ABSTRACT. Compliance, or adherence, as it relates to health care is the extent to which a person's behavior coincides with medical or health advice. Medication compliance is critical for all aspects of pediatrics, specifically in successful treatment, disease prevention, and health promotion. Compliance depends on the patient's and physician's committing to the same objectives. It is unfortunate that numerous studies and physician accounts reveal difficulties in achieving compliance with pediatric medication therapy. Medication compliance in pediatric patients ranges from 11% to 93%. At least one third of all patients fail to complete relatively short-term treatment regimens. Poor compliance places children at risk for problems such as continued disease, complicates the physician-patient relationship, and prevents accurate assessment of the quality of care provided. This article presents the issue in the context of its incidence of and barriers to compliance and provides general principles to improve compliance in pediatrics by improving communication and characteristics of the practice setting. A oneon-one relationship between physician and patient is needed for communication and improved compliance. T his article is based on reviews of medical literature concerning compliance issues, on information gathered by the American Academy of Pediatrics (AAP) Taskforce on Medication Compliance, the AAP Periodic Survey (no. 44), and personal clinical experiences of the authors.As we begin the 21st century, the average medication compliance is ϳ50% in the pediatric population. 1 The range is from 5% to 15% for urban adolescent medication compliance to 85% to 95% for suburban newborn immunization compliance. There are a host of factors that affect medication compliance, but key among them include social and economic circumstances, particularly health literacy, patient belief systems, patient education, acceptability and palatability of the medication, and adverse effects of the medication. The costs of noncompliance to the health care are not trivial. Although not pediatric specific, the National Pharmaceutical Council estimated that $8.5 billion is unnecessarily spent annually on hospitalizations and physician visits caused by noncompliance to prescription regimens. 2 In pediatrics, it is necessary to deal with not only the issues of the patient but also the issues of the parent or other caregiver, which adds to the complexity of medication compliance.Medication compliance was well reviewed by Jones 3 in 1983, and little has changed since then in terms of medication issues. However, compliance issues are changing because dramatic shifts in the financing and organizing of health care already exert a negative effect on medication compliance. In response to increasing health care costs, particularly for prescription drugs, employers are instituting more restrictive formularies and shifting more of the costs to the employee through such innovations as multitiered copay systems. It remains to be seen whether parents who are f...