Objective: To assess physician goals and practice in child health supervision and the role of social learning theory constructs to explain physician behavior.

Design: Random sample survey of American Academy of Pediatrics Fellows.

Participants: 1610 pediatricians were surveyed with a return rate of 72%. The 556 who have finished training and currently perform child health supervision were included.

Survey Topics: Pediatricians were asked about their goals related to seven areas of health supervision-biomedical, development, behavior, family functioning, safety education, interpersonal and system interaction. They were also asked about the prevalence of counseling on specific topics and their self-efficacy and outcome expectations in these areas.

Results: Assurance of physical health and normal development were the most important goals of child health supervision. Goals involving behavioral, family, and safety issues were less important and less likely to be addressed in their practice. Issues of growth and nutrition, physical illness, and child development were always discussed in well visits. Most never or only occasionally discussed family stress and substance abuse (53%, 78%), guns in the home (79%), and television (65%). In these areas, physicians had less confidence they could provide guidance and lower expectation that they could prevent problems. Factors felt to be most important in determining the content of preventive health visits included comfort and knowledge in topics, perceived effectiveness of the topic, and physician's experience.

Conclusions: Physician goals in child health supervision were primarily biomedical with psychosocial and safety issues of lesser importance. Rarely discussed were issues of family stress and substance abuse, guns in the home and television because of low self-efficacy and expectation of effectiveness. These results have implications for education and research.