Texas Health and Human Services / Texas Health Steps

Anticipatory Guidance:
How Should You Counsel these Patients?

Education and counseling provided during a medical checkup help the child and parent/guardian understand expected growth and development. Anticipatory guidance also serves to provide information about the benefits of healthy lifestyles and practices, as well as accident and disease prevention.

Texas Health and Human Services Commission (2023)

For at least a century, “physicians who take care of children have been answering parents' questions about basic aspects of child rearing. In contemporary times, providing preventive advice is called anticipatory guidance, and it is an integral part of well-child care,” according to an influential article from Archives of Pediatrics and Adolescent Medicine (2000).

Anticipatory guidance is a federally mandated component of each Texas Health Steps medical and dental preventive checkup. Anticipatory guidance topics depend on the patient’s age, exam results, provider’s clinical judgement, and questions or concerns expressed by the patient or parent. Topics range from newborn safe sleep to age-specific nutrition to prevention of sexually transmitted diseases.

“Pediatricians and other (primary health-care providers) are a trusted source of health information for parents (American Academy of Pediatrics [AAP], 2023). Anticipatory guidance offers a key opportunity for providers to target health messages and prevention tips to specific patients, while allowing patients and parents to ask questions and discuss concerns.

Quick Quiz

Test your knowledge of anticipatory guidance by selecting Yes or No to identify which of the following advice and discussion topics are recommended for parents and the young patients described below.

portrait of infant
Marina 4 months

Marina, age 4 months, whose parents are concerned because she has started waking more often during the night.

Marina may be teething. Encourage the parents to take time to soothe her once teething begins.

Recommend that the parents share a bed with Marina to promote better sleep for themselves and the baby.

Suggest that the parents put Marina in bed with a bottle to help her sleep.

portrait of boy
Hayes 12 years

Hayes, age 12 years, who received a skateboard for his birthday.

Encourage Hayes to take plenty of water the skateboard park for hydration and to avoid energy drinks and soda.

Now that Hayes is an adolescent, assure him and his parents he is old enough to skateboard without wearing a helmet.

Encourage Hayes to participate in physical activity such as skateboarding for one hour a day.

portrait of teen girl
Nova 16 years

Nova, age 16 years, has been dating a boy for almost a year and considers the relationship to be serious.

Delay discussion about pregnancy intention and contraception until Nova’s 17-year Texas Health Steps preventive medical checkup.

Discuss the family’s expectations about dating, sexual contact, abstinence, substance use and peer pressure.

Discuss with Nova self-safety in the event she experiences stalking, relationship abuse or bullying.

Note: Anticipatory guidance may be directed to parents only, to children and parents together, or to adolescents only, depending on the patient’s age, maturity and topic being discussed.

Providers’ Anticipatory Guidance Toolkit

The AAP and Texas Health Steps offer age-specific guides to help health-care providers offer the most beneficial guidance. Both guides offer lists of topics for each age-specific checkup, but providers are not expected to address all possible age-level topics during each preventive medical or dental checkup. Rather, providers can tailor guidance and health education based on patients’ individual needs.

Texas Health Steps offers the interactive Anticipatory Guidance Provider Guide. The guide states, “We encourage you to individualize and prioritize the topics according to checkup findings and questions or concerns raised by the child and parent or guardian.”

Topics in the Anticipatory Guidance Provider Guide are consistent with those included on the Texas Health Steps Clinical Record Forms, which are recommended but not required for use by Texas Health Steps providers.

The AAP, supported by the U.S. Department of Health and Human Services, offers the theory-based and evidence-driven Bright Futures Guidelines (4th edition). It has recommendations for pediatric health promotion, health supervision and anticipatory guidance for 31 age-based preventive health checkups.

Why it Matters

Parents, children and adolescents rely on primary care providers for information and education about how to stay healthy and safe as young people grow and develop. Texas Health Steps requires anticipatory guidance at each preventive medical and dental checkup for children and youth ages birth through 20 years. Time management is key to a successful medical or dental practice, so health-care providers are not expected to address every age-appropriate topic with every patient. However, providers “should be capable of addressing all recommended guidance topics, even if they tailor what they cover to each family's particular needs. Most parents have a broad range of child-rearing concerns, and many would like to discuss them with physicians” (Archives of Pediatrics and Adolescent Medicine).

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References

American Academy of Pediatrics. (2023). Clinical Report: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics, 51(2): e2022060640.

American Academy of Pediatrics. (2017). Bright Futures Guidelines (4th edition).

Schuster, M. A., Duan, N., Regalado, M., & Klein, D. J. (2000). Anticipatory Guidance: What Information Do Parents Receive? What Information Do They Want?Archives of Pediatrics and Adolescent Medicine, 154(12):1191–1198.

Texas Health Steps. (2023). Anticipatory Guidance Provider Guide.