New Tools Make Using Bright Futures Guidelines Easier

What’s Inside
Letter From the Bright
Futures Steering
Committee Chairperson
Page 2
Bright Futures in Wisconsin:
County’s Success Expands
to State Level
Page 3
Coming Soon! The Bright
Futures Family Pocket Guide
Page 4
Announcements
Page 6
Bright Futures Virginia
Page 10
Guidelines, References,
and Tools
Page 11
In the Works
Page 12
Bright Ideas The Bright Futures Newsletter
TM
New Tools Make Using Bright
Futures Guidelines Easier
R
eleased in 2008, the Bright Futures: Guidelines for Health Supervision
of Infants, Children and Adolescents, Third Edition, provides detailed
information on well-child care for health care practitioners. This text is
considered the gold standard for pediatric care, and its accompanying
Pocket Guide boils down the information to its most basic points for quick reference.
Now, the package is complete with the release of the Bright Futures Tool and
Resource Kit, a new resource designed to help pediatricians and other health care
practitioners put the Guidelines into practice. The Kit and the Guidelines fit together
beautifully: the Guidelines provides the background knowledge that makes it
possible to use the Tool and Resource Kit effectively, and the Kit is a resource that
helps providers carry out the Guidelines efficiently, thoroughly, and intuitively.
The Kit, which is being released on CD, provides questionnaires, forms, handouts,
and other tools for each of the Bright Futures well-child visits, from prenatal to age
21. Providers can use or adapt these materials to meet the needs of their practices
and ensure they cover all the bases when delivering care to their pati ents.
The Tool and Resource Kit includes 3 groups of core tools:
1. Pre-visit Questionnaires, which parents (or adolescent patients) fill out
before seeing the caregiver. This form asks about Bright Futures priority topics
appropriate for the particular age-based visit, and allows the patient or parent to
note any special concerns. Having the patient or parent fill out the form before
the visit means that practitioners have more quality and personal time to spend
with patients — time that would otherwise have been spent asking the questions
on the form.
2. Documentation Forms, which give the practitioner guidance on which
questions to ask and issues to address, based on the age of the child and the
visit’s Bright Futures priorities. These simple, 1-page forms are more than just
typical encounter forms. They help practitioners make sure to touch on the right
topics for the visit. If used consistently over a patient’s entire pediatric lifetime
(up to 21 years), they ensure that the child has received all of the Bright Futures
recommended screenings and that no aspect of care has fallen through the cracks.
3. Parent Handouts, which cover the anticipatory guidance priorities discussed
in each visit. At least 5 parent-friendly handouts have been developed for each
age-based visit, and the information has been drawn from thoroughly tested and
researched materials developed by experts in each topic. The Handouts cover the
anticipatory guidance topics from the Guidelines, as well as a wide range of other
issues relevant to the needs of all children.
Continued on Page 8
Volume 6 / Issue 1 / 2009

The American Academy of Pediatrics (AAP) offers Bright
Ideas, the Bright Futures newsletter, to health professionals,
public and private partners with key health constituencies,
and communities and families interested in promoting and
improving the health, education, and well-being of infants,
children, and adolescents. The newsletter is intended as a
forum for sharing information about Bright Futures and health
promotion and preventive service strategies. Bright Ideas is
funded through cooperative agreement (#U04 MC 07853)
from the US Department of Health and Human Services,
Health Resources and Services Administration, Maternal and
Child Health Bureau, to the AAP.
Bright Futures Steering Committee
Paula M. Duncan, MD, FAAP, Chairperson, Bright Futures:
Steering Committee
Betsy Anderson, Federation for Children with Special Needs,
Family Voices
Mary Margaret Gottesman, PhD, RN, CPNP, National
Association of Pediatric Nurse Practitioners
Joseph F. Hagan, Jr, MD, FAAP
Judith S. Shaw, EdD, MPH, RN, American Pediatrics Association,
Mary Story, PhD, RD, American Dietetic Association
Jack Swanson, MD, FAAP
Eric M. Wall, MD, MPH, American Academy of
Family Physicians
Federal Liaison
Christopher DeGraw, MD, MPH, FAAP, Maternal and Child
Health Bureau, Health Resources and Services Administration
AAP Staff
V. Fan Tait, MD, FAAP, Principal Investigator,
Bright Futures Education Center and Pediatric
Implementation Project
Edward Zimmerman, MS, Coprincipal Investigator,
Bright Futures Education Center
Darcy Steinberg-Hastings, MPH, Director and Coprincipal
Investigator, Bright Futures Education Center and Pediatric
Implementation Project
Jane Bassewitz, MA, Manager, Bright Futures, Education Center
Amy Pirretti, MS, Manager, Bright Futures Materials
Development and Promotion
Maryjo Reynolds, Product Manager, Bright Futures
Sandy Szott, Program Assistant, Bright Futures Education
Center
Effie Tonkovic, Program Assistant, Bright Futures Education
Center
Copyright © 2009 American Academy of Pediatrics
Any part of this newsletter may be reproduced for
noncommercial educational purposes.
The recommendations contained in this newsletter and in
the mentioned publications do not indicate an exclusive
course of treatment or serve as a standard of medical care.
Variations, taking into account individual circumstances, may
be appropriate. This newsletter discusses titles published by
organizations other than the American Academy of Pediatrics.
Statements and opinions expressed in these publications
are those of the authors and not necessarily those of the
American Academy of Pediatrics.
Letter from the Bright Futures Steering
Committee Chairperson
W
e are delighted to bring you this update on our activities since the
last newsletter.
Most importantly, we have completed another piece in the Bright Futures family of
materials. First came the Guidelines themselves and its accompanying Bright Futures
Family Pocket Guide. Now, I’m pleased to announce the release of the Bright Futures Tool
and Resource Kit. This Kit provides essential materials that will help practitioners carry
out the Guidelines efficiently and effectively. The Kit contains pre-visit questionnaires,
documentation forms, patient/parent handouts, practice management tools, and screening
and assessment tools. Read all about the Kit in the feature article on page 1. We couldn’t
have put this valuable resource together without the help and expertise of the many child
health professionals who developed and reviewed all the materials. My sincere gratitude
and thanks go to all of you.
Several states and communities are putting Bright Futures into practice in innovative ways,
and this issue of the newsletter highlights these activities in Virginia and Dodge County,
Wisconsin. Also featured in this issue is a story about the Bright Futures Family Pocket
Guide, developed by Family Voices as a way to translate highlights of the Bright Futures
Guidelines into a “family-friendly” resource for parents and other caregivers. Several other
exciting new publications are also described in this newsletter, including Building Your
Medical Home Toolkit, Tools for Working with Practices to Improve Preventive Care Using
Bright Futures, Bright Futures in Practice: Nutrition, and Coding for Pediatric Preventive
Care 2010.
I’m also happy to announce that the Bright Futures Activity Book has won a silver National
Health Information Award from the Health Information Resource Center. Congratulations to
those who developed this wonderful resource for parents and children!
Young investigators are being encouraged to conduct research on the effectiveness of health
supervision in primary care through the Academic Pediatric Association Bright Futures
Young Investigators Awards Program. Details of the program are described on page 7, and
the deadline for applications is October 25, 2009.
Looking to the future, our work will continue to promote Bright Futures activities at the
national, state, and local levels through workshops, presentations, and joint projects. We are
developing a quality improvement project addressing oral health risk assessment in primary
care practice. A second quality improvement project, the Bright Futures EQIPP module,
will allow clinicians and their medical home teams to measurably improve their delivery of
preventive services. We’ll provide more details as these projects unfold.
We also want to know how you use the Guidelines and the new Bright Futures Tool and
Resource Kit. Do these Guidelines, tools, and resources make your work easier? Have
you come up with a creative way to promote the Bright Futures messages? Have you
incorporated the Guidelines and tools into your workplace? Submit your stories at the
Bright Futures Web site, brightfutures.aap.org, or via e-mail at brightfutures@aap.org. We
will feature some of the stories in future publications and possibly on our Web site so others
can benefit from your experiences.
With warmest regards,
Paula M. Duncan, MD, FAAP
Chairperson, Bright Futures Steering Committee

Bright Futures in Wisconsin: County’s Success
Expands to State Level
I
n the past year, public health
professionals in Dodge County,
Wisconsin have worked closely with
the American Academy of Pediatrics
(AAP) to implement Bright Futures in their local
county health system. This effort was set into motion
by Gretchen Klug, RN, a public health nurse in
Dodge County who was looking for an innovative
way to organize and promote maternal–child health
programs in her county, as well as provide a consistent
framework for prevention activities that could be
easily communicated to other health care practitioners.
Ms. Klug was looking for a strong, credible standard
of care that local public health nurses could use to
support the preventive care available to children and
families in their county. She was impressed by both
the approach of Bright Futures and the materials
available, and contacted the AAP for guidance in
implementing Bright Futures in Dodge County.
“This is what public health already does. Bright
Futures provides us a framework, puts it into the
context of what is important, and validates what public
health departments have been doing for a long time”
Ms. Klug said.
Bright Futures staff began working with Ms. Klug
and Southern Regional office staff for the Wisconsin
Department of Health Services, to develop a regional
Bright Futures training, which was conducted in June
2008. More recently, a full-day Bright Futures training
was presented at a statewide public health nursing preconference
in Wisconsin.
These trainings provided participants with an
overview of the Bright Futures approach to preventive
health care. Participants came out of the training with
an understanding that effective health promotion and
disease prevention require the coordinated efforts
of both medical and non-medical professionals and
agencies. And they saw the special role that public
health nurses have in providing this coordinated
preventive care.
Although Bright Futures only has been in place in
Dodge County for little more than a year, positive
outcomes already have been observed from its
implementation, including:
Participants have embraced the Bright Futures
approach to preventive care
Bright Futures health promotion themes are evident
in their daily work with families
Physicians and other health care practitioners are
more aware of the services that the county’s public
health nurses can and do provide
Although any new program faces hurdles, Ms. Klug
said that Bright Futures has been very well received
in Dodge County. “The AAP gives us credibility and
reliability. We have been focusing on the 10 health
promotion themes in Bright Futures for a long time
and now the AAP has tied it all together for us.”
Bright Futures now has been implemented in Dodge
County because Ms. Klug took the initiative to seek
out tools that support public health programs that
focus on preventive care in her county. And now the
Bright Futures effort has grown beyond the local level
championed at the Wisconsin Department of Health
Services by Murray Katcher, MD, the state’s Chief
Medical Officer for Community Health Promotion and
Ann Stueck, a public health nursing consultant.
The next step in Wisconsin is a series of live Webcasts
jointly sponsored by the AAP and the state Department
of Health Services, Division of Public Health, Family
Health Section. These Webcasts will focus on the
needs of public health nurses and each will feature a
specific Bright Futures theme. Currently the following
dates and topics have been scheduled:
January 21, 2010 — Bright Futures on Promoting
Oral Health
March 11, 2010 — Bright Futures on Promoting
Healthy Weight
May 27, 2010 — Bright Futures on Promoting
Healthy Nutrition
Additional information on these Web casts will
be available at http://dhs.wisconsin.gov/phnc/
LinksToWebcasts/index.htm. ■
Volume 6 / Issue 1 / 2009 brightfutures.aap.org
3

Coming Soon!
The Bright Futures Family Pocket Guide
I
n the same way that Bright Futures:
Guidelines for Health Supervision of
Infants, Children, and Adolescents, Third
Edition informs pediatricians and other
child health care practitioners about the range of
health issues children face, the Bright Futures Family
Pocket Guide will do the same for parents and other
caregivers.
Families want and need much of the same information
used by their health care practitioners, but the
Guidelines — largely developed for health
professionals — may prove too detailed for many.
The Family Pocket Guide, developed by Family
Voices, seeks to solve that problem by translating
the highlights of the guidelines into “family-friendly”
language, and organizing the information in such a
way that families and other care givers can easily refer
to it later, as they need it. The Family Pocket Guide is
being updated to complement the latest edition of the
Bright Futures guidelines, which were released
in 2008.
Not only will the updated Family Pocket Guide
give families access to the wealth of Bright Futures
information, but it also encourages and fosters
the relationship between family and health care
practitioner by allowing them to share a common
language. For example, the Family Pocket Guide is
organized by the 4 Bright Futures age groups or stages
of development (infancy, early childhood, middle
childhood and adolescence) and provides a framework
for families to plan their health supervision visits,
from an initial pre-birth visit through late adolescence
(0 to 21 years).
The Appendix contains helpful checklists on a wide
range of child development topics, information about
screening tests, and useful resources for families about
topics such as organizations and resources for children
with special needs.
“We want families to be good partners at the [health
supervision] visits,” said Betsy Anderson, Director,
Family Voices IMPACT. “Families carry out well
child care for their children every day. What we put on
the table, whether we encourage our children to brush
their teeth, all of these relate to Bright Futures and
health promotion.”
Ms. Anderson explained that there are 2 angles to the
updated Family Pocket Guide. The first is to provide
answers to families’ common questions and concerns
by covering such topics as:
How to choose and work with a health care
practitioner
How a child grows from birth to age 21
What will happen at each health care visit and
what the family will need
What to expect when a child gets older
Resources for more information on important
topics, including diversity issues and special needs
Bright Futures for Families is a
national initiative of Family Voices
through which families and communities
promote and improve the
health and well-being of children of
all ages.
The organization offers resources for
families based on the award-winning,
federally supported Bright Futures
initiative, developed through the
support of public health, non-profit,
and corporate organizations.
Visit Bright Futures for Families online
at www.brightfuturesforfamilies.
org.
The second is to present the information based on
child developmental stages Ms. Anderson explained.
Because children don’t develop at the same rate or
do everything at a set age, the Family Pocket Guide
is designed to alleviate parents’ anxiety and focus on
age, while alerting them to potential developmental
delays that they may not recognize, such as delayed
walking or lack of eye contact.
The organization is aiming for release of the Family
Pocket Guide in the fall of 2009, with a version in
Spanish to follow.
Family Voices is also updating its “Bright Futures for
Families Theme Sheets,” which families can download
for free from www.brightfuturesforfamilies.org. Like
the Family Pocket Guide, these information sheets are
4 Bright Ideas The Bright Futures Newsletter

written and organized for easy reference for families.
They cover a range of health-promotion topics,
including healthy food and eating, and oral and dental
health. For example, the dental health sheet addresses:
The appearance of new teeth
Jaw and tooth position
Keeping teeth healthy
Correcting problems quickly
The Theme Sheets provide basic, helpful health
information for families, as well as resources for
more information, health promotion tips, and a
section called “Ages and Stages,” which explains the
developmental stage that children should achieve in
each general Bright Futures age group: infancy, early
childhood, middle childhood and adolescence. The
Bright Futures for Families Theme Sheets will also be
released in Spanish.
Also available is Bright Futures Family Matters, a
free, electronic newsletter for families. Bright Futures
Family Matters is published 5 to 6 times a year. The
current issue is on Promoting Healthy Sexuality.
To be placed on a list to receive information about the
release of the Family Pocket Guide, contact via e-mail
at Amartinez@familyvoices.org. ■
Family Voices, a non-profit organization,
became a partner in the Bright
Futures program in 1994. Family
Voices’ Bright Futures activities
address the health and well-being of
all children, including children with
special health care needs.
With a grant from the US Department
of Health and Human Services,
Family Voices works to ensure that
families are seen as essential partners
in their children’s health and
well-being. In addition, Family Voices
works on Bright Futures activities
with the American Academy of Pediatrics
and many other organizations.
With the Bright Futures for Families
initiative, Family Voices develops
materials for families to provide
them with the same information
used by health care practitioners,
written in easy-to-understand
language and organized for easy
reference.
Visit Family Voices online at
www.familyvoices.org
Volume 6 / Issue 1 / 2009 brightfutures.aap.org
5

Announcements
Building Your Medical Home
Toolkit — Available Now!
http://www.pediatricmedhome.org
B
rought to you by the American
Academy of Pediatrics (AAP)/ Maternal
and Child Health Bureau (MCHB)
/National Center for Medical Home
Implementation, the Building Your Medical Home
toolkit is a new (and free!) resource that supports
the primary care pediatrician’s improvement of a
pediatric medical home. It also prepares a pediatric
office to apply for and potentially meet the National
Committee for Quality Assurance (NCQA)
Physician Practice Connections Patient Centered
Medical Home (PPC-PCMH) Recognition program
requirements. This toolkit can help a practice
assess and improve its medical home capacity with
resources and downloadable tools organized into 6
“building blocks”/sections that provide guidance for
implementation:
• Care Partnership Support addresses family access
and communication
• Clinical Care Organization addresses standards
for practice organization and use of clinical
information
• Care Delivery Management addresses the
promotion of clinical care that is consistent with
scientific evidence, as well as patient and family
preference
• Resources and Linkages addresses successfully
linking patient and families with community
resources to help meet their needs
• Practice Performance Measurement addresses the
organization and promotion of safe and high-quality
care
• Payment and Finance addresses the need to match
quality care and NCQA recognition with payment
and value
The Toolkit’s “Resources and Linkages” section
highlights the importance of successfully linking
patient and families with community resources to
help meet their needs. Within this section, there
is a reference and link to the Bright Futures:
Promoting Community Relationships and
NATIONAL CENTER FOR
MEDICAL HOME
I M P L E M E N T A T I O N
A cooperative agreement between the Maternal and Child
Health Bureau/HRSA and the American Academy of Pediatrics
Resources Information Sheet. This resource and
others in the Toolkit provide useful information
about developing and promoting positive community
relationships, which is critical in implementing
medical home for all children and youth.
The National Center for Medical Home Implementation
is a cooperative agreement between the MCHB/Health
Resources and Services Administration and the AAP.
The National Center works to ensure that all children
and youth, including those with special health care
needs, have the services and support necessary for full
community inclusion through medical homes.
For more information, please visit
http://www.pediatricmedhome.org or contact
Angela Tobin, Manager of Technical Assistance,
at atobin@aap.org. ■
Coding for Pediatric
Preventive Care 2010
T
he Coding for Pediatric Preventive Care
has been newly updated to reflect all the
2010 changes in both the ICD-9-CM and
CPT codes. This coding resource contains
comprehensive listings of all the current CPT and
ICD-9-CM codes that are commonly reported by
pediatric health care practitioners in providing preventive
care services. This convenient tool is spiral bound and
organized for easy access and accurate reference.
To download your copy of this important resource, go
to the Bright Futures Web site at brightfutures.aap.org
and click on the Clinical Practice tab. ■
6 Bright Ideas The Bright Futures Newsletter

Young Investigator Grants
Deadline October 25
T
he Academic Pediatric Association
(APA) Bright Futures Young Investigator
Awards Program, supported by the
Maternal and Child Health Bureau in
partnership with the American Academy of Pediatrics,
will provide funding for as many as 6 small grants
(up to $15,000 each) to young investigators for
research on the effectiveness of health supervision in
primary care, using materials from the Bright Futures
Guidelines, Third Edition, and the Bright Futures Tool
and Resource Kit.
The final deadline for receipt of proposals is October
25, 2009. Work on funded projects will begin in
March 2010 and should be completed within 1 year.
The goal of this funding is to encourage young
investigators to conduct scholarly research to close
the gap between practice and science while supporting
evidence-based primary care.
This will be the second cycle of funds available for
this program. Grants were awarded in the previous
cycle for projects on obesity prevention in preschool
children, safety issues in a pediatric clinic, and
nutritional guidance for low-income Spanish-speaking
parents.
For further information please visit the APA Web site
at www.ambpeds.org. ■
Bright Futures Activity
Book Wins National Health
Information Award!
B
right Futures is proud to announce
that the Bright Futures Activity Book
won a silver National Health Information
Award from the Health Information
Resource Center. Designed to encourage parentchild
interaction, the Activity Book provides a fun,
informative, and interactive overview of the
10 themes from the third edition of the Bright
Futures Guidelines.
For 16 years, the Health Information
Resource Center has given its National
Health Information Awards — the most
comprehensive of its kind — to recognize the
best consumer health information materials
and programs from organizations throughout
the nation. A panel of health information experts from
across the country judged entries based on content,
format, success in reaching the targeted audience, and
overall quality.
The Activity Book won the award as a book,
booklet, or pamphlet produced by an association
or professional society in the category of health
promotion/disease and injury prevention information.
For more information about the Bright Futures
Activity Book, please visit the Bright Futures Web site
at: brightfutures.aap.org. ■
Volume 6 / Issue 1 / 2009 brightfutures.aap.org
7

New Tools Make Using Bright Futures Guidelines Easier (continued)
Continued from Page 1
The Tool and Resource Kit also features additional
materials to enhance providers’ ability to conduct
a Bright Futures visit. They include parent/patient
education handouts on a range of issues relevant to the
needs of all infants, children, and adolescents; practice
management tools for preventive care; and developmental,
behavioral, and psychosocial screening and
assessment tools.
Practitioners who participated in the development
and review process are keen on the advantages of
incorporating the Tool and Resource Kit into a busy
practice. Dr. Charles Barone of Henry Ford Health
System in Detroit notes that the Documentation Forms
in the Kit “keep you from asking the same questions
in every visit.” Dr. Jack Swanson, a pediatrician
in private practice in Ames, Iowa, says that the Kit
provides tools that “help the visit flow well.” He is
eager to use the Kit because it will help him put the
Bright Futures Guidelines into practice. “I’m looking
forward to being able to improve well-child visits and
interact with parents,” he says.
The idea for the Tool and Resource Kit arose because
surveys showed that care providers embrace the
Bright Futures approach and wanted tools that would
help them implement its detailed guidance within the
constraints of a 15-minute office visit. Paula Duncan,
one of the 3 editors of the Bright Futures Guidelines,
Third Edition, and a leader in developing the Tool
and Resource Kit, noted that this was a real challenge
facing the project team, but she articulated their
determination to get it right: “Let’s see if it’s doable in
everyday well-child care.”
“It’s been an interdisciplinary labor of love for the
well-being of all children,” says Mary Margaret
Gottesman, pediatric nurse practitioner, and an
associate professor and Specialty Program director in
the Pediatric Nurse Practitioner Program at The Ohio
State University College of Nursing. Dr. Gottesman
helped develop and review some of the materials in
the Kit. “It’s so user-friendly, attractive, and accurate,”
she says. “The forms provide a convenient system
of tracking patients and providing thorough care. We
know we’re covering everything we need to cover.
Efficiently.”
Dr. Gottesman added that she can give parents the
handouts and talk to them, knowing the messages will
be consistent. There won’t be any conflict between
what she says and the information in the handouts.
Noting the “countless hours” spent on researching,
developing and reviewing the materials, she says
she can give parents the handouts confident that the
information is accurate and reliable.
The Documentation Forms provide another
benefit that has proven elusive for care providers:
standardized care. All health care practitioners who
use Kit materials will be providing the same care
to their patients, regardless of location, social and
economic circumstances, patient load, and other
matters that result in health and health care disparities
in the US.
“It’s really important that we all approach wellchild
care in the same way,” Dr. Barone says. “The
Documentation Forms are complete and have all the
elements needed if these visits are audited by health
plans for HEDIS [Healthcare Effectiveness Data and
Information Set, a quality-of-care measurement used
by 90% of America’s health plans] or level of service.”
Registered nurse and educator Judith Shaw also was
instrumental in developing and reviewing the Tool
and Resource Kit. Dr. Shaw, executive director of the
Vermont Child Health Improvement Program and an
editor of the Bright Futures Guidelines, explains that
introducing these new tools into practice won’t happen
automatically. The Kit forms and other materials are
state-of-the-art, but the people who are going to use
them need time to become familiar with them before
they become routine.
Having a “champion” on staff who encourages
everyone to use the Kit is often a key to successful
implementation. Dr. Shaw suggests practices first
train their staffs in using the materials, and then
introduce them for a few patients on the first day, and
a few more on the next day, and so on, until everyone
becomes comfortable using them for every patient.
Some practices may choose to use only some of the
materials in the Kit, such as the Parent Handouts.
“We’re not trying to make the Bright Futures Tool
and Resource Kit prescriptive for everybody. We are
making it flexible for everybody to use, whatever their
population,” she said.
Dr. Joseph Hagan, a pediatrician and editor of the
Guidelines, who reviewed the Kit materials, puts it
simply: “Pediatricians feel passionately about care and
doing it efficiently. This will help them do it.” ■
8 Bright Ideas The Bright Futures Newsletter

Sample Forms and Handout
for the 18 Month Visit
The Bright Futures Tool and Resource Kit
is being released in October 2009. Place
an online order for your Kit at aap.org/
bookstore.
18 Month Previsit Questionnaire
• For parent to fill out before seeing the practitioner
• Helps practitioner attend to parent’s concerns
• Initiates medical screening by integrating risk-assessment questions
• Obtain developmental surveillance information from parents
ACCOMPANIED BY/INFORMANT PREFERRED LANGUAGE DATE/TIME
DRUG ALLERGIES CURRENT MEDICATIONS
WEIGHT (%) LENGTH (%) WEIGHT FOR LENGTH (%) HEAD CIRC (%)
See growth chart.
History
Previsit Questionnaire reviewed Child has special health care needs
Child has a dental home
Concerns and questions None Addressed (see other side)
Follow-up on previous concerns None Addressed (see other side)
Interval history None Addressed (see other side)
Medication Record reviewed and updated
Social/Family History
See Initial History Questionnaire. No interval change
Family situation
Parents working outside home: Mother Father
Child care: Yes No Type
Changes since last visit
HE0490
Review of Systems
See Initial History Questionnaire and Problem List.
No interval change
Changes since last visit
Nutrition: Breast Bottle Cup
Milk Ounces per day
Solid foods
Juice
Source of water Vitamins/Fluoride
Elimination: NL
Sleep: NL
Behavior: NL
Activity (playtime, no TV): NL
Development
SAMPLE
Structured developmental screen NL Tool
Autism-specific screen NL Tool
Name
ID NUMBER
Developmental Surveillance (if not reviewed in Previsit Questionnaire)
SOCIAL-EMOTIONAL COMMUNICATIVE PHYSICAL DEVELOPMENT
w Helps in the house w Speaks 6 words w Stacks 2 small blocks
w Laughs in response COGNITIVE w Runs
w Points to 1 body part w Uses spoon and cup without
to others w Knows name of favorite book w Walks up steps
spilling most of the time
TEMPERATURE BIRTH DATE AGE
Physical Examination
= NL
Bright Futures Priority Additional Systems
EYES (red reflex, GENERAL APPEARANCE HEART
cover/uncover test) HEAD/FONTANELLE Femoral pulses
SKIN (nevi, café au lait, bruising) EARS/APPEARS TO HEAR ABDOMEN
NEUROLOGIC (gait, NOSE GENITALIA
coordination) LUNGS Male/Testes down
TEETH (caries, white spots, MOUTH AND THROAT Female
staining) EXTREMITIES/HIPS
BACK
Abnormal findings and comments
Assessment
Well child
Anticipatory Guidance
Discussed and/or handout given
FAMILY SUPPORT LANGUAGE SAFETY
w Family time PROMOTION/HEARING w Car safety seat
w Time for self and other children w Read, talk, and sing w Falls
w Reinforce limits w Simple words w Burns
w Prepare for new sibling w Feelings and emotions w Smoke detectors
w Smoke-free environment READINESS w Poisons
(if necessary) TOILET TRAINING w Guns
CHILD DEVELOPMENT w Wait until child is ready
AND BEHAVIOR w Reading books/praise
w Anticipate anxiety
w Praise
w Consistent discipline
w Daily playtime
18 Month Parent Handout
• Parent handout keyed to the 5 priorities for this age visit
• Covers anticipatory guidance looking ahead to next visit
• Each is written with plain language approach in mind
Plan
Immunizations (See Vaccine Administration Record.)
Laboratory/Screening results
Referral to
Follow-up/Next visit
See other side
PROVIDER 1
PROVIDER 2
Print Name Signature
well child/18 months
Volume 6 / Issue 1 / 2009 brightfutures.aap.org
M F
18 Month Documentation Form
• Concise documentation of all major components of a Bright Futures visit
• Convenient resource for documenting activities within the typical health
supervision visit for this age visit
• Simplifies proper coding and helps practitioner secure appropriate
payment for each visit’s activities
Safety
Talking and Hearing
• Read the instructions about your car safety • Have the parent of the same sex as your
• Read and sing to your child often.
seat to check on the weight and height child or an older brother or sister take your
requirements.
child to the bathroom.
• Talk about and describe pictures in books.
• Everyone should always wear a seat belt in • Praise sitting on the potty or toilet even with
• Use simple words with your child.
the car.
clothes on.
• Tell your child the words for her feelings.
• Lock away poisons, medications, and lawn • Take your child to choose underwear when
• Ask your child simple questions, confirm her and cleaning supplies.
he feels ready to do so.
answers, and explain simply.
• Call Poison Help (1-800-222-1222) if you
• Use simple, clear words to tell your child are worried your child has eaten something
what you want her to do.
harmful.
• Set limits that are important to you and ask
others to use them with your toddler.
• Place gates at the top and bottom of stairs
and guards on windows on the second floor • Be consistent with your toddler.
• Create time for your family to be together.
and higher.
• Praise your child for behaving well.
• Keep outings with a toddler brief—1 hour or
• Move furniture away from windows.
• Play with your child each day by doing things
less.
• Watch your child closely when she is on she likes.
• Do not expect a toddler to share.
the stairs.
• Keep time-outs brief. Tell your child in simple
• Give older children a safe place for toys they
• When backing out of the garage or driving words what she did wrong.
do not want to share.
in the driveway, have another adult hold • Tell your child what to do in a nice way.
• Teach your child not to hit, bite, or hurt other
your child a safe distance away so he is not • Change your child’s focus to another toy or
people or pets.
run over.
activity if she becomes upset.
• Your child may go from trying to be
• Never have a gun in the home. If you must • Parenting class can help you understand
independent to clinging; this is normal.
have a gun, store it unloaded and locked your child’s behavior and teach you what
• Consider enrolling in a parent-toddler
with the ammunition locked separately from to do.
playgroup.
the gun.
• Expect your child to cling to you in new
• Ask us for help in finding programs to help • Prevent burns by keeping hot liquids,
situations.
your family.
matches, lighters, and the stove away from
• Prepare for your new baby by reading books your child.
about being a big brother or sister.
• Have a working smoke detector on every floor.
• Spend time with each child.
• Make sure you are also taking care of
yourself.
• Signs of being ready for toilet training include • Your talking child
• Tell your child when he is doing a good job. • Dry for 2 hours
• Your child and TV
• Give your toddler many chances to try a new • Knows if he is wet or dry
• Car and outside safety
food. Allow mouthing and touching to learn • Can pull pants down and up
• Toilet training
about them.
• Wants to learn
• How your child behaves
• Tell us if you need help with getting enough • Can tell you if he is going to have a bowel
food for your family.
movement
Poison Help: 1-800-222-1222
• Read books about toilet training with your child.
Child safety seat inspection:
• Use a car safety seat in the back seat of
1-866-SEATCHECK; seatcheck.org
all vehicles.
SAFETY FAMILY SUPPORT
LANGUAGE PROMOTION/HEARING
Your Child and Family
SAMPLE
TOILET-TRAINING READINESS
Bright Futures Previsit Questionnaire
18 Month Visit
For us to provide you and your baby with the best possible health care, we would like to know how things are going.
Please answer all of the questions. Thank you.
What would you like to talk about today?
Do you have any concerns, questions, or problems that you would like to discuss today?
We are interested in answering your questions. Please check off the boxes for the topics you would like to discuss the most today.
q Taking time for yourself q Being a role model q Your child getting along with brothers and sisters
Your Child and Family
q Family time together q Having another child q Getting your child to try new foods q Your child’s weight
q How your child acts q How to tell your child she did a good job q Fun activities for your child
Your Child’s Behavior
q Your child being scared in new places q Setting limits and discipline
Talking and Hearing q How your child talks q Helping your child to learn
Toilet Training q Knowing when your child is ready q How to toilet train
Safety q Car safety seats q Preventing falls, fires, and poisoning q Gun safety q Keeping your child safe outside
Have any of your child’s relatives developed new medical problems since your last visit? If yes, please describe: q Yes q No q Unsure
Bright Futures Parent Handout
18 Month Visit
Here are some suggestions from Bright Futures experts that may be of value to your family.
SAFETY
Toilet Training
Your Child’s Behavior
What to Expect at Your
Child’s 2 Year Visit
We will talk about
SAMPLE
PAGE 1 OF 1
Questions About Your Child
Do you have concerns about how your child hears? q Yes q No q Unsure
Hearing
Do you have concerns about how your child speaks? q Yes q No q Unsure
Do you have concerns about how your child sees? q Yes q No q Unsure
Does your child hold objects close when trying to focus? q Yes q No q Unsure
Vision Do your child’s eyes appear unusual or seem to cross, drift, or be lazy? q Yes q No q Unsure
Do your child’s eyelids droop or does one eyelid tend to close? q Yes q No q Unsure
Have your child’s eyes ever been injured? q Yes q No q Unsure
Does your child have a sibling or playmate who has or had lead poisoning? q Yes q No q Unsure
Does your child live in or regularly visit a house or child care facility built before 1978 that is being
Lead
q Yes q No q Unsure
or has recently been (within the past 6 months) renovated or remodeled?
Does your child live in or regularly visit a house or child care facility built before 1950? q Yes q No q Unsure
Was your child born in a country at high risk for tuberculosis (countries other than the United States,
q Yes q No q Unsure
Canada, Australia, New Zealand, or Western Europe)?
Has your child traveled (had contact with resident populations) for longer than 1 week to a country
Tuberculosis
q Yes q No q Unsure
at high risk for tuberculosis?
Has a family member or contact had tuberculosis or a positive tuberculin skin test? q Yes q No q Unsure
Is your child infected with HIV? q Yes q No q Unsure
Do you ever struggle to put food on the table? q Yes q No q Unsure
Anemia
Does your child’s diet include iron-rich foods such as meat, eggs, iron-fortified cereals, or beans? q No q Yes q Unsure
Does your child have a dentist? q No q Yes q Unsure
Oral Health
Does your child’s primary water source contain fluoride? q No q Yes q Unsure
Does your child have any special health care needs? q No q Yes, describe:
Have there been any major changes in your family lately? q Move q Job change q Separation q Divorce q Death in the family q Any other changes?
Does your child live with anyone who uses tobacco or spend time in any place where people smoke? q No q Yes
PAGE 1 OF 2
CHILD DEVELOPMENT AND BEHAVIOR
TOILET-TRAINING READINESS
The recommendations in this publication do not indicate an
exclusive course of treatment or serve as a standard of medical
care. Variations, taking into account individual circumstances,
may be appropriate. Original document included as part of
Bright Futures Tool and Resource Kit. Copyright © 2010
American Academy of Pediatrics. All Rights Reserved. The
American Academy of Pediatrics does not review or endorse
any modifications made to this document and in no event shall
the AAP be liable for any such changes.
9

Bright Futures Virginia
B
Healthy Futures Implementation Ideas
from the Virginia AAP Chapter
The program’s next step? Delivering its messages
and videos by cell phone.
Imagine you are grocery shopping, and wonder if
a certain food is appropriate for your toddler. You
text in a question, “What should my 15-month-old
child be eating?” and a video comes back to your
cell phone with the answer.
The parent doesn’t have to wait for the health care
practitioner to return a phone call, and will have a
better idea of which food to purchase for their child
while they are still in the store shopping.
Not everyone has a computer or knows how to use
one, Dr. Kraft said, but almost everyone has a cell
phone these days.
“We want to reach people where they’re at before
we take them where we want them to be,” Dr. Kraft
said.
Visit www.healthyfuturesva.com today and begin
using these valuable online resources with the
families you serve.
right Futures Virginia is bringing the third
edition of the Bright Futures Guidelines
to life by turning them into videos that
are available online for parents to watch
at their convenience at healthyfuturesva.com
Colleen Kraft, MD, immediate past president of
the Virginia chapter of the American Academy of
Pediatrics (AAP), explained that Bright Futures
provides an abundance of written material, which is
a great resource for health care practitioners, but isn’t
always the best way to reach parents, particularly
those whose health literacy is limited. To address this
audience, Bright Futures Virginia has developed the
online video series, designed to provide Bright Futures
messages and guidance in an accessible, easy-tounderstand
format.
“We conducted 16 focus groups of parents and teens
around the state to identify the key health and wellness
messages on which we should focus,” according
to Joanne Boise, Division Director for Child and
Adolescent Health with the Virginia Department of
Health, sponsor of the Web site.
“There is tremendous interest
in information on normal
child development, obesity
prevention, and positive
youth development — all of
which are inherent in Bright
Futures. Creating a resource
for parents and other
caregivers was the natural
next step for our Bright
Futures initiative,” Ms. Boise
said. Before going live, the
site was tested by parents and
home visitors. The response
was overwhelmingly
positive.
While the primary audience
for the site is parents and
caregivers, the Virginia team
is also marketing it as a tool
for case managers and other
health and human service
professionals who work with
families and need trusted
resources for subject matter
expertise. The Virginia WIC
program is a prime example
of how other professionals
can make use of the information; staff can use the
Bright Futures videos to reinforce teaching with clients,
and increase their knowledge of well-child care.
The videos – 1 to 2 minutes in length each – currently
cover topics from visits up to the 4-year visit.
How does it work? Parents with questions can just go
to the Web site at healthyfuturesva.com and choose
the topic that interests them. The topics are arranged
by age, theme, and health visit. For example, parents
can choose “The 4-year Visit,” and watch videos
that explain the topics Bright Futures focuses on for
children that age, such as “School Readiness,” or
“TV and Media.”
A parent might also choose to search by a health
theme, such as “Oral Health,” where they can see
videos about creating a “dental home” or promoting
dental health at various ages.
Another option is for parents to see all of the topics
that might apply to their child’s age group (from
pre-natal to 4 years), and choose the video that best
addresses their concern.
Videos address such topics as “How should I choose a
car seat?” and from “Why should I not drink alcohol
while I’m pregnant?” to “When should we start potty
training?”
According to Dr. Kraft, the videos provide a credible
source of information from a provider’s perspective
because the videos deliver the same information that
a pediatrician would and they serve to reinforce the
Bright Futures messages.
“For health care providers, we love having a userfriendly
resource for our parents that gives up-to-date,
medically accurate information. In an age where
there is so much misinformation on the Web and
in the media, healthyfuturesva.com gives the type
of information we would give to our parents in our
office,” Dr. Kraft said.
The video library is a collaborative project of the
Virginia Department of Health, WIC, James Madison
University and the national AAP. The Web site and the
short, entertaining videos are being produced by staff
at James Madison University. Ms. Boise credits the
Virginia WIC program for funding the launch of this
project, which will be completed in the coming year
to cover all of the Bright Futures themes and visits
through adolescence. ■
10 Bright Ideas The Bright Futures Newsletter

GUIDELINES, REFERENCES, AND TOOLS
New from Bright Futures and the AAP! Coming October 2009
Bright Futures Tool and Resource Kit
The Bright Futures Tool and Resource Kit on CD-ROM is
designed to accompany and support the Bright Futures:
Guidelines for Health Supervision of Infants, Children, and
Adolescents 3rd Edition, the national standard for well-child
care. The toolkit is intended to make available to pediatric
providers and organized compilation of current forms and
materials that relate to preventive health supervision and
healh screening for infants, children, and adolescents.
The toolkit focuses on 4 main areas
• Bright Futures Visit Forms
Documentation and medical screening for preventive services at all well-child visits from
1 week to 21 years including patient education handouts and expert reviewed anticipatory
guidance linking to the 5 key Bright Futures priorities for each visit.
• Practice Management Tools and Resources
Resources that increase ease of practice management for preventive services, including coding
• Developmental/Behavioral/Psychological Screening Resources
Recommendations and accompanying screening tools for behavioral, developmental, and
psychosocial issues
• Community Resources
Tools that focus on strategies for building a stronger community referral network
CD-ROM, available October 2009 • P-BF0028 • Price $325
Introductory Price $275—SAVE $50 • Order Yours Now!
The purchase price cited includes a license for use for up to 3 users for the purpose of providing health care
services. Full terms are included with the product.
For more than 3 users, practice and institutional licensing information, contact aapsales@aap.org or call
800/433-9016, ext. 7608.
To order publications from the American Academy of Pediatrics, please use any of the following 4 easy ways:
INTERNET
PHONE: Toll-Free 888/227-1770 FAX: 847/228-1281 MAIL
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(847/434-4000 outside the US & Canada.)
of PO. Do not mail confirming PO.
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X- BF0028 NEW! Save $50 Bright Futures Tool and Resource Kit $325 $275 $325 $275
X-BF0026 Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition $59.95 $59.95
X-BF0031 Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition Pocket Guide (Set of 5 Guides) $64.95 $64.95
X-BF0033 Bright Futures Activity Book (Set of 10) $15 $15
X-BF0030 Save $5 Bright Futures Set (Book and Pocket Guide) $69.95 $69.95
X-BF0034 Save $5 Bright Futures Activity Set (Book and 10 Activity Books) $69.95 $69.95
X-BF0032 Save $15 Bright Futures PDA Package (Book, Pocket Guide, and PDA) $129.95 $129.95
* Illinois Residents: Sales tax applicable to all products except patient education materials. If you or your organization is tax-exempt, please provide us with a copy of
your Tax-Exempt Certificate. If the publication(s) is for resale, please provide us with a copy of your Resale Certificate.
† Canadian Orders: HST applies to all customers within the provinces of Nova Scotia, New Brunswick, Newfoundland, and Labrador.
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Bright Futures: Guidelines for Health Supervision of Infants,
Children, and Adolescents, 3rd Edition
Joseph F. Hagan, Jr, MD, FAAP; Judith S. Shaw, RN, MPH, EdD;
and Paula Duncan, MD, FAAP, Editors
Delivers the latest well-child supervision standards
Part I is organized into 10 themes common to all stages of child development, with
special emphasis on 2 new significant challenges, mental health and healthy weight.
Elicits support from families and communities
Part II focuses on specific guidance for each of 31 age-based health care visits. Each
visit enumerates 5 priorities for that visit, including sample questions, and discussion
points for parent and child.
Softcover, 2007—approx. 612 pages $59.95
Bright Futures, 3rd Edition, Pocket Guide
All the essentials, one easy reference
Pocket Guide summarizes each visit—developmental observation, physical examination,
medical screening, immunizations, and anticipatory guidance. Includes 4 all-new
appendices—medical screening tables, resources, screening tools, and sample scripts.
Preorder today!
Softcover, 2007—100 pages (Set of 5 Pocket Guides) X-BF0031 $64.95
Address (Street # required for delivery)
SHIPPING & HANDLING
Bright Futures Activity Book
The Bright Futures Activity Book is designed to increase a
child’s understanding and appreciation of good health
and to lay a foundation for lifelong healthy habits through
reading, coloring, and drawing, on these beautifully illustrated pages.
An added bonus–includes English and Spanish text.
Softcover, 2008—20 pages • X-BF0033 • Set of 10 • Price $15
(If different from
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L
In the Works
Bright Futures Training and
Implementation Materials
As an outgrowth from the Bright Futures Training Intervention
With Office Staff (BFTI) project (reported on in Volume 4, Issue 1
of the Bright Ideas newsletter), AAP has developed a 3-volume set
of materials entitled Tools for Working with Practices to Improve
Preventive Care Using Bright Futures (available Winter 2010). The
year-long pilot project funded by the Commonwealth Fund, tested
a framework that included 6 office system components — use of
a structured developmental assessment; use of a parental strengths
and needs assessment form; development of recall and reminder
system; development of linkages to community resources;
identification of children with special health care needs; and use
of a preventive services summary sheet. Lessons learned from
the BFTI project has served as the foundation for the new EQIPP
(“Educating Quality Improvement in Pediatric Practices” module
described below.
The 3-volume set of materials described below will help office
staff, facilitators, and trainers establish a system at the practice
level that will support implementation of the Bright Futures
Guidelines in the office setting.
Volume 1: Improving Preventive Care in Your
Office: Tools for Office Improvement
This volume is designed to guide physician offices and other
clinical teams through the development and implementation of
Bright Futures to enhance the preventive care for infants, children,
and adolescents. These tools can be adapted by clinical sites for the
age of the child, the patient population, and the local community.
B o o k m a r k
and visit often
brightfutures.aap.org
Coming Soon! A New Way to Implement the
Bright Futures Guidelines for Health Supervision
of Infants, Children, and Adolescents
with the EQIPP Bright Futures course!
earn how to implement the Bright Futures concepts in your
practice by taking advantage of the newest EQIPP course,
Bright Futures. With a recently updated and easy-to-navigate
EQIPP Web site, you will be able to evaluate your patients’
care using tools that collect and analyze patient data. This course will help
you implement Bright Futures, and use data to identify gaps in procedures
and patient care related to the preventive screening, office systems, and
health promotion needs of your patients. EQIPP will also give you solutions
to create a plan to close those gaps.
EQIPP’s Bright Futures available in early 2010 will make an impact on your
practice, and ultimately the health and well-bring of your patients. For more
information on EQIPP visit: http://www.pedialink.org/cme/EQIPP. ■
Volume 2: Working with Practices to Improve
Preventive Care: A Leader’s Guide
This step-by-step guide will help individuals, facilitators or other
project staff plan and implement the BFTI.
Volume 3: Training Materials to Improve
Preventive Care in Office Practices: Bright
Futures Workshop Materials
This volume contains the workshop binder contents, slide
presentations, and worksheets from the two 1-day workshops held
during the pilot project of the BFTI which focused on delivery of
screening and preventive services for children under age 5.
The full journal article outlining the findings of the Bright Futures
Training Intervention With Office Staff is available at: http://
pediatrics.aappublications.org/cgi/content/full/122/1/e163.
A multimedia presentation of the project findings is also available
at brightfutures.aap.org.
Look for these new tools early next year to help you implement
and teach Bright Futures!
Bright Futures in Practice:
Nutrition
As good nutrition is one of the cornerstones of Bright Futures,
the third edition of Bright Futures in Practice: Nutrition is
being completed for a 2010 release. This edition provides a
thorough overview of nutrition supervision during infancy,
early childhood, middle childhood, and adolescence. Each chapter
contains current information on the nutritional needs of infants,
children, adolescents, and their families and completely consistent
with the Bright Futures Guidelines for Health Supervision, Third
Edition. This edition updates the second edition, which was
published in 2002. ■
Putting Bright Futures to Work
T
he Bright Futures Web site presents many examples
examples of how Bright Futures has been used and
and adapted in a variety of settings including by
state and local government agencies, in clinical
settings, for training health care practitioners, and to educate
families. Watch the About Bright Futures video (go to the Multimedia
Tab) to hear your colleagues describe their use of Bright
Futures, and read about other implementation efforts by visiting
the Putting Bright Futures to Work section of our Web site.
Have you used or adapted Bright Futures to better suit your
needs, making you more effective in caring for children
and youth, whether as a parent, practitioner, or community
agency representative? E-mail us with your success stories
at brightfutures@aap.org and there is a chance that your
work could be featured on our site or in the next newsletter.
Share your success story with others in the Bright Futures
community!
Visit brightfutures.aap.org now and in the future to access
all Bright Futures, Third Edition, materials described in this
newsletter! ■