Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. e993-e997 (doi:10.1542/peds.2007-2060)
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COMMENTARY

Basic Training for the Pediatrician: How to Provide Comprehensive Anticipatory Guidance Regarding Military Service

William P. Adelman, MD, FAAP

Department of Pediatrics, Adolescent Medicine Service, Walter Reed Army Medical Center, Washington, DC

The first 300 words of the full text of this article appear below.

It may be laid down as a primary position, and the basis of our system, that every Citizen who enjoys the protection of a Free Government owes not only a proportion of his property, but even of his personal services, to the defense of it.

—George Washington

Effective anticipatory guidance for adolescents requires developmentally appropriate discussions of preventive health issues.1 National organizations differ in their recommendations for what topics to address, and how often to screen.1–5 The American Academy of Pediatrics recommends yearly visits to the health care provider during adolescence, with anticipatory guidance that is used to review educational performance and counseling in relation to specified risk behaviors.4,6 No national guideline or evidence-based task force recommends anticipatory guidance for a specific educational choice, vocation, or profession, such as military service. Despite this assertion, recent commentary in Pediatrics recommended that routine adolescent anticipatory guidance include "discussion of military service issues" recognizing that it will require "additional time and effort on the part of health care providers."7 This commentary recommended discussion of the selective service system in anticipation of a possible future draft, offered that an alternative to hypothetical future conscription could be conscientious objection, reviewed how to establish conscientious objector status in case of a hypothetical future draft, and recommended providing information about the health risks of combat and options for service outside the military. It included a discussion on how to avoid military recruitment. Such routine anticipatory guidance is inappropriate, because it is contrary to current national recommendations, offers physician bias in place of evidence, is less than a comprehensive review of military service, provides no proven benefit for the teenager, and is impractical to implement.

Instead, I suggest that when an adolescent or family has questions for the health care provider regarding military service, the responsible pediatrician must . . . [Full Text of this Article]

Address correspondence to William P. Adelman, MD, FAAP, Department of Pediatrics, Adolescent Medicine Service, Walter Reed Army Medical Center, 6900 Georgia Ave NW, Washington, DC 20708. E-mail: william.adelman@us.army.mil


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