Summary Health Supervision of Infants, Children, and Adolescents

Bright Futures at the American Academy of Pediatrics Founded in 1930, the American Academy of Pediatrics (AAP) is an organization of 66,000 pediatricians who are committed to attaining optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. The Bright Futures initiative was launched in 1990 under the leadership of the federal Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration to improve the quality of health services for children through health promotion and disease prevention. In 2002, MCHB selected the AAP to lead the Bright Futures initiative. With the encouragement and strong support of MCHB, AAP and its many collaborating partners set out to update the Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents as a uniform set of recommendations for health care profes- sionals. The Bright Futures Guidelines are the cornerstone of the Bright Futures initiative and the foundation for the development of all Bright Futures materials. Other Bright Futures materials, aimed at specific target audiences such as health care professionals or families, have been developed, including provider training materials, anticipatory guidance tools, quick-reference guides for families, and a national newsletter to highlight Bright Futures activities around the country. In addition, several states, organizations, and local entities have developed tools and materials based on Bright Futures that are tailored to their own training, outreach, health assessment, and education needs. viii briGHt FuturEs At tHE AMEriCAN ACAdEMy oF PEdiAtriCs What is bright Futures? Bright Futures is a set of principles, strategies, and tools that are theory based, evidence driven, and systems oriented that can be used to improve the health and well-being of all children through culturally appropriate interventions that address their current and emerging health promotion needs at the family, clinical practice, community, health system, and policy levels. Goals of bright Futures ■■ Enhance health care professionals’ knowl- edge, skills, and practice of developmentally appropriate health care in the context of family and community. ■■ Promote desired social, developmental, and health outcomes of infants, children, and adolescents. ■■ Foster partnerships among families, health care professionals, and communities. ■■ Increase family knowledge, skills, and parti- cipation in health promotion and disease prevention activities. ■■ Address the needs of infants, children, and adolescents with special health care needs through enhanced identification and sources. For more information about Bright Futures and available materials and resources, visit . 1 HoW to usE tHis GuidE How to Use This Guide The Pocket Guide is based on Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition, published in 2017. Presenting key information from the Guidelines, the Pocket Guide serves as a quick reference tool and training resource for health care professionals. sections of the Pocket Guide bright Futures Health Promotion themes: Highlights 12 cross-cutting child health topics that are discussed in depth in the Guidelines. These themes are important to families and health care professionals in their mission to promote the health and well-being of all children. The Pocket Guide lists these themes; see the Guidelines for the full text. introduction to the bright Futures Health supervision Visits: Discusses the content, timing, and structure of the visit and supporting evidence for visit components. the bright Futures Visits: The Pocket Guide includes an abbreviated version of each of the visits included in the Guidelines. Each visit includes the following components: Observation: Includes developmental surveillance and observation of parent-child interaction. Physical Examination, Screening, and Immunization: Includes the physical examination and spe- cial issues to be noted, universal and selective screening procedures, risk assessment, and immunizations. 2 HoW to usE tHis GuidE Anticipatory Guidance: Presents guidance for fam- ilies organized by the 5 priorities of each visit. Sample questions also are provided for selected topics. Guidance and questions in black type are intended for the parent; guidance and questions in blue type are intended for the child/ adolescent/young adult. These can be modified to match the health care professional’s com- munication style. Appendixes: Includes a list of abbreviations used in the Pocket Guide, developmental milestones and tasks charts, tooth eruption chart, and sexual maturity ratings chart. 3 suPPortiNG FAMiliEs suCCEssFully Supporting Families Successfully Understanding and building on the strengths of families requires health care professionals to com- bine well-honed clinical interview skills with a will- ingness to learn from families. Families demonstrate a wide range of beliefs and priorities in how they structure daily routines and rituals for their chil- dren and how they use health care resources. This edition of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents places special emphasis on 3 areas of vital impor- tance to caring for children and families. social determinants of Health From the moment of conception, individuals grow in physical and relational environments that evolve and influence each other over time and that shape their biological and behavioral systems for life. Dramatic advances in a wide range of bio- logical, behavioral, and social sciences have shown that each child’s future depends on genetic pre- dispositions (the biology) and early environmen- tal influences (the ecology), which affect later abilities to play, learn, work, and be physically, mentally, and emotionally healthy. Social determinants of health are social factors that affect children and families. Bright Futures’ emphasis on social determinants of health reflects the importance of a broad view of health promo- tion. Contemporary health supervision looks beyond the office encounter to assess and address the family’s risks and strengths and protective fac- tors, which emerge from the family’s and commu- nity’s circumstances and which affect health in both positive and negative ways. Although social factors are not new issues for health care profes- sionals who care for children, adolescents, and 4 suPPortiNG FAMiliEs suCCEssFully families, new science underpins their importance and provides evidence for effective interventions. Social determinants of health are one of the 5 Anticipatory Guidance priorities in every Infancy Visit and in most visits thereafter. Children and youth With special Health Care Needs Birth defects, inherited syndromes, developmental disabilities, and disorders acquired later in life, such as asthma, are relatively common—nearly 20% of the childhood population, or 14.6 million chil- dren, have special health care needs. In addition, a growing number of children are receiving diag- noses of developmental disabilities and conduct disorders, which may indicate special health care needs. Family-centered care that promotes strong partnerships and honest communication is especially important when caring for children and youth with special health care needs. At the same time, the effect of specialness or exten- sive health care needs should not overshadow the child. The child or youth with special health care needs shares most health supervision requirements with her peers. Bright Futures uses screening, ongoing assessment, health supervision, and anticipatory guidance as essential interventions to promote wellness and identify differences in development, physical health, and mental health for all children. Cultural Competence Cultures form around language, gender, disability, sexual orientation, religion, or socioeconomic status. Even people who have been fully acculturated within mainstream American society can maintain values, traditions, communication patterns, and child-rearing practices of their original culture. Immigrant families, in particular, face many cultural stressors. 5 suPPortiNG FAMiliEs suCCEssFully It is important for health care professionals who serve children and families from backgrounds other than their own to listen and observe care- fully, learn from the family, and work to build trust and respect. If possible, the presence of a staff member who is familiar with a family’s community and fluent in the family’s language is helpful during discussions with families.