Bright Future Introduction
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 special issues to be noted, universal and selective screening procedures, risk assessment, and immunizations.
- Anticipatory Guidance: Presents guidance for families 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 communication 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.
Bright Futures Health Promotion Themes
A number of themes are of key importance to families and health care professionals in their common mission to promote the health and well-being of children, from birth through adolescence. These themes are
- Promoting Lifelong Health for Families and Communities
- Promoting Family Support
- Promoting Health for Children and Youth With Special Health Care Needs
- Promoting Healthy Development
- Promoting Mental Health
- Promoting Healthy Weight
- Promoting Healthy Nutrition
- Promoting Physical Activity
- Promoting Oral Health
- Promoting Healthy Sexual Development and Sexuality
- Promoting the Healthy and Safe Use of Social Media
- Promoting Safety and Injury Prevention
The Bright Futures Guidelines provide an in-depth, state-of-the-art discussion of these themes, with evidence regarding effectiveness of health promotion interventions at specific developmental stages from birth to early adulthood. Health care professionals can use these comprehensive discussions to help families understand the context of their child’s health and support their child’s and family’s development.
Objectives of the bright Futures Visit
- Disease detection: surveillance and screening
Surveillance is a continuous process in which knowledgeable professionals skillfully observe children as they provide health care. It includes eliciting and attending to parental concerns, obtaining a relevant developmental history, making accurate and informative observations of children, and sharing opinions and concerns with other relevant professionals.
Screening is a formal process that employs a standardized tool to detect a particular disease state. Universal screening is performed on all patients at certain ages. Selective screening is performed on patients for whom a risk assessment suggests concern.
- Disease detection: The Physical Examination
Bright Futures recommends that each visit includes a complete physical examination, with particular focus on certain aspects at each visit. We believe that the complete physical examination comprises “best care” for children and adolescents
- Disease Prevention
Disease prevention includes primary prevention activities applied to a whole population and secondary prevention activities aimed at patients with specific risk factors. Where evidence exists, it has been incorporated into the guidance for that encounter.
- Health Promotion
Health promotion activities focus the health supervision visit on wellness. Health promotion activities shift the focus from disease to assets and strengths, on what the family does well and how health care professionals can help them do even better.
- Anticipatory Guidance
Anticipatory guidance is a process in which child health care professionals anticipate emerging issues that a child and family may face and provide guidance. For anticipatory guidance to be effective, it must be timely (ie, delivered at the right age), appropriate to the child and family in their community, and relevant, so key recommendations are adopted by the family. This is an opportunity to broach important safety topics, help the family address relationship issues, access community services, and engage with the extended family, school, neighborhood, and faith communities.
Components of the bright Futures Visit
Context
Each visit begins with a description of children at the age of the visit, their developmental milieu, their family development, and their environment. It is intended to help the health care professional focus on the unique qualities of a child this age.
Priorities for the Visit
For the visit to be successful, the needs and agenda of the family must be addressed. Thus, the first priority is to address the concerns of the child and parents. Each visit also has 5 additional priorities. The priorities help the health care professional focus the visit on the most important topics for a child this age.
Health supervision
History
A history is taken to assess strengths, accomplish surveillance, and enhance the health care professional’s understanding of the child and family and to guide their work together.
Surveillance of Development
Developmental surveillance occurs with each clinical encounter with the infant, child, and adolescent, and these observations are central to health supervision for children. Each Bright Futures Visit includes a rich discussion of developmental nuance for that age.
Review of Systems
A standard, brief review of systems is an effective method of ensuring that significant problems are addressed.
Observation of Parent-Child/Youth Interaction
Health supervision activities always involve observation of the parent-child/youth interaction. This assessment is context for the work of the visit.
Physical Examination
The physical examination must be comprehensive yet also focus on specific assessments that are appropriate to the child’s or adolescent’s age, developmental attainment, and needs, which are discerned from the patient history.
The health supervision examination should be unhurried, with adequate uninterrupted time set aside for questions and discussion by parents and the child. Beginning in middle childhood and by adolescence, policies related to privacy and confidentiality must be established and reviewed for the child and family. By the 7 or 8 Year Visit, it is appropriate to offer the option of part of the visit without the parent present. Most health care professionals will always excuse the parent from part of the visit by the 12 Year Visit.
Screening
Recommended screening occurs at each Bright Futures Visit. Screening tasks were chosen on the basis of available evidence or of expert opinion statements.
Immunizations
Assessing the completeness of a child’s or an adolescent’s immunizations is a key element of preventive health services. The value of immunizations in avoiding preventable diseases and disease complications is an important discussion for providers to have with parents. Often, parental anxiety and misinformation must be addressed. Bright Futures uses the Centers for Disease Control and Prevention National Immunization Program and the American Academy of Pediatrics Red Book for up-to-date immunization schedules.
Anticipatory Guidance
For each visit, anticipatory guidance is organized by the visit’s 5 priorities and their component elements. Within each priority, the anticipatory guidance begins with a brief contextual description for the health care professional. The sample questions and anticipatory guidance points provide a possible script for discussion and help frame a relevant conversation with the family and child. Health care professionals are encouraged to adjust and enhance the questions and guidance as appropriate for their patients and community.