Latest AAP Recommendations

1
Latest American Academy of Pediatrics Recommendations

Make an appointment to get your baby caught up on any vaccines he may have missed during a shortage.
Be sure to make an appointment with your pediatrician as soon as possible to get your baby caught up on any vaccines he may have missed during any vaccine shortages. Photo by Vincent Iannelli, MD

From car seats to vaccines, the American Academy of Pediatrics 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.

Does the AAP have an opinion about drug testing in schools? Of course. While the AAP is for substance abuse prevention and intervention programs, they oppose "widespread implementation of drug testing as a means of achieving substance abuse intervention goals because of the lack of evidence for its effectiveness." (Adolescent Drug Testing Policies in Schools)

There are also policy statements that address contraception for teens, 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.

2
Vaccines and Following the Immunization Schedule

A set of vaccines that your baby might get at her two and four month old visit to her pediatrician.
If using a combination vaccine, such as Pediarix, then your baby will likely get three shots and RotaTeq, an oral vaccine, at her two and four month old well child checkup. Photo by Vincent Iannelli, MD

Vaccines 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, etc., were once common and potentially life-threatening childhood diseases.

In addition to publishing a yearly immunization schedule with the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists, the President of the American Academy of Pediatrics, Sandra, G. Hassink, MD, FAAP recommends that:

  • all children "follow the recommended immunization schedule"
  • all members of the AAP "follow the approved immunization schedule and to help educate families about the safety and effectiveness of childhood vaccines"

Dr. Hassink also states that "advocacy of delayed or alternative immunization schedules increases the risks to all children." These are the type of non-standard, parent-selected, delayed protection vaccine schedules that have been pushed by Dr. Bob Sears, Dr. Jay Gordon, and many other "vaccine-friendly" pediatricians.

Is acknowledging that a non-standard immunization schedule increases risk indicating a shift in the position of the AAP? 

In the 2005 report, "Responding to Parental Refusals of Immunization of Children," the AAP recommended that pediatricians try to "avoid discharging patients from their practices solely because a parent refuses to immunize his or her child." The AAP's plan for pediatricians and vaccine-hesitant parents had been that as "respect, communication, and information build over time in a professional relationship, parents may be willing to reconsider previous vaccine refusals."

The plan was never for pediatricians to pander to parent's fears about vaccines or even to contribute to them though. It was never to openly advocate for anything other than the recommended immunization schedule. Pediatricians who became 'vaccine-friendly' or disease-friendly, encouraging parents to skip or delay vaccines that they had any concerns about, have helped contribute our current outbreaks of vaccine-preventable diseases.

Instead of making up their own immunization schedules or firing patients, pediatricians must be ready to answer all of the myths and misinformation of the modern anti-vaccine movement.

3
Breastfeeding Guidelines

Breastfeeding is the normative standard for infant nutrition.
The AAP guidelines state that infant should breastfeed until they are at least 12 months old. Photo by Oleksiy Maksymenko/Getty Images

Since 1997, the official policy statement of the AAP has stated that:

  • Human milk is the preferred feeding for all infants, including premature and sick newborns, with rare exceptions.
  • Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth.
  • It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.

The latest policy statement, "Breastfeeding and the Use of Human Milk," published in 2012, reinforces the idea that "Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only 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 WHO/UNICEF Ten Steps to Successful Breastfeeding and also recommends:

  • exclusive breastfeeding for at least 6 months
  • helping new mothers breastfeed as soon as possible after delivery
  • offering no medically unnecessary supplements in the newborn period
  • a formal evaluation of breastfeeding technique each nursing shift while in the hospital after the baby is born to document good position and latch, etc.
  • avoiding pacifier use until babies are about 3 to 4 weeks old and nursing well
  • that babies should sleep close to their mothers

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 is also recommended for exclusively breastfed infants.

Keep in mind that formula fed infants are also supplemented with vitamin D and iron - it is added to their formula, in addition to many of the other things that are included in breast milk.

4
Autism Screening

A child at his pediatrician's office.
Pediatricians should screen all children for autism when they are toddlers. Tetra Images/Brand X Pictures/Getty Images

The 2007 AAP Policy Statement "Identification and Evaluation of Children With Autism Spectrum Disorders," stated that "it is important that pediatricians be able to recognize the signs and symptoms of autism spectrum disorders and have a strategy for assessing them systematically."

Part of that strategy should be performing surveillance and routinely administering an autism spectrum disorder specific screening tool at both the 18 and 24 month well child checkups. This is in addition to conducting "surveillance at every well-child visit," looking for "early 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 two or more positive risk factors, which can including having an autistic sibling or a parent, other caregiver, or pediatrician who is concerned about the child.

The M-CHAT is a commonly used autism screening checklist that many pediatricians use.

5
Recommendations for Car Seats

Children should sit in a car seat until seat belts fit them correctly.
Children should sit in a car seat until seat belts fit them correctly, which may not be until they are 57 inches tall (about 8 to 12 years old). Photo by Bruno Vincent/Getty Images

A 2011 policy statement on "Child Passenger Safety" updated the AAP's recommendations on how kids should safely ride in a car, including that that they should ride:

  • in a rear-facing car seat up to age 2 years (infant-only seat or a rear-facing convertible car seat)
  • in a forward-facing car seat through at least age 4 years, although kids should sit in a car seat with a harness "for as long as possible, up to the highest weight or height allowed by the manufacturer." (forward-facing convertible or combination car seat)
  • in a belt-positioning booster seat through age 8 to 12 years, when they are about 4 feet 9 inches tall, and seat belts are likely to fit properly
  • using a lap-and-shoulder seat belt once they have outgrown their booster seat, when "the lap portion of the belt should fit low across the hips and pelvis, and the shoulder portion should fit across the middle of the shoulder and chest when the child sits with his or her back against the vehicle seat back.
  • in the back seat until they are at least 13 years old

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 NHTSA meet Federal Safety Standards and strict crash performance standards." Some are easier to use than others though, which might factor into which car seat you buy.

Most importantly, buy a car seat that is age and size appropriate for your child, that fits in your car, and which is easy for you to install and use.

Also remember that there are no absolute ages at which you should switch seats. These are guidelines, not deadlines. So you don't always have to switch your child from a rear-facing to forward-facing car seat at age 2-years.

Consider both your child's age and size when thinking about which car seat is best and safest. For example, a smaller child might stay in a rear-facing car seat until he is 3-years-old, a forward-facing car seat until he is 7-years-old, and a booster seat until he is 12-years-old. On the other hand, some bigger kids might really be ready for a forward-facing car seat at age 12-months, a booster seat at age 4-years, and seat belts at age 8.

Dennis Durbin, MD, FAAP, lead author of the policy statement and accompanying technical report states that "Parents often look forward to transitioning from one stage to the next, but these transitions should generally be delayed until they’re necessary, when the child fully outgrows the limits for his or her current stage."

Keep your kids safe when they are riding in the car. Make sure they are in the correct seat that is installed correctly every time they ride in the car.

6
Rules for Starting Solids for Babies

A baby feeding herself yogurt.
Yogurt can be a good source of calcium and vitamin D. Photo by Ruslan Dashinsky/Getty Images

"In the first 6 months, water, juice, and other foods are generally unnecessary for breastfed infants."

Gradual introduction of iron-enriched solid foods in the second half of the first year should complement the breast milk diet.

The diet of an infant drinking baby formula too.

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 though.

The AAP clinical report on the "Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infant and Young Children" does suggest that  "the introduction of iron-containing complementary foods after 4 to 6 months of age" can help meet an infant's iron needs and that "when infants are given complementary foods, red meat and vegetables with higher iron content should be introduced early."

Iron fortified cereals are also a good way to help meet your infant's need for iron at this age.

What about avoiding 'allergy foods' and other rules for starting solids?

In general, a 2008 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, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas," threw out a lot of that advice. They concluded that there was no evidence that "delaying the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein" would protect a child from developing atopic disease.

So are there any rules for feeding infants now?

Sure there are and they include that you:

  • start solid foods once your child is 4 to 6 months
  • solid foods with higher iron content, including iron fortified cereals, red meat, and vegetables (green beans, peas, and spinach, etc.) with higher iron content are good foods to start early
  • give your exclusively breastfed infant a vitamin with iron starting at 4 months of age until they are regularly eating baby foods with iron each day
  • avoid choke foods - remember that giving an infant or toddler 'foods containing peanut protein' does not mean giving him whole peanuts and giving red meat doesn't mean giving a piece of steak that he has to chew.
  • if drinking formula, don't switch to cow's milk until your child is at least 12 months old
  • if necessary, offer only up to 4 to 6 oz of 100% fruit juice in a cup once your infant is 6 months old (keep in mind that this more of a limit and not a daily recommended amount - most kids don't need any juice)
  • offer some fluoridated water each day beginning at 6 months
  • start finger foods and table foods once your baby can sit up well by herself and easily pick up soft, small pieces of food that are well-cooked and finely chopped or cut up

Why start at around 4 to 6 months?

That's usually about the time when most infants are developmentally ready for solid foods.

Has your baby doubled his birth weight?

Does he have good head control when sitting?

And does he not seem satisfied with breastmilk or formula anymore?

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 give grand-ma a heart attack and start with a fruit or meat?

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.

7
First Visits for your Child

A baby getting weighed at her first visit to her pediatrician.
A baby getting weighed at her first visit to her pediatrician. Photo by Vincent Iannelli, MD

In addition to learning 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.

Remember that 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 not losing too much weight.

Other firsts for your child should be that:

  • your infant has their hematocrit or hemoglobin checked at age 12 months to evaluate for iron deficiency anemia
  • your toddler has their body mass index measured by age two years to evaluate for childhood obesity
  • your preschooler has their first eye test by age three years
  • your preschooler has their blood pressure checked for the first time by age three years
  • your preschooler has their hearing tested for the first time by age four years

And the First Visit to the Dentist should be by 1 year of age. While some parents, and even some family dentists, think that this is too early, keep in mind that the 2014 AAP policy statement, "Maintaining and Improving the Oral Health of Young Children," 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."

The First Visit to the Gynecologist should likely be when your pediatrician recognizes "abnormalities that warrant referral to a gynecologist," as many pediatricians ("Gynecologic Examination for Adolescents in the Pediatric Office Setting") feel that "with appropriate backup from a gynecologist, most medical gynecologic issues can be managed by the clinician in the primary care office setting." The American College of Obstetricians and Gynecologists does recommend that "girls should have their first gynecologic visit between the ages of 13 years and 15 years." However, the first pelvic exam typically isn't until a girl is sexually active or having abnormal bleeding, etc. And the first Pap test isn't usually until age 21 years.

The First Visit to a non-Pediatrician should be when your older teen is between the ages of 18 and 21 years. 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 had a long-standing relationship with them.

8
Youth Sports and Exercise

Encourage your kids to be physically active and have fun.
It is important that parents encourage their kids to be physically active and have fun. Photo by Vincent Iannelli, MD

The AAP has several policy statements to help guide parents and encourage kids to participate in organized sports, be physically active, but not go too far.

Among the recommendations are that:

  • organized sports should not take the place of free play
  • young children "should avoid early sports specialization" and children should instead "be encouraged to participate in a variety of different activities and develop a wide range of skills"

Kids do need to be physically active though.

The 2006 policy statement, "Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity," advised that:

Physical activity needs to be promoted at home, in the community, and at school ...

From encouraging toddlers to play outside and go for walks and co-ed sports and free play for elementary school age children to competitive and non-competitive youth sports for older kids, daily physical activity is important. In fact, experts recommend that children and teens should participate in moderate intensity exercise for at least 60 minutes each day.

To avoid sports injuries though, it also important that coaches, parents, and players recognize and prevent:

  • heat stress - with an emphasis on kids being given the ability to "gradually and safely adapt to preseason practice and conditioning, sport participation, or other physical activity in the heat by appropriate and progressive acclimatization" and that "sufficient, sanitary, and appropriate fluid should be readily accessible and consumed at regular intervals before, during, and after all sports participation and other physical activities to offset sweat loss and maintain adequate hydration while avoiding overdrinking."
  • concussions - with everyone understanding that "athletes with concussion should rest, both physically and cognitively, until their symptoms have resolved both at rest and with exertion" and that they "should not be returned to play on the same day of the concussion, even if they become asymptomatic."
  • overuse injuries - including pitching injuries, heel pain, Osgood-Schlatter disease, etc.

How active are your kids?

9
Children's Oral Health

A baby's first tooth
Good dental care begins as your child gets his first tooth. Photo by Mary Gascho

In the policy statement, "Maintaining and Improving the Oral Health of Young Children," which was issued in December 2014, the AAP advises that parents follow these habits for healthy teeth:

  • start brushing their child's teeth twice a day as soon as they get one, starting with a smear or grain-of-rice sized amount of fluoride toothpaste and then moving up to a pea sized amount of fluoride toothpaste by 3 years of age
  • schedule the first visit to a dentist with their child (have a dental home) by their first birthday
  • start flossing when teeth are close enough together that you can't brush in between them well
  • help or monitor their kids brushing until they are at least 8 years old
  • consider having a dentist apply fluoride varnish or sealants if your child is at high risk for getting cavities

Unfortunately, cavities (dental caries) are very common in kids. It is 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 children:

  • breastfeed
  • should have their gums cleaned, even before they get any teeth, with a soft washcloth or soft infant toothbrush and water each day
  • avoid falling asleep with a bottle and get weaned from bottles by their first birthday
  • drink fluoridated tap water between meals and limit sugary foods and drinks to mealtimes
  • limit 100% fruit juice to just 4 to 6 ounces each day and avoid other drinks with added sugar
  • continue to see a dentist every 6 months

Child safety is a part of oral health too. To prevent dental injuries, the AAP recommends that parents "cover sharp corners of household furnishings at the level of walking toddlers, ensure use of car safety seats, and be aware of electrical cord risk for mouth injury." An early visit to a pediatric dentist can also help to make sure that you have a plan ready for emergency dental trauma.

10
Childhood Obesity

Childhood obesity continues to be a problem for many kids. a
A combination of daily exercise and healthy eating habits is necessary to help overweight kids. Photo by Peter Dazeley/Getty Images

In a 1957 panel discussion on "Obesity in Pediatric Practice," the participants noted that "obesity in the preschool years is relatively uncommon." And they noted that even when "susceptible children" put on a little excess fat during the school years, many of them will "gradually lose their obesity and emerge as young adults with quite acceptable figures."

A lot has changed since the 1950s.

Among them is that child obesity now "represents a clear and present danger to the health of children and adolescents." Of course, it didn't happen overnight.

To help reverse the trend, the AAP recommends that:

  • pediatricians ask how much time per day kids spend with screen media - should be no more than 2 hours each day and screen time should be avoided all together for infants and toddlers under age 2 years
  • pediatricians ask if kids have a TV set or unrestricted, unmonitored Internet access in the house and in the child's bedroom - kids shouldn't have a TV or internet access in their bedroom, nighttime screen media should be limited, and parents should monitor access (coview)
  • kids be physically active for at least 60 minutes each day - should be unstructured (free play), fun, and moderately intense activities, but doesn't have to be all at once
  • kids have daily PE classes at school
  • kids have recess time
  • parents "promote healthy eating patterns by offering nutritious snacks, such as vegetables and fruits, low-fat dairy foods, and whole grains; encouraging children’s autonomy in self-regulation of food intake and setting appropriate limits on choices; and modeling healthy food choices"

Kids should also have their BMI plotted at each well child checkup, in addition to recording the amount of physical activity they do and the amount of time they spend in non-physical activities.

11
Setting Screen Limits

Watching television and other media use can contribute to childhood obesity.
Watching television and other media use can contribute to childhood obesity, as kids eat junk food, drink soda, see ads for junk food, and are less active. Photo by Ivonne Wierink-vanWetten

Parents 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.

What are the AAP's recommendations about screen limits? In a 2013 policy statement on "Children, Adolescents, and the Media," the AAP recommended that:

  • infants and toddlers less than age 2 years should be discouraged from having any screen time
  • children who are at least 2-years-old be limited to less than 1 to 2 hours of total entertainment screen time each day
  • electronic devices, including a TV set, iPad, computer, or video game console (Xbox, PlayStation, or Wii), etc., should be kept out of a child's bedroom and shouldn't be used during meals or after bedtime
  • parents should monitor what their kids are watching and playing on their screens

Ironically, as many of us work to limit screen time at home, kids seem to be getting more and more screen time at school. How much screen time do your kids get at school? What are they doing on those screens?

The AAP also supports:

  • strong regulations to restrict advertising of fast food and junk food to kids
  • new laws that would ban advertising of alcohol on TV
  • making movies smoke-free
  • maximizing prosocial media content and minimizing content that can be harmful, such as violence and characters who drink or smoke

Does your family need a media diet?

12
Broncholitis and RSV

Nebulizer treatments are no longer a routine treatment for RSV.
Nebulizer treatments are no longer a routine treatment for RSV. Photo by Steve Debenport/Getty Images

Although many parents aren't familiar with bronchiolitis, they do know about RSV, the virus that commonly causes it.

Unlike the common cold, an upper respiratory tract infection, bronchiolitis is a lower respiratory tract infection. It is commonly caused by the respiratory syncytial virus (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 can then also develop difficultly breathing and wheezing. It is these lower respiratory tract signs and symptoms that sometimes leads to infants with bronchiolitis requiring hospitalization, especially those who are just one or two months old.

Although RSV and bronchiolitis seems to 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. And 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, including that:

  • Most kids with bronchiolitis do not routinely need laboratory tests or xrays. Bronchiolitis should usually be diagnosed based on the child's history of symptoms and physical exam. Routine testing to see if a child has RSV is also not recommended.
  • Albuterol is not a recommended treatment for bronchiolitis. Doctors used to try an albuterol breathing treatment in kids with bronchiolitis, and if it seemed to help, then continue them. This albuterol trial is no longer recommended or thought to be helpful.
  • Other treatments that aren't recommended include epinephrine, nebulized hypertonic saline (unless the child is hospitalized), steroids, chest physiotherapy (CPT), oxygen if saturations are above 90%, or the use continuous pulse oximetry.

The new recommendations also changed the recommendations for using Synagis, the monthly injection that can help to prevent RSV in premature babies. 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.

13
Iodine for Breastfeeding Mothers

Pregnant women should take a prenatal vitamin with iodine.
Does your prenatal vitamin contain idodine, an important mineral for pregnant and breastfeeding women?. Photo by IAN HOOTON/Getty Images

In the 2014 policy statement, "Iodine Deficiency, Pollutant Chemicals, and the Thyroid: New Information on an Old Problem," the AAP recommends that pregnant and breastfeeding women:

  • take a supplement with adequate iodide - at least 150 μg of iodide
  • avoid exposure to excess nitrate in drinking water (may be a problem with well water) and too many high nitrate vegetables (many leafy and root vegetables), including celery, lettuce, spinach, carrots, beets, etc.
  • avoid exposure to thiocyanate by not smoking and avoiding secondhand smoke, and not eating large amounts of cruciferous vegetables, especially when raw, including cabbage, turnips, broccoli, brussels sproutes, etc.
  • use iodized table salt

Although pregnant women should be aware of the issue, the AAP does state that "few consume  enough  cruciferous, leafy, or root vegetables for these sources to be of concern."

Although table salt in the United States has long been fortified with iodine (since 1924), many people are surprised to learn that:

  • most brands of Sea Salt are not iodized (fortified with iodine)
  • Kosher salt is not iodized
  • processed foods are typically made with noniodized salt
  • table salt is not fortified with iodine in all countries, especially Europe, where milk, sugar, and even cooking oil, etc., might be routinely iodized instead

Most importantly, keep in mind that few foods are naturally good sources of iodine, but may include seafood, shellfish, and seaweed.  The iodine content of foods depends on where they were caught or grown though, 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 involved the use of iodized animal feed (meats and dairy products).

The American Thyroid Association also recommends that pregnant and lactating women take a supplement with adequate iodide.

14
Calcium and Vitamin D for Healthy Bones

Milk is a good source of vitamin D and calcium.
Drinking milk is a good way to help your kids have healthy bones. Photo by Thomas Northcut / Getty Images

Are your kids working to build healthy bones in their adulthood?

Do they get enough calcium and vitamin D in their diet?

Do they do plenty of weight-bearing exercises and activities?

Do they have any chronic medical conditions or take any medications that could cause reduced bone mass in children and teens?

The 2014 AAP Clinical Report "Optimizing Bone Health in Children and Adolescents," recommends that pediatricians:

  • Ask whether your kids are getting enough calcium and vitamin D from food (dairy and nondairy sources) or supplements, drinking too much soda, and getting enough exercise, especially at the 3 year, 9 year, and teen well child visits.
  • Encourage kids to get enough calcium and vitamin D containing foods and drinks in their diet each day.
  • Encourage kids to participate in weight-bearing activities, including running, jumping, and dancing, etc.

  • Do not routinely check the vitamin D levels of all healthy children.

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 since "approximately 40% to 60% of adult bone mass is accrued during the adolescent years," it isn't something to put off too long.

15
Vitamin D for Breastfeeding Babies

Breastfeeding infants need extra vitamin D.
Breastfeeding infants should get a supplement with 400 IU/d of vitamin D. Photo by Tom Fullum/Getty Images

Although "breastfeeding and human milk are the normative standards for infant
feeding and nutrition," the AAP in their latest policy statement (2012 on "Breastfeeding and the Use of Human Milk" stated that it is important that:

all breastfed infants routinely should receive an oral supplement of vitamin D, 400 U per day, beginning at hospital discharge.

This helps to reduce the rising incidence of vitamin D deficiency and rickets, which has become more of a problem lately "as a result of decreased sunlight exposure secondary to changes in lifestyle, dress habits, and use of topical sunscreen preparations."

This isn't really a new recommendation though, as the 2008 AAP policy statement, "Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents," said the same thing:

Breastfed and partially breastfed infants should be supplemented with 400 IU/day of vitamin D beginning in the first few days of life.

Before that, a 2003 policy statement, "Prevention of Rickets and Vitamin D Deficiency: New Guidelines for Vitamin D Intake," recommended 200 IU of vitamin D per day.

Keep in mind that it isn't just breastfed babies or even just babies or who need vitamin D.

Nonbreastfed babies, toddlers, and teens all need vitamin D too.

These infants and older children will hopefully get their vitamin D from other vitamin D fortified sources though, including formula and vitamin D fortified milk. The issue is just that breastmilk is not a good source of vitamin D.

Vitamin D supplements for breastfeeding infants and children might include:

  • Enfamil D-Vi-Sol
  • 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 sold.

16
AAP Recommendations on Circumcision

A newborn baby boy getting his diaper changed by his father.
Even with the health benefits, whether a baby boy is circumcised often has a lot to do with his parent's cultural and religious beliefs. Photo by Thanasis Zovoilis/Getty Images

The AAP's position on circumcision has evolved quite a bit over the years:

  • There are no valid medical indications for circumcision in the neonatal period. (1971)
  • There is no absolute medical indication for routine circumcision of the newborn. (1975)
  • Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained. (1989)
  • Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. (1999)
  • Evaluation of current evidence indicates that 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 included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. (2012)

Still, even in their latest Circumcision Policy Statement, the AAP also states that "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 "to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices."

And of course, the AAP "opposes all types of female genital cutting."

17
Fruits and Veggies

Do your kids eat enough fruits and veggies?
Fruits and veggies are some of the best foods for kids. Photo by Getty Images

Do your kids eat enough fruits and vegetables each day?

Do you even know how many they are supposed to be eating?

In general, to get enough fruits and veggies, the AAP recommends that you follow the MyPlate recommendations and make half your plate fruits and vegetables.

More specifically, depending on their activity level, kids should eat about:

  • 1 cup of fruit when they are 2-3 years old
  • 1 to 1 1/2 cups of fruit when they are 4-8 years old
  • 1 1/2 cups of fruit when they are 9-13 years old
  • 1 1/2 cups (girls) to 2 cups (boys) of fruit when they are 14-18 years old

Recommendations for eating vegetables are similar, and include that kids should eat:

  • 1 cup of vegetables when they are 2-3 years old
  • 1 1/2 cups of vegetables when they are 4-8 years old
  • 2 cups (girls) to 2 1/2 cups (boys) of vegetables when they are 9-13 years old
  • 2 1/2 cups (girls) to 3 cups (boys) of vegetables when they are 14-18 years old

It is 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.

18
Kids and Caffeine

From soda to Starbucks, many kids get too much caffeine.
From soda to Starbucks, many kids get too much caffeine. Photo by Hauke Dressler / LOOK-foto/Getty Images

Many parents probably don't think that their kids get a lot of caffeine... until they think about all of the caffeinated drinks that they might be getting, such as:

  • sweet tea
  • caffeinated soda - unless they are getting a caffeine-free drinks, such as Root Beer, Sprite, 7-Up or Ginger Ale, then their soda likely includes caffeine
  • energy drinks - Red Bull, Monster and Rockstar, etc.
  • a caramel Frappuccino or other coffee drink from Starbucks

It is likely that your kids are getting more caffeine that you imagine, which is unfortunate, as the AAP advises that the dietary intake of caffeine "should be discouraged for all children."

In their clinical report on "Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?," the AAP specifically warned that energy drinks "are not appropriate for children and adolescents and should never be consumed."

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Sports Drinks and Energy Drinks

Kids rarely need sports drinks
Plain water is more appropriate than sports drinks for most kids when they exercise. Photo by Getty Images

Since your pediatrician likely wants your kids out playing sports or other physical activities everyday, you would think sports drinks are okay, right?

Nope.

Sports drinks, with their extra carbs and calories, are too often misused.

A 2011 clinical report, "Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?," states that they are not a healthy alternative to soda and are not needed during or after non-vigorous physical activities.

Energy drinks, since they have caffeine, have "potential health risks" and "should never be consumed" by children or teenagers.

Instead, after their recommended daily amounts of low-fat milk, water should be "the principal source of hydration for children and adolescents."

Sports drinks may have a place for children and teens involved in "competitive endurance, repeated-bout sports," but for most kids involved in "routine physical activity," water is likely a better choice.

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Lipid Screening in Childhood

All kids school have a cholesterol test
It is now recommended that all children be tested for high cholesterol. Photo by Getty Images

The "current epidemic of childhood obesity with the subsequent increasing risk of type 2 diabetes mellitus, hypertension, and cardiovascular disease in older children and adults" led the AAP to take a new approach to "Lipid Screening and Cardiovascular Health in Childhood" in 2008 when they began to recommend that:

  • high risk children have a fasting lipid profile done "after 2 years of age but no later than 10 years of age."

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, and we had new recommendations:

  • universal lipid screening for high cholesterol between ages 9 to 11 years and 17 to 21 years
  • targeted fasting lipid profile for children between the ages of 2 to 8 years if they are at high risk

What does it mean to be at high risk?

High risk kids might:

  • have a parent with high cholesterol (total cholesterol greater than 240)
  • be over the 95th percentile for BMI, have diabetes, high blood pressure, or smoke cigarettes
  • have a parent, grandparent, aunt/uncle, or a sibling who had a myocardial infarction, angina, a stroke, and/or coronary artery bypass graft (CABG)/stent/angioplasty before they were 55 years (males) to 65 years (females) old

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Screening for Sexually Transmitted Infections (STIs)

Pediatricians routine screen sexually active teens for STIs, including chlamydia and HIV.
Does your teen know to see his or her pediatrician for routine STI screening?. Photo by Getty Images

A July 2014 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:

  • chlamydia and gonorrhea - all sexually active females (25 years of age and under) and males who have sex with males (MSM)
  • trichomoniasis - females who are high risk, such as having multiple partners or a history of STIs
  • syphylis - only if high risk (females and males) and usually includes a RPR or VDRL test, with an additional test if positive to confirm the diagnosis - usually the TP-PA test.

This testing or screening is in line with recommendations for STD and HIV screening from the CDC and can help "to identify and treat individuals with treatable infections, 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 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 3 months.

The AAP has also recommended (since 2011) either:

  • routine HIV screening for all teens by age 16 to 18 years
  • routine HIV screening for all sexually active teens if HIV prevalence in the community is low
  • annual HIV screening for high risk teens

Are your teens sexually active?

Have they been screened for a sexually transmitted infection?

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