Bright Futures: A Comprehensive Approach to
Health Supervision
Bright Futures: Guidelines for Health Supervision
of Infants, Children, and Adolescents describes a
system of care that is unique in its attention to
health promotion activities and psychosocial
factors of health and its focus on youth and family
strengths. It also is unique in recognizing that
effective health promotion and disease prevention
require coordinated efforts among medical and
nonmedical professionals and agencies, including
public health, social services, mental health, edu-
cational services, home health, parents, caregivers,
families, and many other members of the broader
community. The Guidelines address the care needs
of all children and adolescents, including children
and youth with special health care needs and
children from families from diverse cultural
and ethnic  backgrounds.
Since 2001, the Maternal and Child Health Bureau
(MCHB) of the US Department of Health and
Human Services’ Health Resources and Services
Administration has awarded cooperative agree-
ments to the American Academy of Pediatrics
(AAP) to lead the Bright Futures initiative. With
the encouragement and strong support of the
MCHB, the AAP and its many collaborating part-
ners developed the third and fourth editions of the
Bright Futures Guidelines.
An Evolving Understanding of Health
Supervision for Children
When the Bright Futures Project Advisory
Committee convened for the third edition, the
members began with key questions: What is Bright
Futures? How can a new edition improve upon
existing guidelines? Most important, how can
a new edition improve the desired outcome of
guidelines, which is child health? We turned to the
previous editions of Bright Futures Guidelines for
insight and direction.
The first edition of the Bright Futures Guidelines,
published in 1994, emphasized the psychosocial
aspects of health. Although other guidelines at
the time, notably the AAP Guidelines for Health
Supervision, considered psychosocial factors,
Bright Futures emphasized the critical importance
of child and family social and emotional function-
ing as a core component of the health supervision
encounter. In the introduction to the first edition,
Morris Green, MD, and his colleagues demon-
strated this commitment by writing that Bright
Futures represents “…‘a new health supervision’
[that] is urgently needed to confront the ‘new mor-
bidities’ that challenge today’s children and fami-
lies.”1 This edition continues this emphasis.
The second edition of the Bright Futures Guidelines,
published in 2000, further emphasized that care
for children could be defined and taught to both
health care professionals and families. In collab-
oration with Judith S. Palfrey, MD, and an expert
advisory group, Dr Green retooled the initial
description of Bright Futures to encompass this
new dimension: “Bright Futures is a vision, a
philosophy, a set of expert guidelines, and a prac-
tical developmental approach to providing health
supervision to children of all ages from birth to
For the third edition of the Bright Futures
Guidelines, the AAP’s cooperative agreement
with the MCHB created multidisciplinary Bright
Futures expert panels working through the Bright
Futures Education Center.3 The panels, which
first met in September 2003, further adapted the
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