From car seats and vaccines to screen time and obesity, the American Academy of Pediatrics (AAP) routinely publishes guidelines and advice to help parents keep their kids safe and healthy. In fact, there is likely an AAP policy statement for just about every major pediatric issue. Show
The AAP even weighs in on issues like drug testing in schools. For instance, the AAP supports substance use prevention and intervention programs, but they conclude "that research evidence does not support the initiation or expansion of school-based drug testing programs at this time." They also offer policy statements that address everything from contraception for teens to school start times and cheerleading injuries. Being aware of the latest policy statements and guidelines from the AAP can help you make the best decisions for your kids from birth through adolescence. Here is an overview of some of the top AAP guidelines for parents. Autism ScreeningThe 2020 AAP Policy Statement "Identification, Evaluation, and Management of Children With Autism Spectrum Disorder" indicates the importance of pediatricians being able to recognize the signs and symptoms of autism spectrum disorders (ASD) and have a strategy for assessing them systematically. Part of that strategy includes performing developmental surveillance at all visits as well as standardized autism-specific screening tests at both the 18- and 24-month well-child checkups. These screenings are in addition to looking for subtle red flags that indicate the possibility of an ASD. When results are positive or concerning, pediatricians should then:
Most importantly, pediatricians should not take a "wait-and-see" approach if a child has a positive screen result or has two or more positive risk factors. Risk factors can include having an autistic sibling or a parent as well as having a pediatrician or other caregiver who is concerned about the child. Breastfeeding GuidelinesThe AAP's "Breastfeeding and the Use of Human Milk" policy statement is one of the organization's most accessed policies. The statement details not only the benefits of breastfeeding but also discusses the importance of breastfeeding high-risk infants and the role pediatricians play in promoting breastfeeding.
"Breastfeeding and the Use of Human Milk" reinforces the idea that breastfeeding provides short- and long-term medical and neurodevelopmental advantages. It also suggests that breastfeeding and infant nutrition also should be considered a public health issue and not just a lifestyle choice. After all, breastfeeding and human milk are the normative standards for infant feeding and nutrition. To support effective breastfeeding and increase breastfeeding rates, the AAP also endorses the World Health Organization's "Ten Steps to Successful Breastfeeding" as well as recommends:
The AAP clinical report on the "Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infant and Young Children" does suggest that exclusively breastfed babies be supplemented with oral iron until they start eating age-appropriate iron-containing foods at 4 to 6 months of age. Vitamin D also is recommended for exclusively breastfed infants. Keep in mind that formula-fed infants also are supplemented with vitamin D and iron as it is added to their formula, in addition to many of the other things that are included in breast milk. Bronchiolitis and RSVAlthough many parents aren't familiar with bronchiolitis, they do know about the respiratory syncytial virus (RSV) that commonly causes it. Unlike the common cold, which is an upper respiratory tract infection, bronchiolitis is a lower respiratory tract infection. It is commonly caused by RSV and other viral infections, typically in the late winter and early spring. Similarly to a cold, children with bronchiolitis can have a runny nose and cough, but they also can experience difficulty breathing and wheezing. It is these lower respiratory tract signs and symptoms that sometimes lead hospitalization, especially for babies who are just 1 or 2 months old. Although RSV and bronchiolitis scare a lot of parents, it is important to keep in mind that in the highest risk group—newborns and younger infants—just 3% end up requiring hospitalization. Meanwhile, hospitalization rates are much lower for older infants and children. If your child does get bronchiolitis, the AAP has some recommendations that were published in the November 2014 issue of Pediatrics.The following is an overview of those recommendations:
The new recommendations also changed the recommendations for using Synagis (palivizumab), the monthly injection that can help to prevent RSV. It is now recommended that Synagis only be used in babies who were born before 29 weeks, unless they also have chronic lung disease or heart disease. Car Seat RecommendationsThe AAP policy statement on "Child Passenger Safety" provides recommendations on how kids should safely ride in a car. The following are the key points of car seat safety:
While parents often focus on the brand when buying a car seat, it is important to keep in mind that all car seats rated by National Highway Traffic Safety Administration (NHTSA) meet federal safety standards and strict crash performance standards. Some seats are easier to use than others, which might factor into which car seat you buy. Most importantly, buy a car seat that is age and size appropriate for your child, fits in your car, and is easy for you to install and use. Also, remember that there are no absolute ages at which you should switch seats. The AAP provides guidelines, not deadlines. So you don't always have to switch your child from a rear-facing to a forward-facing car seat as soon as they are 2 years old. Consider both your child's age and size when thinking about which car seat is best and safest. For example, smaller children might stay in a rear-facing car seat until they are 3 years old, in a forward-facing car seat until they are 7 years old, and in a booster seat until they are 12 years old. And even though you may look forward to transitioning from one stage to the next, keep in mind that you should not rush through these transitions. For instance, you should delay moving your child from a rear-facing car seat until your child fully outgrows the manufacturer's limits. Also make sure they are in the correct seat for their height and weight and the car seat hasn't been recalled. You also should double-check to ensure that the seat is installed correctly every time they ride in the car, especially if you frequently move the seat between vehicles. CircumcisionThe AAP's position on circumcision has evolved quite a bit over the years. For instance, the 1999 policy statement said that existing scientific evidence demonstrates potential medical benefits of newborn male circumcision. However, they also stated data was not sufficient to recommend routine circumcision during the neonatal period. Meanwhile, the most current policy recommendation from 2012 states that after evaluating the current evidence, the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified include prevention of urinary tract infections (UTIs), penile cancer, and transmission of some sexually transmitted infections (STIs), including HIV. Still, the AAP also states that the health benefits are not great enough to recommend routine circumcision for all male newborns—even though it is usually well-tolerated with infrequent complications. They urge parents to weigh the medical information in the context of their own religious, ethical, and cultural beliefs and practices in order to make a decision. First Doctor VisitsIn addition to hearing about your child's first smile, first words, and first steps, your pediatrician will be more directly involved in many other firsts to keep your child healthy. For instance, the first visit to the pediatrician is typically by the time they are 3 to 5 days old, depending on how quickly they were discharged from the hospital. In addition to a jaundice check, this first visit can help your pediatrician review how well your baby is feeding and gaining weight, or at least verify that they aren't losing too much weight. Here are some other firsts your pediatrician will be involved with:
DentistThe first visit to the dentist should be by 1 year of age. Some parents, and even some family dentists, think that this is too early. But keep in mind that the 2014 AAP policy statement, "Maintaining and Improving the Oral Health of Young Children," which was reaffirmed in 2019, states that with an "early referral to a dental provider, there is an opportunity to maintain good oral health, prevent disease, and treat disease early." GynecologistThe first visit to the gynecologist should likely be when your pediatrician recognizes anything abnormal that might warrant a referral, according to the "Gynecologic Examination for Adolescents in the Pediatric Office Setting" statement, which was reaffirmed in 2013. Many pediatricians feel that with appropriate support from a gynecologist, most medical issues can be managed by the pediatrician. The American College of Obstetricians and Gynecologists (ACOG) does recommend that girls have their first gynecologic visit between the ages of 13 and 15. However, the first pelvic exam typically isn't until a girl is sexually active or having abnormal bleeding. And the first Pap test usually doesn't occur until they are 21. Family DoctorThe first visit to a non-pediatrician should be when your older teen is between 18 and 21 years old. While the transition from child- to adult-oriented health care depends on many factors, it is important to keep in mind that many pediatricians continue to see older teens and some young adults, especially if they have a long-standing relationship with them. Immunization SchedulesVaccines have been an important part of the history of pediatrics. That's not surprising, as many now vaccine-preventable diseases (such as smallpox, measles, polio, and diphtheria) were once common and potentially life-threatening childhood diseases that children have since been vaccinated against. According to the Centers for Disease Control and Prevention (CDC), a yearly immunization schedule is published based on input from the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. Likewise, the American Academy of Pediatrics recommends that these immunization schedules be followed by both families and pediatricians. Immunization Recommendations
Advocacy of delayed or alternative immunization schedules increases the risks to all children. Likewise, in the "Responding to Parental Refusals of Immunization of Children" report, which was reaffirmed in 2013, the AAP recommends that pediatricians avoid releasing patients from their practices solely because their parents refuse to immunize them. The AAP's approach for pediatricians and vaccine-hesitant parents has been that as respect, communication, and information build over time in a professional relationship, parents may be willing to reconsider previous vaccine refusals. However, the plan was never for pediatricians to pander to parent's fears about vaccines or even to contribute to them. They also never intended for pediatricians to openly advocate for anything other than the recommended immunization schedule. Pediatricians who encourage parents to skip or delay vaccines that they have concerns about have helped contribute to current outbreaks of vaccine-preventable diseases. Instead of making up their own immunization schedules or firing patients, pediatricians must be ready to respond to all myths and misinformation provided by the modern anti-vaccine movement. Iodine for Breastfeeding MothersIn the policy statement, "Iodine Deficiency, Pollutant Chemicals, and the Thyroid: New Information on an Old Problem," the AAP recommends that pregnant and breastfeeding women address potential iodine issues. Here is an overview of their recommendations:
Although pregnant women should be aware of the issue, the AAP does state that very few women consume enough cruciferous, leafy, or root vegetables for these sources of thiocyanate to be of concern." What's more, table salt in the United States has long been fortified with iodine, but many people are surprised to learn that not all salts contain iodine:
Most importantly, keep in mind that few foods are naturally good sources of iodine, and may include seafood, shellfish, and seaweed. The iodine content of foods also depends on where they were caught or grown, as the iodine content of seawater and soil varies in different locations. The biggest food sources are typically those that are directly fortified with iodine or that involve the use of iodized animal feed such as meats and dairy products.
The American Thyroid Association also recommends that pregnant and lactating women take a supplement with adequate iodide. Lipid Screening in ChildhoodBecause of the growing incidence of childhood obesity along with type 2 diabetes, hypertension, and cardiovascular disease in older children and adults, the AAP developed guidelines for lipid screening in children and adolescents. By 2011, the AAP had endorsed the "The Expert Panel Report on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents" from the National Heart, Lung and Blood Institute. This endorsement provided pediatricians with new recommendations, including:
Profile of High-Risk Kids
NutritionThe AAP offers a number of recommendations regarding healthy eating and nutrition. Here is an overview of the most pertinent recommendations regarding your child's nutrition. Calcium and Vitamin DWorking to build healthy bones as well as preventing weak bones is an important consideration for parents as their children grow into adolescents and eventually become young adults. Consequently, it's important to ensure your kids are getting enough calcium and vitamin D in their diet. For instance, they should do plenty of weight-bearing exercises and activities and address any chronic medical conditions. This type of activity is especially important if they take any medications that could cause reduced bone mass in children and teens. The AAP Clinical Report "Optimizing Bone Health in Children and Adolescents" recommends that pediatricians:
Overall, you should have your pediatrician check your child's vitamin D levels only as needed. Routine screening for vitamin D deficiency in healthy children is not recommended. If your kids don't like or can't drink milk, there are plenty of other good sources of calcium and vitamin D that you can consider to help your kids build healthy bones. And because approximately 40% to 60% of adult bone mass is accrued during the adolescent years, getting adequate calcium and vitamin D isn't something to put off too long. Fruits and VeggiesDo your kids eat enough fruits and vegetables each day? Do you even know how much they are supposed to be eating? In general, for your child to get enough fruits and veggies, the AAP recommends that you follow the USDA MyPlate recommendations and make half your plate fruits and vegetables. More specifically, depending on their age and activity level, kids should eat about one to two and a half cups of fruit per day. Here is a closer look at the recommendations:
Recommendations for eating vegetables are similar. Kids should eat about one to four cups of vegetables per day depending on their age, sex, and activity level. Here is an overview of the recommendations:
It's also important that kids eat a variety of types of vegetables each week, including dark green vegetables, red and orange vegetables, beans and peas, starchy vegetables, and other vegetables like celery, cucumbers, and avocados. CaffeineMany parents probably don't realize that their kids drink a lot of caffeine—until they think about all of the caffeinated drinks that they might be consuming. Here are a few examples of beverages that contain caffeine.
Most likely, your kids are getting more caffeine than you imagine. Keep in mind that the AAP advises that children should not have caffeine at all. In their clinical report on "Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?," which was reaffirmed in 2018, the AAP also specifically warns that energy drinks aren't appropriate for children or teens and should never be consumed. Sports Drinks and Energy DrinksBecause your pediatrician likely wants your kids out playing sports or other physical activities every day, you also might think sports drinks are OK. But, that's not the case. In fact, sports drinks, with their extra carbs and calories, are often misused by kids and parents. In fact, the clinical report "Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?" indicates that sports drinks are not a healthy alternative to soda and are not needed during or after non-vigorous physical activities. Likewise, energy drinks have potential health risks and should never be consumed by children or teenagers. Instead, water should be the primary way kids and teens stay hydrated. Sports drinks may have a place for children and teens involved in competitive endurance sports, but for most kids, water is the best choice. ObesityChildhood obesity has become a significant health issue. To help reverse this growing trend, the AAP recommends guidelines that encourage activity. Here is a general overview of their recommendations:
Kids also should have their weight plotted at each well-child checkup. Additionally, the amount of physical activity they have each day, as well as the amount of time they spend on non-physical activities, should be recorded as well. Oral HealthIn the "Maintaining and Improving the Oral Health of Young Children" policy statement, which was reaffirmed in 2019, the AAP advises that parents follow certain habits for healthy teeth. Here is an overview of their recommendations:
Unfortunately, cavities are very common in kids. It's estimated that 24% of toddlers and preschoolers and almost half of older kids have cavities. To help prevent cavities, in addition to the recommendations above, the AAP also recommends that parents:
Child safety is a part of oral health, too. To prevent dental injuries, the AAP recommends that parents cover sharp corners of household furnishings and be aware that electrical cords can cause mouth injuries. An early visit to a pediatric dentist also can help ensure that you have a plan ready for emergency dental trauma should it occur. Sexually Transmitted InfectionsThe policy statement from the AAP, "Screening for Nonviral Sexually Transmitted Infections in Adolescents and Young Adults," recommends that sexually active teens have yearly testing for certain diseases, including tests for the following diseases:
This testing or screening is in line with recommendations for STD and HIV screening from the CDC, which can help identify individuals with treatable infections. It also can help reduce transmission to others, avoid or minimize long-term consequences, identify other exposed and potentially infected individuals, and decrease the prevalence of infection in a community. These STIs that they recommend testing for are common and can sometimes occur without any symptoms, especially chlamydia. The policy statement also recommends that those who are infected with chlamydia, gonorrhea, or trichomoniasis be retested in three months. The AAP also recommends:
Setting Screen LimitsParents often complain that their kids watch too much TV and spend too much time in front of screens, all the while giving them more and more access to these devices. But what are the AAP's recommendations about screen limits? In the "Media and Young Minds" and "Media Use in School-Aged Children and Adolescents" policy statements, the AAP recommends limiting screen time:
Ironically, as many of us work to limit screen time at home and model appropriate screen use, kids seem to be getting more and more screen time at school. Consequently, the AAP also supports:
Sports and ExerciseThe AAP has several policy statements to help guide parents and encourage kids to participate in organized sports and be physically active. But according to the policy statement "Organized Sports for Children, Preadolescents, and Adolescents," parents should avoid taking that advice too far. Here is a closer look at their recommendations:
To avoid overuse injuries it's also important that coaches, parents, and players recognize and prevent this common issue. For instance, early specialization in most instances can lead to overtraining and more injuries, including serious overuse injuries. What's more, burnout also can become an issue—especially if kids are getting pressure from parents, coaches, and teammates. In some kids, burnout manifests itself as a syndrome which includes emotional and physical exhaustion, a reduced sense of accomplishment, and a devaluation of the sport. Signs and symptoms include muscle and joint pain, fatigue, elevated resting heart rate, decreased performance, lack of enthusiasm, and personality changes. Kids need to be physically active though and parents are crucial in making sure this happens. The policy statement, "Physical Activity Assessment and Counseling in Pediatric Clinical Settings," advises that physical activity should be promoted at home, in the community, and at school. From encouraging outside play, co-ed sports, and free play for younger kids to recommending competitive and non-competitive youth sports for older kids, daily physical activity in any form is important. In fact, the AAP indicates that the development of physical literacy starts at home. Parents should not only serve as role models for movement and exercise, but also make sure they are playing with their children so that they can build a foundation of physical skills and abilities. Overall, children and teens should participate in moderate-intensity exercise for at least 60 minutes each day. Starting Solids for BabiesDuring a child's first 6 months of life, water, juice, and other foods are generally unnecessary, especially for breastfed infants. However, a gradual introduction of iron-enriched solid foods after 6 months of age complements the breast milk diet as well as the diet of an infant drinking baby formula. The "rules" of exactly when and how to start solid foods as part of your baby's feeding schedule has changed a lot over the years. The AAP clinical report, "Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infant and Young Children," does suggest that introducing iron-containing foods after 4 to 6 months of age helps meet an infant's iron needs. One option for meeting the baby's iron requirements is to offer meat and vegetables. Iron-fortified cereals are also a good way to help meet your infant's need for iron at this age. And as for delaying some solids due to concerns about food allergies—this practice is no longer recommended. In general, a 2019 clinical report from the AAP, "Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Hydrolyzed Formulas, and Timing of Introduction of Allergenic Complementary Foods," threw out a lot of food allergy-related advice. They concluded that there was no evidence that delaying the introduction of highly allergic foods such as fish, eggs, and peanuts would protect a child from developing atopic disease. Recommendations for SolidsHere is an overview of the AAP's recommendations for beginning solids:
Pediatricians recommend 4 to 6 months as the starting age because that's usually when most infants are developmentally ready for solid foods. Other signs babies are ready for solids include doubling their birth weight, having good head control, and appearing no longer satisfied with breastmilk or formula. Once you think your baby is ready, the next big question will be what solid foods to start. Will you be traditional and start with an iron-fortified rice cereal, or will you start with fruit or veggies? Surprisingly, it doesn't matter. While many parents like to start with a cereal and then move to vegetables, fruits, and lastly meats, you can choose any order, as long as your baby gets a good mix of iron-rich foods. Vitamin D for Breastfed BabiesAlthough breastfeeding and human milk are the preferred method for infant feeding and nutrition, the AAP indicates in "Breastfeeding and the Use of Human Milk" that it's important that breastfed infants receive an oral supplement of vitamin D beginning at hospital discharge. Potential vitamin D supplements for breastfeeding infants and children might include Enfamil D-Vi-Sol and Baby D drops. Look for a liquid vitamin D supplement at a concentration of 400IU per drop, keeping in mind that much higher concentrations are also available. Supplementing breastfed babies with vitamin D helps reduce rates of rickets and vitamin D deficiency, issues that can be attributed to decreased sunlight exposure, changes in lifestyle, different dress habits, and the use of topical sunscreens. Keep in mind though that it isn't just breastfed babies who need vitamin D. Non-breastfed babies, toddlers, and teens all need vitamin D, too. Hopefully, these children will get their vitamin D from other fortified sources though, including formula and vitamin D fortified milk. A Word From VerywellNo matter what question you have or issue you're facing, the AAP probably has a policy statement that addresses it. So, while your pediatrician should be your go-to information source for advice and direction, you can supplement this advice with policy statements from the AAP. Keep in mind that all policy statements from the AAP automatically expire five years after publication unless they are reaffirmed, revised, or retired before then. So be sure to check the AAP website for the most current recommendations. What recommendation does the American Academy of Pediatrics make regarding infant nutrition?The AAP recommends: Exclusive breastfeeding for the first 6 months. There is no need to introduce infant formula or other sources of nutrition for most infants. Beyond 6 months, breastfeeding should be maintained along with nutritious complementary foods.
What is the best choice for infant nutrition?Best Overall: Gerber Good Start GentlePro
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Which nutrient does the American Academy of Pediatrics now recommend be given as a supplement to breast fed infants starting in the second month?Breastfed or partially breastfed babies need 400 international units (IU) of liquid vitamin D a day — starting soon after birth.
Which nutrient does the American Academy of Pediatrics recommend supplementing soon after birth for all infants receiving human milk?To avoid developing a vitamin D deficiency, the Dietary Guidelines for Americans and American Academy of Pediatrics recommend breastfed and partially breastfed infants be supplemented with 400 IU per day of vitamin D beginning in the first few days of life.
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