by P GUIDE · 2008 — Bright Futures: Guidelines for Health Supervision of Infants, Children, and. Adolescents, Third Connected Kids aap/ConnectedKids/ClinicalGuide.pdf.
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BRIGHT FUTURES Guidelines for Health Supervision of Infants,Children,and Adolescents THIRD EDITION POCKET GUIDE Editors Joseph F. Hagan, Jr, MD, FAAP Judith S. Shaw, RN, MPH, EdD Paula M. Duncan, MD, FAAP FUNDED BY US Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau PUBLISHED BY The American Academy of Pediatrics
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CITE AS Hagan JF, Shaw JS, Duncan P, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,Third Edition. Pocket Guide. Elk Grove Village, IL: American Academy of Pediatrics. Copyright © 2008 by the American Academy of Pediatrics. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photo- copying, recording, or otherwise, without prior written permission from the publisher. Library of Congress Catalog Card Number: 2007929964 ISBN-13: 978-1-58110-224-6 ISBN-10: 1-58110-224-0 BF0027PUBLISHED BY American Academy of Pediatrics 141Northwest Point Blvd Elk Grove Village, IL 60007-1098 USA847-434-4000 AAP Web site: www.aap.org Bright Futures Web site: http://brightfutures.aap.org Additional copies of this publication are available from the American Academy of Pediatrics Online Bookstore at www.aap.org/bookstore. This publication has been pr oduced by the American Academy of Pediatrics under its cooperative agr eement(U06MC00002) with the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB).
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iiiTABLE OF CONTENTS Bright Futures at the American Academy of Pediatrics vHow to Use This Guide ..viiCore Concepts .ixBuilding Ef fective Partnerships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x Fostering Family-Centered Communication. . . . . . . . . . . . . . . . . . . xi Promoting Health and Preventing Illness. . . . . . . . . . . . . . . . . . . . . . xii Managing T ime for Health Promotion. . . . . . . . . . . . . . . . . . . . . . . xiii Educating Families Through Teachable Moments. . . . . . . . . . . . . . xiv Advocating for Children, Families, and Communities. . . . . . . . . . . xv Supporting Families Successfully .xviiChildren and Youth With Special Health Care Needs. . . . . . . . . . . xvii Cultural Competence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Complementary and Alter native Care. . . . . . . . . . . . . . . . . . . . . . xviii Bright Futures Themes ..xixBright Futures Health Supervision Visits ..1Acronyms Used in the Bright Futures Health Supervision Visits. . . . . 1 Prenatal V isit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NewbornVisit.4First Week Visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1Month Visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2Month V isit.104Month V isit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 6Month V isit.149Month V isit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 12 Month Visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 15 Month Visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 18 Month Visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2Year Visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 212Year Visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 3Year Visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 4Year Visit. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 5and 6 Year Visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 7and 8 Year Visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 9and 10 Year Visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Early Adolescence (11 to 14 Year Visits). . . . . . . . . . . . . . . . . . . . . 42 Middle Adolescence (15 to 17 Year Visits). . . . . . . . . . . . . . . . . . . . 46 Late Adolescence (18 to 21 Y ear V isits). . . . . . . . . . . . . . . . . . . . . . 50 Appendices..53Developmental Milestones at a Glance Ñ Infancy .54Developmental Milestones at a Glance Ñ Early Childhood 55Social and Emotional Development in Middle Childhood. . . . . . . . 56 Domains of Adolescent Development. . . . . . . . . . . . . . . . . . . . . . . 57 Recommended Medical Scr eening Ñ Infancy ..58Recommended Medical Screening Ñ Early Childhood. . . . . . . . . . 59 Recommended Medical Scr eening Ñ Middle Childhood ..60Recommended Medical Screening Ñ Adolescence. . . . . . . . . . . . 61 Tooth Eruption Chart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Sexual Maturity Ratings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Useful Web Sites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
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vBright Futures at the American Academy ofPediatrics Founded in 1930, the American Academy of Pediatrics (AAP) is an organization of 60,000 pedia- tricians who are committed to the attainment of 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 Mater nal and Child Health Bureau (MCHB) of the Health Resources and Services Administration (HRSA) to impr ove the quality of health services for childr en thr ough health pr omotion and disease prevention. In 2002, the MCHB selected the AAP to lead the Bright Futures initiative. With the encourage- ment and str ong support of the MCHB, the AAP and its many collaborating partners set out to update the BrightFutures Guidelines as a uniform set of r ecommendationsfor health care professionals. The Bright Futures Guidelinesare the cornerstone of the Bright Futures initia- tive and the foundation for the development of all Bright Futures materials. 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 Futur es!Enhance health care professionalsÕ knowledge, 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 between families, health car epro-fessionals, and communities. !Increase family knowledge, skills, and participation in health-promoting and prevention activities. !Address the needs of children and youth with special health car eneeds through enhanced identification and services.For mor einformation about Bright Futures and available materials and r esources, visit http:// brightfutures.aap.org.
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viiiAppendices:Includes developmental milestones at-a- glance charts for infancy and early childhood, a chart on social and emotional development in middle childhood, achart on domains of adolescent development, recommended medical screening tables, a tooth eruption chart, a sexual maturity ratings chart, and a list of useful Web sites.
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ixCore Concepts IntodayÕs complex and changing health care system, health care professionals can improve the way they carry out each visit by using an innovative health promotion curriculum developed specifically to help professionals integrate Bright Futures principles into clinical practice. This unique curriculum, developed by a health promo- tion work group supported by the Maternal and Child Health Bureau, includes 6 core concepts: !Partnership!Communication!Health promotion/illness prevention !Time management !Education!AdvocacyAsummary of each of these cor econcepts is pr esent-ed on the following pages to help all professionals, both those in training and experienced practitioners, bring Bright Futur es alive and make it happen for children and families. For more information about this unique health promotion curriculum, visit www.pediatricsinpractice.org. All 6 core concepts rely on the health care profession- alsÕ skills in using open-ended questions to communicate effectively, partner with and educate children and their families, and serve as their advocates to promote health and prevent illness in a time-efficient manner. Open-ended questions !Help to start a conversation !Ask: ÒWhy?Ó ÒHow?Ó ÒWhat?Ó !Are interpretive !Have a wide range of possible answers !Stimulate thinking !Promote pr oblem solving EXAMPLES:¥How do you and your partner manage the babyÕ sbehavior?What do you do when you disagree? ¥(Toachild) Tell me about your favorite activities at school. Techniques !Begin with affirming questions. EXAMPLE:¥ÒWhat are some games youÕre really good at?Ó !Wait at least 3 seconds to allow the family to respond to the question. !Ask questions in a supportive way to encourage communication.
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xBuilding Effective Partnerships Aclinical partnership is a relationship in which participants join together to ensure health care delivery in a way that recognizes the critical roles and contributions of each part- ner (child, family, health care professional, and communi- ty) in promoting health and preventing illness. Following are 6 steps for building effective health partnerships: 1. Model and encourage open, supporting commu- nication with child and family. !Integrate family-centered communication strategies. !Use communication skills to build trust, respect, and empathy. 2. Identify health issues through active listening and Òfact finding.Ó !Selectively choose Bright Futur es Anticipatory Guidance questions.!Ask open-ended questions to encourage more com- plete sharing of information. !Communicate understanding of the issues and pr ovidefeedback.3. Affirm strengths of child and family. !Recognize what each person brings to the partnership. !Acknowledge and r espect each personÕ scontributions.!Commend family for specific health and developmental achievements.4. Identify shared goals. !Promote view of health supervision as partnership between child, family, health care professional, and community. !Summarize mutual goals. !Provide links between stated goals, health issues, and available resources in community. 5. Develop joint plan of action based on stated goals.!Be sure that each partner has a role in developing the plan.!Keep plan simple and achievable. !Set measurable goals and specific timeline. !Use family-friendly negotiation skills to ensure agreement. !Build in mechanism and time for follow-up. 6. Follow up to sustain the partnership. !Share progress, successes, and challenges. !Evaluate and adjust plan. !Provide ongoing support and r esources.
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xiFostering Family-Centered Communication Effective Behaviors !Greet each family member and introduce self. !Use names of family members. !Incorporate social talk in the beginning of the interview. !Show interest and attention. !Demonstrate empathy. !Appear patient and unhurried. !Acknowledge concerns, fears, and feelings of child and family. !Use ordinary language, not medical jargon. !Use Bright Futur es Anticipatory Guidance questions. !Give information clearly. !Query level of understanding and allow sufficient time for r esponse.!Encourage additional questions. !Discuss family life, community ,and school. Active Listening Skills: Verbal Behaviors !Allow child and par ents to state concer ns without interruption.!Encourage questions and answer them completely .!Clarify statements with follow-up questions. !Ask about feelings. !Acknowledge stress or difficulties. !Allow sufficient time for a response (wait time >3 seconds). !Offer supportive comments. !Restate in the parentÕs or childÕs words. !Offer information or explanations. Active Listening Skills: Nonverbal Behaviors !Nod in agreement. !Sit down at the level of the child and make eye contact. !Interact with or play with the child. !Show expression, attention, concern, or interest. !Convey understanding and empathy. !Touch child or parent (if appropriate). !Draw pictur es to clarify. !Demonstrate techniques.
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