One can imagine a not far-off world in which knowledge of patients’ genomes improves diagnosis and, through informed prediction of individual drug metabolism and responsiveness, the selection of therapeutics. Even that hallmark of pediatric practice, anticipatory guidance, will likely be affected. With the advent of sequenced-based newborn screening, pediatricians would have access to a huge volume of information with import for not just the current and imminent health of their patients, but also their more distant future. The increasing availability of genomics is a major driver of recent intensified interest in the “developmental origins of adult health and disease.”75 One can foresee a day in which anticipatory guidance is not only about the next six months or even five years of a patient’s life, but about the next eight decades.
