PROS Pearls:

· During well child visits with children ages 2 to 11 years, providers reported discussing the topics of car restraints, nutrition, dental care, and reading aloud most often (72%-93%). In addition, the topics of regular exercise (52%), firearms (52%) and media use (59%) were discussed at least half of the time.

· The age of the child influenced the topics discussed during the well child visit. Providers discussed more often the topics of discipline and storing medicines for children ages 2-5 but the topics of TV/computer games, bike helmets, regular exercise, smoking around children, guns and family fights for children ages 6-11.

· Concordance between parent and provider was high for all topics (72%-90%) immediately after the visit. Parents reported a mean of 6.33 (SD 2.9) topics discussed compared to the providers' reported mean of 6.9 (SD 2.7) topics. Parents recalled more topics than the provider reported when the number of topics was low (1-4 topics), while the least discrepancy between the reports existed when a medium number of topics was discussed (5-8 topics). However, parent recall dwindles when provider discusses nine or more topics. Even though parents demonstrated good recall one month later compared with their postvisit reports, the same pattern emerged regarding parent recall and provider reporting depending on number of topics.

· The findings suggest that limiting the number of topics discussed, rather than attempting to squeeze more informational content into the visit, might lead to increased retention, a necessary starting point for behavior change.