[Well-child care today: an evidence-based view]

Health promotion is one of the chief activities of pediatricians, although still lacking enough scientific bases. This article reviews the scientific support for the main preventive interventions, as well as who should make them, when and how they should be made.

Systematic review of recent literature, through the search of Medline and Lilacs databases, using the terms well-child care, health supervision and health promotion (both in English and Portuguese); non-systematic review of reference lists of book chapters; non-systematic Internet search of organizations that make recommendations on health supervision; selection of classic articles within this field.

Pediatricians must seek integration with other professionals in providing preventive services, as well as in establishing effective partnerships with all community sectors. It is essential to improve communication skills. The ideal number of health supervision visits has never been established; interventions must be individually adapted according to family and community contextual risk factors. There is scientific evidence of the effectiveness of prenatal visits, preventive guidance, metabolic screening, immunization, and vision and hearing screening. Growth monitoring and development screening must be rationalized. The systematic repetition of complete physical examinations and laboratory tests is not warranted.

Pediatricians play a fundamental role in child and adolescent health promotion, but their actions regarding well-child care must no longer be totally empirical. There are innumerous evidence-based resources to guide pediatricians as to the most effective interventions.