The Milliman and Robertson guide has created a great deal of consternation among pediatricians, particularly the sections that address optimal length of stay for common pediatric conditions. In his accompanying commentary,¹ Dr Yetman introduces the new version of the Pediatric Health Status Improvement and Management² and carefully enumerates its strengths. Although management guidelines play an important role in medicine, we believe that there are a number of important limitations that must be recognized in this revision.

Before authoring this commentary, we carefully reviewed the entire Milliman and Robertson document, noting both its strengths and weaknesses. Our comments reflect our review, discussions with pediatricians, and our clinical experience with how the Milliman and Robertson recommendations are often applied. It should be noted that in the introduction to each section, the authors carefully allude to the importance of individual patient and practitioner decision-making. Although the sections on subspecialty pediatrics, anticipatory guidance, and outpatient guidelines (their term) are well done; from a practical standpoint, the sections on inpatient guidelines and neonatology (including optimal length of stay) garner the most attention, especially when these . . . [Full Text of this Article]