Adaptation: The North Carolina Women & Children Health Services Division provides several preventive health services to children from birth to age 21. These services are given primarily through local health department clinics. The clinics use the Bright Futures Guidelines to develop the schedule of recommended visits. In addition, Bright Futures is also the standard for dental health.

Training: Statewide training and a technical assistance plan have been developed by the Children & Youth Branch. This training included the purchase of the Bright Futures Tool and Resource Kit, and was provided to all local health districts to implement Bright Futures Guidelines using quality improvement approaches. Local health districts will continue to use the required Bright Futures tools to provide anticipatory guidance with respect to car safety and driving during well-child visits for infants, children, adolescents, and their families.

The state also provided regional trainings to child health nurses working with local health departments across the state on pediatric obesity and Bright Futures nutrition tools.​