American Academy of Pediatrics

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American Academy of Pediatrics
American-academy-of-pediatrics-logo.svg
MottoDedicated to the health of all children
Formation1930; 90 years ago (1930)
TypeProfessional association
HeadquartersItasca, Illinois, United States
Coordinates42°02′12″N 87°58′58″W / 42.0366°N 87.9827°W / 42.0366; -87.9827Coordinates: 42°02′12″N 87°58′58″W / 42.0366°N 87.9827°W / 42.0366; -87.9827
Membership
67,000
Official language
English
AAP President
Sara Goza, MD, FAAP
Staff
390
Websiteaap.org

The American Academy of Pediatrics (AAP) is an American professional association of pediatricians, headquartered in Itasca, Illinois. It maintains its Department of Federal Affairs office in Washington, D.C.[1]

Background[edit]

The academy was founded in 1930 by 35 pediatricians to address pediatric healthcare standards.[2] It has 67,000 members in primary care and sub-specialist areas.[3] Qualified pediatricians can become fellows (FAAP).[4]

The academy runs continuing medical education (CME) programs for pediatricians and sub-specialists. The academy is divided into 14 departments and 26 divisions that assist with carrying out its mission.[5]

The AAP's website with child health information for families can be found at www.HealthyChildren.org.

Publications[edit]

It has the largest pediatric publishing program in the world, with more than 300 titles for consumers and over 500 titles for physicians and other health-care professionals. These publications include electronic products, professional references/textbooks, practice management publications, patient education materials and parenting books.[6]

The AAP News is the academy's official newsmagazine,[7] and Pediatrics is its flagship journal.[8]

The AAP issues a weekly report[9] on COVID-19 cases in the United States. From when states started reporting to September 17, 2020, the AAP tracked 587,948 child COVID-19 cases, 5,016 child hospitalizations, and 109 child deaths.[10]

Policy positions[edit]

The academy has published hundreds of policy statements ranging from advocacy issues to practice recommendations. The academy's policy website contains all current academy policies and clinical reports.[11] The AAP policy regarding its statements is to give each statement a five-year life, after which the statement expires unless it is reaffirmed.

Age limit[edit]

The AAP has changed positions on their age limit throughout the years. In 1988, the American Academy of Pediatrics published a statement on the age limit of pediatrics that identified the upper age limit of pediatrics as age 21. The policy had a note that exceptions could always be made when the doctor and family jointly agree to an older age.[12]

Recent studies have shown that the age of 21 years is just an arbitrary line for adolescence because brain development has not reached adult levels of functioning until their early 30s. In a 2017 policy update, AAP changed their policy to discourage age limits of pediatric providers and instead have families reach an agreement with their pediatric provider as when to transition care.[13]

Asthma[edit]

In 2009, the national office and four of its State chapters provided training support to 49 pediatric practices to improve adherence to well-established asthma care guidelines. The percentage of patients at participating practices with well-controlled asthma (as defined by the National Heart, Lung, and Blood Institute) rose from 58 to 72 percent.[14]

Car safety seats[edit]

The AAP periodically issues guidance for child passenger safety, including policy recommendations for transitioning between rear-facing car seats, front-facing car seats, belt-positioning booster car seats, and vehicle safety belts.[15] These recommendations are typically published in the peer-reviewed scientific journal Pediatrics,[16][17] and tend to attract attention and controversy in popular press and social media.[18][19]

Previously, the AAP recommended that children remain rear-facing until they are 2 years of age.[16] In response to updated crash test, simulation, and field data, the AAP revised their guidance to exclude the age guideline entirely.[20] Current AAP Child Passenger Safety recommendations (as of August 30, 2018) state that children should remain in a rear-facing car seat for as long as possible, until they meet the maximum height or weight dictated by the car seat manufacturer.[17] The full recommendations state that:

  1. Infants, toddlers and children should remain rear-facing as long as possible. Currently available car seats provide weight and height limits that allow children to be rear-facing beyond their second birthday.
  2. Once children are transitioned to forward-facing, they should use a car safety seat equipped with a 5-point harness for as long as the manufacturer recommends (i.e., until they reach the manufacturer's weight or height limit). Currently available convertible car seats and combination car seats support the use of a 5-point harness until a child is 65 pounds (29 kg) or more.
  3. Once children are transitioned to a belt-positioning booster car seat, they should continue to use the booster until the vehicle's lap and shoulder belt fit properly, which typically occurs when a child is over 4 feet 8 inches (142 cm) tall, and approximately 8–12 years of age.
  4. Once children are transitioned to the vehicle's lap and shoulder seat belt, they should always use the vehicle's seat belt to maximize protection in the event of an accident.
  5. Children under 13 years of age should be seated in the rear passenger seat (not the front seat) to maximize protection in the event of an accident.

COVID schooling in person[edit]

On June 29, 2020, AAP stated that it "strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school" as remote learning makes it more difficult for education professionals to notice learning deficits, physical and sexual abuse, depression and suicidal ideation. The AAP argued that masks are probably not practical for children younger than middle school unless they can wear a mask without increased face touching. Teachers unions opposed the AAP statement, however, saying "Our educators are overwhelmingly not comfortable returning to schools...They fear for their lives, the lives of their students and the lives of their families."[21] Two weeks later, the AAP walked back its support, under political pressure from teachers and other groups.[22] President Donald Trump had cited AAP's original statement repeatedly, pressuring school leaders to reopen schools.[23]

Digital advertising to children[edit]

In its 2020 statement in Pediatrics, the AAP called for banning all digital advertising targeted to children under the age of 7 and urged limits to advertising aimed at people under 17.[24]

Elective infant circumcision[edit]

In 1999, the academy said that the health benefits of the procedure outweigh the risks, and supports having the procedure covered by insurance.[25][26][27]

In a 2012 position statement, the academy stated that a systematic evaluation of the medical literature shows that the "preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure" and that the health benefits "are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns," but "are not great enough to recommend routine circumcision for all male newborns". The academy takes the position that parents should make the final decision about circumcision, after appropriate information is gathered about the risks and benefits of the procedure.[28]

After the release of the position statement, a debate appeared in the journal Pediatrics and the Journal of Medical Ethics.[29][30][31] In 2013, a group of 38 Northern European pediatricians, doctors, surgeons, ethicists and lawyers co-authored a comment stating that they found the AAP's technical report and policy statement suffered from cultural bias, and reached recommendations and conclusions different from those of physicians in other parts of the world;[29] in particular, the group advocated instead a policy of no-harm towards the infants and respect for their rights of bodily integrity and age of consent.[29] An opinion by two authors stated that, in their view, the AAP's analysis was inaccurate, improper and incomplete.[30] The AAP received further criticism from activist groups that oppose circumcision.[32][33] The AAP responded to these criticisms in the Journal of Medical Ethics, calling for respectful and evidence-based debate.[34]

The AAP policy regarding its statements is to give each statement a five-year life, after which the statement expires unless it is reaffirmed. The 2012 Circumcision Policy Statement has not been reaffirmed, so it expired in 2017. As of 2019, the AAP has no official circumcision policy.[citation needed]

Female genital cutting[edit]

In April 2010, the academy revised its policy statement on female genital cutting, with one part of the new policy proving controversial. Although condemning female genital cutting overall, this statement suggested that current federal law banning the practice had the unintended consequence of driving families to perform the procedures in other countries, where these girls faced increased risk. As a possible compromise, this policy statement suggested that physicians have the option to perform a ceremonial "nick" on girls as a last resort to prevent them from being sent overseas for full circumcision. This particular position proved controversial to advocates for a full ban on female genital cutting under any circumstances[35] and concern from other medical groups[36] that even a "nick" would be condoning this widely rejected procedure. One month later, the academy retracted this policy statement.[37][38]

Genetic testing in children[edit]

The American Academy of Pediatrics AGCM posted guidelines in dealing with the ethical issues in pediatric genetic testing.[39]

Gun violence prevention[edit]

The American Academy of Pediatrics says that although U.S. firearms-related deaths have dropped since the 1990s, guns were responsible for over 80 percent of teen homicides in 2009 and were the most common suicide method among teens.[40] The AAP believes pediatricians should discuss guns and gun safety with parents before babies are born and at children's annual exams.[41] It also advocates for, among other things, more background checks, an assault weapons ban, and federal research on gun violence.[42][43]

Marijuana[edit]

The AAP warns of possible marijuana damage to children and adolescents.[44] In states that have already legalized marijuana, the Academy recommends that pediatricians and regulators treat it as they would with tobacco. The Academy does support "decriminalization" of marijuana—reductions in the penalties for its use and possession—in combination with an increased commitment to substance-abuse treatment. The Academy also recommends changing marijuana from a DEA Schedule 1 to a DEA Schedule 2 to facilitate research into pharmaceutical uses.[45]

School start times for adolescents[edit]

Recognizing that insufficient sleep in adolescents is an important public health issue that significantly affects the health and safety, as well as academic success, the American Academy of Pediatrics strongly supports efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times no earlier than 8:30 a.m. to allow students the opportunity to achieve optimal levels of sleep (8.5–9.5 hours) and to improve physical and mental health, safety, academic performance, and quality of life. Although the AAP acknowledges that numerous factors may impair the amount and/or quality of sleep in adolescents—among them, biological changes in sleep associated with puberty, lifestyle choices, and academic demands—it considers school start times before 8:30 a.m. ("earlier school start times") to be a key modifiable contributor to insufficient sleep, together with circadian rhythm disruption. It also recognizes that a substantial body of research has demonstrated that delaying the start of the school day is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to the physical and mental health, safety, and academic achievement of students—including reduced obesity risk, rates of depression, and drowsy driving crashes as well as improved academic performance and quality of life.[46] Later start times also result in less frequent tardiness.[47]

Abusive Head Trauma[edit]

There is limited medical controversy surrounded the AAP regarding "Abusive head trauma"[48]. The current skepticism is not whether violent shaking, or shaking with slamming, is dangerous to infants or children, but of how the scientific information is used in the legal processes. The AAP updated its policy paper in 2020. In the updated policy paper, the APP states " The AAP continues to affirm the dangers and harms of shaking infants, continues to embrace the “shaken baby syndrome” diagnosis as a valid subset of the AHT diagnosis, and encourages pediatric practitioners to educate community stakeholders when necessary."[49]

Statins for high cholesterol in children[edit]

AAP and the American Heart Association recommended statins for children as young as 8 years with high lipid concentrations and for children as young as 2 years with major cardiovascular risk factors. The AAP was criticized for "fear that it will open the way for drug companies to bombard anxious parents with ads promoting these and other products and increase the number of parents insisting on prescriptions for their children. The ease of popping pills should not distract parents, health professionals, or policy makers from the more arduous tasks of cutting back on junk foods, promoting healthy diets, and putting physical education back into the schools.”[50]

Transgender children[edit]

In 2018, the AAP issued a policy endorsing "gender affirmation" as the only acceptable response to a child expressing transgender feelings[51][52] The claims made in that policy were fact-checked by sex researcher James Cantor, who listed multiple factual inaccuracies and key information to be missing, however.[53]

See also[edit]

References[edit]

  1. ^ "Contacting the American Academy of Pediatrics". American Academy of Pediatrics. May 25, 2004. Retrieved March 30, 2013.
  2. ^ "Pediatric History Center". American Academy of Pediatrics. Retrieved March 30, 2013.
  3. ^ "AAP Facts: Membership". American Academy of Pediatrics. Retrieved May 10, 2016.
  4. ^ "FAAP Certification". American Academy of Pediatrics. Retrieved April 12, 2016.
  5. ^ "Departments & Divisions". American Academy of Pediatrics. Archived from the original on April 1, 2013. Retrieved March 30, 2013.
  6. ^ "AAP Facts: Publications". American Academy of Pediatrics. Retrieved March 30, 2013.
  7. ^ "AAP News". American Academy of Pediatrics. Archived from the original on July 27, 2013. Retrieved March 30, 2013.
  8. ^ "AAP Journals: Pediatrics – The Flagship Journal of the AAP". American Academy of Pediatrics. Archived from the original on May 1, 2013. Retrieved March 30, 2013.
  9. ^ "Children and COVID-19: State-Level Data Report". aap.org. American Academy of Pediatrics. Retrieved September 22, 2020.
  10. ^ American Academy of Pediatrics and the Children's Hospital Association (September 17, 2020). Children and COVID-19: State Data Report (PDF) (Report). American Academy of Pediatrics. p. 9-11. Retrieved September 22, 2020.
  11. ^ "Advocacy & Policy". American Academy of Pediatrics. Retrieved March 30, 2013.
  12. ^ Health, Council on Child and Adolescent (May 1, 1988). "Age Limits of Pediatrics". Pediatrics. 81 (5): 736–736. ISSN 0031-4005. PMID 3357740.
  13. ^ Hardin, Amy Peykoff; Hackell, Jesse M.; Medicine, Committee on Practice and Ambulatory (September 1, 2017). "Age Limit of Pediatrics". Pediatrics. 140 (3). doi:10.1542/peds.2017-2151. ISSN 0031-4005. PMID 28827380.
  14. ^ "National Academy and Affiliated State Chapters Support Pediatricians in Improving Asthma Care, Leading to Better Guideline Adherence and Disease Control, Fewer Acute Episodes". Agency for Healthcare Research and Quality. June 5, 2013. Retrieved June 6, 2013.
  15. ^ "AAP Updates Recommendations on Car Seats for Children". American Academy of Pediatrics. August 30, 2018. Retrieved August 31, 2018.
  16. ^ a b Durbin, D. R.; Durbin, DR (March 21, 2011). "Child Passenger Safety". Pediatrics. 127 (4): 788–793. doi:10.1542/peds.2011-0213. PMID 21422088.
  17. ^ a b Durbin, Dennis R.; Hoffman, Benjamin D. (November 2018). "Child Passenger Safety". Pediatrics. 142 (5): e20182461. doi:10.1542/peds.2018-2461. PMID 30166367. S2CID 52131066.
  18. ^ "Pediatricians drop age limit for rear-facing car seats". CNN. August 30, 2018. Retrieved August 30, 2018.
  19. ^ "New car seat guidelines for rear-facing seats are designed to save lives". All the Moms – A USA Today Publication. August 31, 2018. Retrieved August 31, 2018.
  20. ^ "AAP Updates Recommendation on Car Seats for Children". American Academy of Pediatrics. August 30, 2018. Retrieved August 30, 2018.
  21. ^ https://www.npr.org/sections/coronavirus-live-updates/2020/06/29/884638999/u-s-pediatricians-call-for-in-person-school-this-fall
  22. ^ https://www.npr.org/sections/coronavirus-live-updates/2020/07/10/889848834/nations-pediatricians-walk-back-support-for-in-person-school
  23. ^ https://www.npr.org/sections/coronavirus-live-updates/2020/07/10/889848834/nations-pediatricians-walk-back-support-for-in-person-school
  24. ^ Prior, Ryan (June 23, 2020). "Physicians group calls for legislation to regulate digital advertising and its effect on kids". CNN.
  25. ^ Rabin, Roni (August 27, 2012). "Benefits of Circumcision Are Said to Outweigh Risks". The New York Times. Retrieved March 30, 2013.
  26. ^ Brown, Eryn (August 26, 2012). "Pediatricians' Group Shifts in Favor of Circumcision". Los Angeles Times. Retrieved March 30, 2013.
  27. ^ Tanner, Lindsey (August 27, 2012). "Circumcision Benefits Outweigh Risks and Insurers Should Pay; Pediatricians Revise Stance". Associated Press (via National Post). Retrieved March 30, 2013.
  28. ^ American Academy of Pediatrics Task Force on Circumcision (August 27, 2012). "Circumcision Policy Statement". Pediatrics. 130 (3): 585–586. doi:10.1542/peds.2012-1989. PMID 22926180.
  29. ^ a b c Aigrain, Yves; Barauskas, Vidmantas; Bjarnason, Ragnar; Boddy, Su-Anna; Czauderna, Piotr; de Gier, Robert P.E.; de Jong, Tom P.V.M.; Fasching, Günter; Fetter, Willem; Gahr, Manfred; Graugaard, Christian; Greisen, Gorm; Gunnarsdottir, Anna; Hartmann, Wolfram; Havranek, Petr; Hitchcock, Rowena; Huddart, Simon; Janson, Staffan; Jaszczak, Poul; Kupferschmid, Christoph; Lahdes-Vasama, Tuija; Lindahl, Harry; MacDonald, Noni; Markestad, Trond; Märtson, Matis; Nordhov, Solveig Marianne; Pälve, Heikki; Petersons, Aigars; Quinn, Feargal; Qvist, Niels; Rosmundsson, Thrainn; Saxen, Harri; Söder, Olle; Stehr, Maximilian; von Loewenich, Volker C.H.; Wallander, Johan; Wijnen, Rene (April 2013). Frisch, Morten (ed.). "Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision" (PDF). Pediatrics. American Academy of Pediatrics. 131 (4): 796–800. doi:10.1542/peds.2012-2896. PMID 23509170.
  30. ^ a b Svoboda, J Steven; Van Howe, Robert S (July 2013). "Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision". Journal of Medical Ethics. 39 (7): 434–441. doi:10.1136/medethics-2013-101346. PMID 23508208. S2CID 39693618.
  31. ^ Stehr, M (September 16, 2013). "Präventive Zirkumzision - Europäische Ärzte zweifeln AAP-Report an" [Preventive circumcision - European doctors doubt AAP report]. Aktuelle Urologie (in German). 44 (05): 337–338. doi:10.1055/s-0033-1356849. PMID 24043524.
  32. ^ Emmons, Sasha (August 27, 2012). "AAP: Health benefits of circumcision outweigh the risks". CNN. Retrieved September 22, 2014.
  33. ^ Rochman, Bonnie (August 27, 2012). "Circumcision: Pediatricians Say Benefits Trump Risks". Time. Retrieved September 22, 2014.
  34. ^ The AAP Task Force on Circumcision 2012 (July 2013). "The AAP Task Force on Neonatal Circumcision: a call for respectful dialogue". Journal of Medical Ethics. 39 (7): 442–443. doi:10.1136/medethics-2013-101456. PMID 23508207.
  35. ^ Belluck, Pam (May 6, 2010). "Group Backs Ritual 'Nick' as Female Circumcision Option". The New York Times. Retrieved March 30, 2013.
  36. ^ "Joint RCOG/RCPCH statement on the AAP policy statement on FGM". Royal College of Obstetricians and Gynaecologists. May 12, 2010. Retrieved March 30, 2013.
  37. ^ "American Academy of Pediatrics withdraws policy statement on female genital cutting". American Academy of Pediatrics. May 27, 2010. Archived from the original on October 13, 2013. Retrieved March 30, 2013.
  38. ^ Belluck, Pam (May 26, 2010). "Doctors Reverse Stand on Circumcision". The New York Times. Retrieved March 30, 2013.
  39. ^ "AAP Issues New Guidance on Genetic Testing of Children". American Academy of Pediatrics. February 21, 2013. Retrieved October 21, 2017.
  40. ^ Pittman, Genevra (October 18, 2012). "Pediatricians call for strict gun laws to protect kids". Reuters. Retrieved October 21, 2013.
  41. ^ Rho, Helena (February 1, 2013). "The Pediatricians vs. the NRA: How the gun lobby is trying to gag doctors from talking about kids and guns". Slate. Retrieved October 21, 2013.
  42. ^ Viebeck, Elise (April 29, 2013). "Pediatricians to push for gun control on Capitol Hill". The Hill. Retrieved October 21, 2013.
  43. ^ "American Academy of Pediatrics Gun Violence Policy Recommendations" (PDF). January 2013. Retrieved October 21, 2013.
  44. ^ Committee on Substance Abuse; Committee on Adolescence (January 26, 2015). "The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update". Pediatrics. 135 (3): 584–587. doi:10.1542/peds.2014-4146. PMID 25624383. S2CID 42875063.
  45. ^ "American Academy of Pediatrics Reaffirms Opposition to Legalizing Marijuana for Recreational or Medical Use". American Academy of Pediatrics. January 26, 2015. Archived from the original on April 26, 2018. Retrieved April 24, 2018.
  46. ^ Adolescent Sleep Working Group; Committee on Adolescence (2014). "School Start Times for Adolescents". Pediatrics. 134 (3): 642–9. doi:10.1542/peds.2014-1697. PMID 25156998.
  47. ^ Hale, Lauren; Troxel, Wendy; Buysse, Daniel J. (2020). "Sleep Health: An Opportunity for Public Health to Address Health Equity". Annual Review of Public Health. 41: 81–99. doi:10.1146/annurev-publhealth-040119-094412. PMID 31900098.
  48. ^ Narang, Sandeep (October 1, 2016). "Acceptance of Shaken Baby Syndrome and Abusive Head Trauma as Medical Diagnoses". Journal of Pediatrics. 177: 273–278. doi:10.1016/j.jpeds.2016.06.036.
  49. ^ Narang, Sandeep (April 1, 2020). "Abusive Head Trauma in Infants and Children". Pediatrics. 145. doi:10.1542/peds.2020-0203.
  50. ^ Tanne, Janice Hopkins (July 19, 2008). "US paediatricians and cardiologists are criticised for recommending statins for children". BMJ. 337 (7662): 134–135. doi:10.1136/bmj.a813. PMC 2483893. PMID 18632713.
  51. ^ https://www.nbcnews.com/feature/nbc-out/pediatricians-group-recommends-affirmative-care-transgender-youth-n910451
  52. ^ https://www.nytimes.com/2018/10/15/well/family/helping-pediatricians-care-for-transgender-children.html
  53. ^ Cantor, James M. (December 14, 2019). "Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policy". Journal of Sex & Marital Therapy. 46 (4): 307–313. doi:10.1080/0092623X.2019.1698481. PMID 31838960.

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