Bright Futures has long been an important initiative of the federal Maternal and Child Health Bureau (MCHB). It is designed to promote children’s current and future health. The centerpiece of this initiative is Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, first published in 1994. The 4th and most recent edition of the Bright Futures Guidelines was published by the American Academy of Pediatrics (AAP) in 2017 (https://brightfutures.aap.org).
- Increase health care providers’ knowledge, skills, and practice.
- Promote social, developmental, and health outcomes for children.
- Foster partnerships among families, health care providers, and communities.
- Increase family knowledge about, skills for, and participation in promoting children’s health and prevention activities.
- Address the developing needs of children and youth with special health care needs through identification and delivery of resources and related services.
“Children and youth with special health care needs are those who have or are at risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”2
The importance of families as equal partners in promoting the health of their children is central to Bright Futures. Family representatives served alongside their professional partners as writers and reviewers of the Bright Futures Guidelines. This 3rd edition of the Family Pocket Guide, as were the previous editions, has been written for and by families to help families and providers partner more effectively in the health care of children.
The Family Pocket Guide is a quick reference for families that highlights
- Timely, up-to-date information that is culturally responsive.
- Support for the roles you play every day in the health and well-being of your child.
- Information about the importance of well-child visits for all children, including children and youth with special health care needs and their families.
- Encouragement to speak up, be listened to, and take an active role in your child’s care as an equal partner and expert.
- Ideas and strategies about ways to form partnerships with others (eg, families, professionals, community service providers) to improve policies, care, services, and support for all children and families.
- An overall framework for children’s health and insight into the many people who contribute to it.
- Relevant information about child development and building resilience—the ability to bounce back and withstand challenges.
The Bright Futures Guidelines includes many recommendations for families. In its development, the authors included the most accurate and up-to-date standards and evidence. Because scientifically designed studies are not available for every aspect of children’s preventive services, it is most appropriate to refer to Bright Futures as “evidence-informed.” This Family Pocket Guide is based on these recommendations.
If you ever have a question about whether a specific aspect of care or a recommendation applies to your child, don’t hesitate to ask your health care provider. If you are overwhelmed by the recommendation(s), talk about this with your health care provider. They may
- Clarify the recommendation(s).
- Know of resources that can support you.
- Be able to refer you to community partners that might help.
- Discuss with you suggestions about how to make the recommendation(s) more doable.
Each recommendation has a scientific basis and rationale. Though most apply to all children, there are always instances when something may differ for your child. Health care providers and families will want to work together so that all recommendations take into account your child’s unique needs, the environment, and your community.
How to Use this Family Pocket Guide
The guide is divided into 4 age groups or stages of development:
- Infancy (birth through 11 months)
- Early Childhood (1 through 4 years)
- Middle Childhood (5 through 10 years)
- Adolescence (11 through 21 years)
Each section includes information on what to expect during regular well-child visits to your health care provider. Additionally, each section highlights stage-specific aspects of the Bright Futures “health promotion” themes. These themes are important to children’s health across their lifetime. For each visit, you will find information and strategies to promote and encourage strategies for your child’s good health and help prevent illness and disease.
A well-child visit may be called by different names—well-child, well-check, check-up, annual visit, or another name. The purpose of these visits is to help families keep children healthy and to identify any potential problems as early as possible.
Look for each of the following signposts in each visit:
Here you’ll find reminders and suggestions of questions or topics you can write down to discuss during the visit.
This section includes reminders of things to consider if your child has special health care needs as they, just like all children, need high-quality, well-child care. Note: the well-child visit for CYSHCN can improve clinical outcomes, as measured by hospitalizations, emergency department use, and detection of rare complications.
This section notes what your child might be doing or be ready to do at specific ages. Use these points to help ask questions or start discussions with your child’s health care providers to learn and track what is appropriate for your child.
Each well-child visit has a set of age-specific priorities that the health care provider may want to discuss with you and your child. YOUR questions and concerns are always the #1 priority. Share these, along with your child’s interests and achievements, and help your child learn to take an active role in this partnership.
This section gives a brief overview of the well-child exam. Families should always feel free and comfortable to ask health care providers for more information about any tests or procedures.
Each visit section includes some tips created by families for families to promote healthy ways to build resilience and connections among you, your family and friends, and your community.
Think of the yearly well-child visit (more often for kids under 3 years of age) as a road map that provides clinical evaluation, information, and guidance to help you navigate the health of your children as they grow through each age and stage. Each visit is a chance for you to work with your child’s health care provider as a team, to think specifically about your child’s development, and to consider the best ways to help your child grow. Remember, each day also offers a chance to improve the health and well-being of your family!
Think of your child’s health care team as a group of people who have your child’s health and well-being at heart. This team knows the value of working together—particularly including working with you and your child. Your child’s health care provider may be a pediatrician, family medicine physician, internal medical-pediatrician physician, physician’s assistant, or nurse practitioner. Your child’s health care team may also include specialists, therapists, and counselors.
If your child has special health care needs, your team may be larger and include providers in many roles. Keeping track of all the members of the team, appointments, recommendations, and medications can be challenging. Coordinating this care for your child can best happen through family-centered care and the medical home.
Family-centered care recognizes that you are the constant in your child’s life. Yet, while you have the main responsibility, you are not alone in caring for your child. This approach to providing care ensures the health and well-being of your child and family by focusing on respectful family/professional partnerships. Focusing on partnership helps foster two-way information sharing, communication, and trust, as well as shared decision-making, in the care and health of your child. Family-centered care
- Honors the strengths, cultures, traditions, and expertise of everyone.
- Makes life easier.
- Reduces stress and conflict.
- Improves care, communication, and your child’s health.
The elements of a successful family/professional partnership are mutual commitment, respect, trust, open and honest communication, cultural responsiveness, and flexibility. Partnerships can be formal or informal, short term or lifelong. Partnerships change as your child grows and as your needs, interests, and circumstances do. In any partnership, families should feel that their experiences and traditions are valued and respected. In turn, families should respect the intentions and expertise of health care providers and others. As in any relationship, there will be ups and downs and times when compromise and negotiation are needed.
These “homes” are not buildings, but instead models of providing care. A medical or dental home is a health care setting that is accessible, affordable, high quality, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally responsive. Why do you want a medical and dental home for your child? Having one primary person/location in charge of your child’s health that knows and understands your child and family makes communication and coordination easier. A primary health care team, led by a physician, gets to know the child and family. This team identifies and addresses all medical and non-medical needs. The family—including the child—and the health care providers are respected as equal partners in the child’s care.
Bright Futures is built on the belief that every child benefits from and deserves medical and dental homes. For more information on the medical home, visit the website for the National Resource Center for Patient/Family-Centered Medical Home at https://medicalhomeinfo.aap.org/. For more information on the dental home, go to the American Academy of Pediatric Dentistry’s website at https://www.aapd.org/research/oral-health-policies--recommendations/Dental-Home.
Introductory Visit: Before your baby is born.
Infancy: Newborn, First Week, 1 Month, 2 Months, 4 Months, 6 Months, 9 Months.
Early Childhood: 12 Months, 15 Months, 18 Months, 2 Years, 2 1/2 Years, 3 Years, 4 Years
Middle Childhood:5 & 6 Years, 7 & 8 Years, 9 & 10 Years
Adolescence:11‒14 Years (Early), 15‒17 Years (Middle), 18‒21 Years (Late)
While the words “health promotion and prevention” may not be part of daily family conversations, they are one of the most important parts of your child’s life from birth through late adolescence. Health promotion and prevention focus on ways to engage and empower children, families, and communities to choose healthy behaviors and reduce risk. Families are key in promoting children’s health—and families are also the primary providers of care.
Care is not limited to the health care provided in a doctor’s office. It includes
- The food you serve.
- The physical activities you encourage.
- Other things families do every day.
- If your child has special health care needs, carrying out therapies and other forms of care.
Families are role models, teachers, “encouragers,” and supporters among many other roles. You can help children develop patterns of healthy living that last a lifetime.
From the very beginning, parents and families are important role models for children by demonstrating
- What we do.
- What we don’t do.
- The way we handle daily life.
As children grow, other adults often come to play important roles, too. It is important to “live out loud.” This means you live your life in a way that sets an example for your children. Your children learn skills, behaviors, and language by listening to and watching you. If you practice healthy habits, it will be easier for them to do the same.
Health care providers, teachers, and others may offer your family many recommendations. Sometimes, being a parent involves determining how this good advice fits into your family’s life. It can take time to figure out what is important to you and how recommendations may affect your time, energy, and resources. If you have questions—or if you disagree with the recommendations to begin with—discuss them with your child’s health care provider. Sometimes, recommendations can be clarified or changed to meet your customs, traditions, or beliefs. You’ll receive lots of recommendations—in today’s busy world, it is important and necessary to compromise and prioritize.
- Promoting Lifelong Health for Families and Communities
Every child deserves a bright future. Children need the opportunity to grow up in a loving family and supportive community. Experiences starting at birth—or even prenatally—can affect your child’s entire life. Strong relationships with family members and others can help children recover from challenging experiences and provide a solid foundation for lifelong learning, healthy behaviors, and wellness. Remember that your community, state, and government also play roles. The goal of Bright Futures is to support your child’s movement through life so that the strengths and protective factors outweigh the risk factors.
- Promoting Family Support
Raising a healthy family is important, hard work. Everyone needs timely and accurate information and support that is culturally responsive. Think about what tools you need to be the best and who your supporters are—family, friends, health care providers, and others in your community. Think also about the kinds of support you can offer to others.
- Promoting Health for Children and Youth With Special Health Care Needs
All children need good preventive health care—including children and youth with special health care needs. Children and youth with special health care needs expect and deserve “a life like yours” in which they can enjoy life with access to family and friends, have fun, attend school, and plan for a future. Working together as partners with your child’s health care providers, teachers, and other care providers can go a long way to helping your child become as healthy and independent as possible, even with health challenges now and in the future.
- Promoting Healthy Development
Children grow and develop in so many ways and move from each stage of life quickly. As parents and caregivers, we provide love and support. And, just as our children change, our role as parents changes, too. We must learn
- When to help.
- When to set limits.
- When to stand back as your child takes steps toward adulthood.
Every child is different and develops at their own rate, so we need to understand each child’s individual path.
- Promoting Mental Health
Health includes both physical and mental well-being. Families, friends, health care providers, teachers, coaches, and others can contribute to a child’s self-worth, self-confidence, and sense of joy and belonging. Learn about emotional and social development so that you will know
- What to expect.
- When to be concerned.
- Where to find resources.
- Promoting Healthy Weight
Healthy foods, healthy eating habits, and physical activity are important for maintaining healthy weight and lifelong health. Children learn from role models. When they see parents and others eating healthy food and being active, they are more likely to do the same. Maintaining a healthy weight is a challenge for many today. Fortunately, now more than ever, resources and supports are available to help find and prepare foods that support a healthy diet.
Body mass index is a measure used to determine healthy weight. For children 2–19 years, it is based on height, weight, and a child’s developmental age. For more information, visit the Centers for Disease Control and Prevention (CDC) website at https://www.cdc.gov/healthyweight/assessing/bmi/index.html.
- Promoting Healthy Nutrition (Healthy Food and Eating)
Nutrition contributes the main part of children’s growth, lifelong health, and well-being. Your family’s culture and access to healthy foods help shape your children’s eating habits. You can help them learn when and what to eat, as well as how to prepare foods to stay healthy. Sharing meals as a family and with others is an important social aspect of healthy eating.
- Promoting Physical Activity
Get Moving! That’s today’s message for everybody—infants to seniors. Physical activities help children and families build healthy habits that support a lifetime of health and well-being. Physical activity, combined with good nutrition, promotes a healthy weight. Sports, games, and other activities are a great way for children and adults to develop new skills and have fun together.
- Promoting Oral Health
Oral health is more than teeth. It includes the health of an individual’s mouth including gums, lips, teeth, throat, and bones around the mouth and face. It also includes chewing and swallowing, because these motions affect a child’s ability to eat and speak, among other functions. Oral health may also influence children’s self-confidence—how they feel about their overall appearance. A dental home is important for all children.
- Promoting Healthy Sexual Development and Sexuality
Healthy sexual development and sexuality includes
- Building healthy relationships.
- Developing a healthy body image.
- Learning about the body.
- Learning appropriate ways to show affection including appropriate and inappropriate touch and language.
- Learning the difference between love and sex, as well as how to make responsible decisions about being sexually active.
- In some cases, developing and understanding gender roles and identification.
Children and youth make better decisions when they have strong connections with their families and trusted adults. They can connect with these adults to talk about sexuality and sexual development.
- Promoting Healthy and Safe Use of Social Media
Social media in all its forms is an ever-present part of the daily life for children, teens, and adults. It can help us learn about the world and connect with other people, but it also has risks. You can find guidance and a strategy on how to set up a family social media plan on page 19.
- Promoting Safety and Injury Prevention
Children need safe environments to grow and thrive. Caregivers are responsible for their babies’ and young children’s safety. As children grow, friends, child care providers, teachers, coaches, and others also help keep children safe. Older children and teens begin to learn to take charge of their own safety. While it may be hard to let go, health care providers help parents learn how to support their children in making safe decisions and taking responsibility for themselves.
Health literacy is more than just being able to read health information well (like a prescription or instructions on medicine bottles). It also includes
- How you get health information.
- How well you use that information to make informed health decisions.
- What you do to stay healthy or follow health recommendations.
So much of staying healthy depends on what you do every day at home.
To help your children become healthy adults, you can be their champion! By developing your own health-literacy skills and using those skills to care for, model and teach health literacy to your children, you reduce their health risks. As a health champion, you teach them to defend their right to a healthy lifestyle.
Partnering with your child’s health care provider is the perfect place to start.
- Ask questions during visits.
- Use services and resources that health care providers offer.
- Encourage your child’s growing role in health visits.
You can use your Bright Futures Family Pocket Guide for this. Remember, it is normal for concerns or questions to arise after you leave the doctor’s office; so, before you leave the provider’s office, ask staff how to stay in touch with them in between appointments.
Most of us are aware of the role biological factors, such as genes or prenatal health, can play in the future health of our children. Similarly, “social determinants,”—or the web of interpersonal and community relationships experienced by your children and family—can affect your child’s future health. According to the World Health Organization, social determinants of health are “the things that make people healthy or not.”3 They include
- The social and economic environment.
- The physical environment.
- The person’s individual characteristics and behaviors.
These social determinants can be strengths or risk factors, and everyone has both in their lives. Examples of social factors affecting health could include safe, predictable home routines; education; homelessness; domestic abuse; food insecurity; racism; poverty; and neglect. Other factors can negatively affect children and families, including drug use, violence (including police violence), and unsafe neighborhoods. Notably, these factors do not necessarily “determine” health nor do they pose risks to health in the same way for each child. Families, friends, providers, communities, teachers, and many others can work together to provide resources and build resilience to overcome risks.
One goal of the CONNECT BUILDING RESILIENCE tips in each section is to give family-to-family ideas to tackle these social complexities. These strategies will help you teach your kids to do more than just weather each storm. They can build connections that help them grow and thrive.
The Family: A Description
We all come from families. Families are big, small, extended, nuclear, multi-generational, with one parent, two parents, and grandparents. We live under one roof or many. A family can be as temporary as a few weeks, as permanent as forever. We become part of a family by birth, adoption, marriage, or from a desire for mutual support. As family members, we nurture, protect, and influence each other. Families are dynamic and are cultures unto themselves, with different values and unique ways of realizing dreams. Together, our families become the source of our rich cultural heritage and spiritual diversity. Each family has strengths and qualities that flow from individual members, and from the family as a unit. Our families create neighborhoods, communities, states, and nations.4
Families and health care providers are often challenged by the differences among them. They may be unsure of how to connect or communicate, let alone partner. Differences may arise in terms of race and ethnicity, language, gender, sexual orientation/identification, immigration status, education, religion, or income level. In addition, families may face demands and constraints with time and responsibilities. As a result, you may have a different belief and idea about how to partner and communicate than your child’s health care provider. Through open communication and sharing of information and resources, you can build bridges that support true partnerships between your family and professionals. As a family member, you are encouraged to share your thoughts, feelings, expectations, and other issues of importance to you, your child, and your family. This will help your health care provider learn the best ways to communicate with your family and what partnership means for your family.
“Cultural responsiveness is the ability to learn from and relate respectfully with people of your own culture as well as those from other cultures.”5
For more information, visit the National Center for Cultural Competence at Georgetown University at https://nccc.georgetown.edu/.
There are lots of terms used to describe children who may have disabilities, diagnoses, and/or special health care needs. Beyond and apart from their diagnoses, they are children first and foremost. The MCHB uses the term “children and youth with special health care needs” (or CYSHCN) and defines it as “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”2
If your child has already been diagnosed with, or you think they may have, a special health care need, you are not alone. A 2017‒2018 national survey indicates that nearly 20% of children or 14.6 million children (1 in 5) have special health care needs.6 CYSHCN have such a range of abilities and needs—no one description captures all. Some disabilities or chronic illnesses affect only a few areas of a child’s body; others affect many body systems. For example, a child with a hearing impairment may have few or no other special health care needs. Yet another child may have such significant health care needs that all health, educational, and other recommendations and care need to be adapted to be effective.
This Family Pocket Guide can help you connect with your child, their providers, and other families with similar challenges. These relationships can empower you to learn more about your child’s health care, educational, social, behavioral, and other needs.
CYSHCN require ongoing well-checks, in addition to the same monitoring of physical activity, screen time, healthy eating, and other “typical” kid “health and life stuff” experienced by children without special health care needs. They may also require more involved health and developmental screening and monitoring as well as medications, treatments, and more providers. Each child develops differently, and the way your child’s special health care needs impact your child will likely mean that some recommendations, such as some in this booklet, will need to be adapted. Your health care provider can help you figure out what to expect in terms of speech, toilet training, walking, social skills, and other stages of development.
At times, you may feel overwhelmed with all that goes into your child’s care. Take a deep breath and turn to those who support you, to family-led community organizations, and to your child’s providers. For ideas on how to begin to organize all of the paperwork, take a look at how to make a Care Notebook just for your child on the AAP website at https://medicalhomeinfo.aap.org/tools-resources.
Passed in 1975, the Individuals with Disabilities Education Act (IDEA) is the federal law that provides a free, appropriate public education for children with disabilities from birth through age 21.7
Part C of IDEA, known as Early Intervention, is for infants and young children with disabilities or at risk for disability, up until age 3. Some states have an extended Part C that goes until age 5. Families and professionals develop an Individualized Family Service Plan (IFSP) that serves as a road map for early intervention services.
Part B of IDEA provides access to public school for eligible children ages 3 through 21 with the development of a plan known as an Individualized Education Plan (IEP). The IEP provides a child with accommodations, modifications, and specialized instruction that allow the child to access the educational curriculum.
Some children who do not qualify for IDEA may benefit from supports and accommodations through Section 504 of the Rehabilitation Act of 1973,8 administered by the US Office of Civil Rights (OCR), with a 504 Plan. These children might
- Need to use wheelchairs, crutches, or walkers.
- Have allergies or asthma.
- Have a diagnosis of attention-deficit/hyperactivity disorder (ADHD) or another behavioral health challenge.
Visit the Center for Parent Information and Resources (https://www.parentcenterhub.org) for resources including information about the nearly 100 Parent Training and Information Centers (PTICs) and Community Parent Resource Centers (CPRCs) in the United States and US territories. These centers work directly with families, children, and youth from birth to age 26 and help parents participate effectively in their children’s education. Additionally, these centers partner with professionals and policymakers to improve outcomes for all children with disabilities.
Most parents today are seeking guidance to monitor and guide their children’s use of technology and social media in each age and stage of growth. New devices, sites, and apps appear daily, making it a challenge for parents to stay on top of what is safe and acceptable. Just as you monitor your child’s activity in your neighborhood and community, you are right to monitor and guide their media and internet use.
Devices, social media, and the internet are part of all of our everyday lives. You can help your children learn to set limits on their use and use media and the internet responsibly, positively, and safely. These powerful tools connect and unite us—teaching children how to manage their potential in order to learn and grow is an important part of modern parenting.
Work together as a family to develop rules and a family media plan that balances the realities of the digital age and child and family needs for physical activity, sleep, school activities, and unplugged time. Consider using social media sources or tools that allow you to protect your family’s privacy.
Guide
- Help them find sites and apps appropriate for their age and personality.
- Help them understand that nothing is truly private or temporary with media and the internet.
- Help them be safe: for example, do not give out personal information.
- Help them understand how content can be misunderstood—and hurtful—and how to use media and the internet for good.
Monitor
- Place your family computer where you can easily see the sites your children visit.
- Check the internet history regularly to be sure you approve of your children’s choices. You can purchase safety equipment and programs to help prevent access to questionable websites.
- Young children learn more from educational media when you watch or do it with them and talk about it afterward. Older children also benefit from open discussions.
- Get to know popular video games, TV programs, and music for kids in your children’s age group.
- Show an interest in your child’s online activity.
- Set limits according to your beliefs and values.
- Know who your children communicate with on a cell phone or through social media. Limit their phone, media use, and contacts to people you approve.
The AAP HealthyChildren.org website provides additional useful tips on developing a family social media plan at https://www.healthychildren.org/English/media/Pages/default.aspx.