Purpose of review Advances in genetics are occurring at a rapid pace. It will ultimately be the primary care pediatrician who assimilates this knowledge and applies it to patient care. This article is written in a patient encounter format with which the pediatrician is familiar. The vignettes are from the author's own experiences in 13 years of general pediatric practice. Recent findings The current literature reinforces the idea that changes in the complexity of the diagnostic evaluation and the time spent explaining the recommended testing will be required by the pediatrician. With this responsibility comes the need of new training strategies for medical students and established pediatricians. Summary Pediatricians will be called upon to incorporate new genetic findings into patient care. This task will ultimately be no different than it was for past pediatricians to incorporate new immunizations or antibiotics into the care plan for each patient. Patient care will improve because therapy will be tailor-made for both the disease and the patient. © 2008 Wolters Kluwer Health|Lippincott Williams & Wilkins.