The term anticipatory guidance refers to the practice in which pediatricians provide information and counsel parents about child development and behavior. It helps families understand what to expect during their child’s, or adolescent’s, current and approaching stage of development. Studies show parents value these interactions and, in general, view them favorably. Pediatricians should take steps to learn what families are doing and target the discussion to the particular needs of each family.

Guidelines published by the American Academy of Pediatrics (AAP) and by others through the Bright Futures collaborative focus on health behaviors that have profound effects on childhood health and well-being. Topics to be discussed with patients of all ages include healthy habits, prevention of illness, nutrition, oral health, sexuality, social development, family relationships, parental health, community interactions, self-responsibility, and school/vocational achievement. Certain safety topics are appropriate to raise at any age such as motor vehicle safety, sun protection, a tobaccofree home, and smoke detectors. The AAP urges pediatricians to provide counseling for violence prevention, including discussing firearms in the home, physical and sexual abuse, and media exposure. Below is a summary of particular topics that may be raised, according to patient age.

Nutrition discussions with parents of infants should cover breast milk and formula, food preparation, transitioning to solid food, preventing choking and avoiding honey, which, if it contains the spores of Clostridium botulinum, could cause botulism. Elimination is an important issue, particularly as an increase in the diversity of the diet can lead to changes in stooling patterns. Additionally, supplementation with iron and vitamin D should be discussed. Oral health topics include preventing bottle caries and fluoride supplements. Safety discussions should cover safe sleep environment, car seats, burn prevention, fall prevention, choking prevention, drowning prevention, and cardiopulmonary resuscitation. Discussions about development and behavior should involve milestones in motor abilities and language. Reading aloud
should be introduced early on. Guidance about family relationships may include childcare and postpartum depression.

In the toddler/preschool age group, providers should check that patients are visiting the dentist and brushing habits should be discussed. Elimination (bowel and bladder) training is an important topic at this age. Injury prevention should cover traffic safety, burn prevention, fall prevention, drowning prevention, and dealing with strangers. Poison prevention includes keeping medicines and household products locked up and the poison control telephone number (1-800-222-1222) readily available. Behavior guidance may focus on discipline and temper tantrums.