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We thank Dr Sadof for his comments on our article. He highlights the central challenge that pediatricians face when caring for a child with a chronic condition: delivering chronic illness and preventive care that both addresses parents' concerns and adheres to national guidelines.
We believe that many parents see little distinction between chronic illness–related care and health promotion. During a disease-management visit for a patient with asthma, for example, parents and pediatricians will expect to discuss parental smoking cessation and physical activity. Similarly, during a disease-management visit for a patient with attention-deficit/hyperactivity disorder, parents and pediatricians will expect to cover school performance, peer interactions, and safety. These same health-promotion topics are also covered during well-child care visits.
Van Cleave J, Heisler M, Devries JM, Joiner TA, Davis MM. Discussing Illness at Well-Child Care Visits—Reply. Arch Pediatr Adolesc Med. 2008;162(8):795. doi:10.1001/archpedi.162.8.795