Anticipatory Guidance: Making it Work for Your Patients and Your Practice

The current trend in primary care medicine is for physicians to move their practices toward a functional concept of a medical home. Within the construct of the medical home is the expectation that physicians will provide care that is "accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective to every child and adolescent."¹

Woven through those objectives, and arguably holding together the fabric of the medical home, are the threads of anticipatory guidance that pediatricians introduce throughout the 22 preventive care visits across a child's lifetime. Given that the provision of anticipatory guidance to parents and adolescents is a fundamental objective for pediatricians working within a system that is increasingly constrained by time and financing, we would benefit from having a better understanding of: what anticipatory guidance is, or should be; what evidence exists for the effectiveness of anticipatory guidance; and what anticipatory guidance parents actually want from their pediatricians.

Answering these questions, while acknowledging the constraints of time and money, will allow pediatricians to better define their priorities as they strive to build the optimal family-centered medical home for patients and their families.

Anticipatory Guidance Defined

Bright Futures, a national health promotion initiative, defines anticipatory guidance as "information that helps families prepare for expected physical and behavioral changes during their child's or teen's current and approaching stage of development."² A literal interpretation of this definition could lead a physician to limit anticipatory guidance merely to educating parents on "what to expect" now and in the upcoming developmental stage -- eg, "Your child will begin to babble, feed herself, walk, talk, learn his letters, learn to read, experience a linear growth spurt, develop axillary and pubic hair, learn to drive, desire dating relationships, go to college..."

However, the anticipatory guidance as outlined for each visit in the 3rd edition of Bright Futures³ is not focused simply on educating parents on "what to expect," but rather is focused heavily on "helping families prepare," which is a much more ambiguous and all-encompassing term. To that end, for anticipatory guidance to have meaning for a family, it must be timely, appropriate, and relevant.³

To help "families prepare," a physician may choose to educate a mother on when to introduce solid food to her infant...