of confidence in counseling techniques and benefits are barriers to effective provision of guidance.⁴ Ideally, counseling moments are discussed naturally and seamlessly during the visit. Counseling should be woven into all interactions with the family to include your direct observations during the visit, as well as questions during the history and physical examination. Make the history interactive by not only asking questions but also providing timely information. For example, when taking the dietary history, use this as an opportunity to recommend healthy foods and eating habits not mentioned by the parent, or discuss alternative foods and physical activities to reduce the risk for obesity. Advise teenagers about weight and healthy eating habits while exploring their perception of body image. When assessing the developmental status, use this opportunity to educate the parents regarding anticipated milestones, recommendations for skills improvement such as reading, recommendations for television viewing, and personal and environmental measures for injury prevention. The physical examination provides many opportunities for focused health education. Discuss proper oral health care during the dental examination. If bruises or lacerations are observed, this is an ideal time to discuss safety and injury prevention. Direct observations of infant/toddler temperament or parent-child interactions can be made during the office visit. These observations may provide insight into the parent-child dynamics and lead to discussions about normal behavior and temperament.