American Academy Of Pediatrics Policy Research Articles

Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Policy Statement.

Reading together often with infants and young children strengthens their relationships with parents/caregivers at a critical time in child development, stimulating brain circuitry and early attachment. A positive parenting practice, shared reading helps build the foundation for healthy social-emotional, cognitive, language, and literacy development, setting the stage for school readiness and providing enduring benefits across the life course. Pediatric physicians and advanced care providers have a unique opportunity to encourage parents/caregivers to establish routines and enjoy conversations around books and stories with their children beginning in infancy. Research has demonstrated that parents read and children learn when pediatricians offer literacy promotion as a practical and evidence-based primary prevention strategy in primary care practice to support early brain and child development. This supports families with a strengths-based approach, shaping a child's life trajectory and helping mitigate stress and adverse experiences. The American Academy of Pediatrics (AAP) recommends that pediatricians encourage shared reading beginning at birth and continuing at least through kindergarten as a strategy for supporting parents/caregivers, enhancing foundational relationships, promoting positive language-rich interactions, and helping families create a nurturing and stimulating home environment. The integration of literacy promotion into pediatric resident education is crucial to achieve that goal and thus is also essential. The AAP supports advocacy toward establishing public and private funding for diverse high-quality, developmentally appropriate children's books in the languages preferred by the family to be provided at pediatric health supervision visits to all children, but especially to children living in underresourced communities. This statement is supported by multiple AAP policies and implementation resources, including the accompanying "Literacy Promotion: An Essential Component of Primary Care Pediatric Practice: Technical Report."

Food Insecurity Screening and Referral Practices of Pediatric Clinicians in Metropolitan Washington, DC.

In 2022, 17.3% of US households with children experienced food insecurity (FI). The objective of this study was to examine pediatric clinicians' FI screening and management immediately following the release of the American Academy of Pediatrics (AAP) 2015 FI Policy Statement. Data were collected in 2016 from 85 primary care pediatric clinicians via an online survey of clinicians in the Washington, DC metropolitan area. Descriptive statistics were calculated using univariate/bivariate analyses. Fisher's exact test and Chi-square tests were used to explore the association between FI screening, health insurance, and clinician demographics. Sixty-six percent of clinicians indicated that they infrequently screened for FI. Only 13% of clinicians used a standardized FI screening tool. Forty-five percent of clinicians screened for FI only when they perceived an acute concern. About 70% of them screened for FI when a patient presented with poor weight gain or was underweight. Immediately after the release of the AAP Policy Statement, it was found that few pediatric clinicians appropriately and frequently screened for FI in our regional sample. Our data emphasize the common misconceptions held by clinicians around FI and the necessity to incorporate training that underscores the invisibility of FI along with effective techniques to screen and intervene.

Palivizumab Prophylaxis in Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection.

Guidance from the American Academy of Pediatrics (AAP) for the use of palivizumab prophylaxis against respiratory syncytial virus (RSV) was first published in a policy statement in 1998. AAP recommendations have been updated periodically to reflect the most recent literature regarding children at greatest risk of severe RSV disease. Since the last update in 2014, which refined prophylaxis guidance to focus on those children at greatest risk, data have become available regarding the seasonality of RSV circulation, the incidence and risk factors associated with bronchiolitis hospitalizations, and the potential effects of the implementation of prophylaxis recommendations on hospitalization rates of children with RSV infection. This technical report summarizes the literature review by the Committee on Infectious Diseases, supporting the reaffirmation of the 2014 AAP policy statement on palivizumab prophylaxis among infants and young children at increased risk of hospitalization for RSV infection. Review of publications since 2014 did not support a change in recommendations for palivizumab prophylaxis and continues to endorse the guidance provided in the 2021 Red Book.

Paediatric surgeons’ current knowledge and practices of obtaining assent from adolescents for elective reconstructive procedures

PurposeAdolescents develop their decision-making ability as they transition from childhood to adulthood. Participation in their medical care should be encouraged through obtaining assent, as recommended by the American Academy of...

Guiding Principles for Managed Care Arrangements for the Health of Newborns, Infants, Children, Adolescents and Young Adults.

Managed care arrangements are an approach to health care delivery in which the payer or other health care entity has policies that affect where care is delivered, what services are covered, and how payment is determined. When policies are intentionally designed, transparently administered, and continuously monitored, they are more likely to improve the population's utilization of services, access to quality primary and specialty care, and access to appropriate medications. When managed care arrangements are designed well, particularly within evolving payment models, health care can be delivered in a manner that supports the goals of the Quadruple Aim: to reduce per capita costs of health care, to improve the health of populations, to improve the experience of patients receiving care, and to improve the experience of those who are providing care. The American Academy of Pediatrics (AAP) urges payers and health care entities to use the key principles outlined in this statement when designing and implementing managed care arrangements and policies that cover newborn infants, infants, children, adolescents, and young adults to support the goal of improving the effectiveness of the health care delivery system for the pediatric population. The principles described in this statement are intended to complement those previously published in other AAP policies including "Principles of Child Health Care Financing," "Scope of Health Care Benefits for Children From Birth Through Age 26," "Patient- and Family-Centered Care and the Pediatrician's Role," and the "AAP Access Principles."

Seven years later: state neonatal risk-appropriate care policy consistency with the 2012 American Academy of Pediatrics Policy.

To assess consistency of state neonatal risk-appropriate care policies with the 2012 AAP policy seven years post-publication. Systematic, web-based review of all publicly available 2019 state neonatal levels of care policies. Information on infant risk (gestational age, birth weight), technology and equipment capabilities, and availability of specialty staffing used to define neonatal levels of care was extracted for review. Half of states (50%) had a neonatal risk-appropriate care policy. Of those states, 88% had language consistent with AAP-defined Level I criteria, 80% with Level II, 56% with Level III, and 55% with Level IV. Comparing policies (2014-2019), consistency increased in state policies among all levels of care with the greatest increase among level IV criteria. States improved consistency of policy language by each level of care, though half of states still lack policy to provide minimum standards of care to the most vulnerable infants.

Impact of the 2014 American Academy of Pediatrics Policy on RSV Hospitalization in Preterm Infants in the United States.

Despite being a leading cause of hospitalization due to lower respiratory tract infections, the treatment of respiratory syncytial virus (RSV) infection is primarily supportive. Palivizumab is the only licensed immunoprophylaxis (IP) available for preventing severe RSV infection in high-risk populations including ≤ 35 weeks’ gestational age (wGA) infants and children with chronic lung disease of prematurity or congenital heart disease. The American Academy of Pediatrics (AAP) has published its IP recommendations since the approval of palivizumab. In 2014, the AAP stopped recommending RSV IP in 29–34 wGA infants without comorbidities and stated that RSV hospitalization (RSVH) risk in otherwise healthy ≥ 29 wGA infants and term infants was similar. Since then, experts in the field have debated the appropriateness of the 2014 policy change, and several real-world evidence studies at the national and regional levels in the US have examined the impact of the AAP policy on 29–34 wGA infants. Overall, these studies showed a significant decline in RSV IP use and a concurrent increase in RSVH risk among 29–34 wGA infants relative to term infants in the seasons after the 2014 policy change. A similar decrease in IP use and increase in RSVH risk was also observed among < 29 wGA infants relative to term infants after the 2014 policy change. This decrease could be an unintended consequence as < 29 wGA infants are an in-policy population recommended to receive RSV IP. According to the National Perinatal Association, strong evidence exists to support the use of RSV IP in all ≤ 32 wGA and 32–35 wGA infants with risk factors such as attending day care, having ≥ 1 school-aged siblings, twin or greater multiple gestation, younger age, and exposure to parental smoking. Until new preventive and treatment options become available, palivizumab can help prevent and mitigate RSV disease burden among high-risk preterm infants.

Current State of Respiratory Syncytial Virus Disease and Management.

Respiratory syncytial virus (RSV) is a major cause of hospitalizations due to pneumonia and bronchiolitis. Substantial morbidity and socioeconomic burden are associated with RSV infection worldwide. Populations with higher susceptibility to developing severe RSV include premature infants, children with chronic lung disease of prematurity (CLDP) or congenital heart disease (CHD), elderly individuals aged > 65 years, and immunocompromised individuals. In the pediatric population, RSV can lead to long-term sequelae such as wheezing and asthma, which are associated with increased health care costs and reduced quality of life. Treatment for RSV is mainly supportive, and general preventive measures such as good hygiene and isolation are highly recommended. Although vaccine development for RSV has been a global priority, attempts to date have failed to yield a safe and effective product for clinical use. Currently, palivizumab is the only immunoprophylaxis (IP) available to prevent severe RSV in specific high-risk pediatric populations. Well-controlled, randomized clinical trials have established the efficacy of palivizumab in reducing RSV hospitalization (RSVH) in high-risk infants including moderate- to late-preterm infants. However, the American Academy of Pediatrics (AAP), in its 2014 policy, stopped recommending RSV IP use for ≥ 29 weeks’ gestational age infants. Revisions to the AAP policy for RSV IP have largely narrowed the proportion of pediatric patients eligible to receive RSV IP and have been associated with an increase in RSVH and morbidity. On the other hand, after reviewing the recent evidence on RSV burden, the National Perinatal Association, in its 2018 clinical practice guidelines, recommended RSV IP use for a wider pediatric population. As the AAP recommendations drive insurance reimbursements for RSV IP, they should be revised to help further mitigate RSV disease burden.

Protecting the American Dream: a Pediatric Imperative.

* Abbreviations: AAP — : American Academy of Pediatrics VVN — : Vital Village Network The American dream is a fundamental ethos of the nation passed from generation to generation. In 1931, James Truslow Adams coined the term as “that dream of a land in which life should be better and richer and fuller for everyone.” Most Americans across all incomes still believe their children and grandchildren will achieve the American dream.1 Yet, in reality, it is out of most children’s reach. The American dream is intrinsically tied to the capacity for upward mobility, whereby children can grow up to surpass their parent’s income level. The groundbreaking work of Harvard Professor of Public Economics Dr Raj Chetty reveals that there is less upward mobility in the United States today than at any other time, likely because of lower overall economic growth and greater inequality in its distribution. Specifically, Chetty et al2 found that, since 1940, the fraction of children who earn more than their parents has fallen from >90% to ∼50%. However, the decline in the American dream is not equally distributed across the United States. Chetty et al3 has revealed great variation in upward mobility, with significant differences even among neighborhoods within the same city. Higher–upward-mobility areas are associated with less residential segregation and income inequality and greater … Address correspondence to Arvin Garg, MD, MPH, Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. E-mail: Arvin.Garg{at}umassmemorial.org

In the Wake of a Pandemic: Revisiting School Approaches to Nonmedical Exemptions to Mandatory Vaccination in the US

Mandatory school vaccination policies with exclusion of unvaccinated students can be a powerful tool in ensuring high vaccination rates. Some parents may object to mandatory vaccination policies, claiming exemptions based on medical, religious, or philosophical reasons. Individual schools, school systems, or local or regional governments have different policies with respect to whether, and what kind of, exemptions may be allowed. In the setting of the current pandemic, questions regarding the acceptability of exemptions have resurfaced, as schools and local governments struggle with how to safely return children to school. Anticipating that school attendance will be facilitated by the development of a vaccine, school systems will face decisions about whether to mandate vaccination and whether to permit exemptions. The American Academy of Pediatrics promulgates policy favoring the elimination of nonmedical exemptions generally in schools. This discussion considers whether schools should eliminate nonmedical exemptions to vaccination as proposed in the American Academy of Pediatrics policy, ultimately concluding that broad elimination of exemptions is not justified and advocating a more nuanced approach that encourages school attendance while promoting vaccination and broader public health goals.

Moving to a Medical Model of Substance Use Treatment of Youth.

* Abbreviations: ACA — : Affordable Care Act SBIRT — : Screening Brief Intervention Referral to Treatment SUD — : substance use disorder Although the majority of the articles contained in this supplement address the need for comprehensive evidence based clinical standards and principles of care for young adults with substance use disorders (SUD), it is also critical that we address several important policy factors that can dramatically impact care for this population. In this article, we identify several of these factors, including a strategic focus on substance use as a health condition, access to affordable and equitable public and private insurance coverage, and thorough integration of substance use care with primary care settings that are supported by enhanced provider training. The recommendations in this article are not American Academy of Pediatrics policy, and publication herein does not imply endorsement. Historically, both substance use policy and funding have reflected a moralistic and punitive approach to the problem, despite the scientific recognition of addiction as a medical condition. Since the late 20th century, the majority of federal funding has been spent on supply side reduction efforts and deterrence through law enforcement and the criminal justice system, with comparatively little spent on treatment or prevention. News media coverage reinforces the problem by emphasizing the problem of illegal drug dealing and highlighting law enforcement solutions designed to arrest and prosecute the individuals responsible for diverting opioid analgesics onto the illegal market. The flaws … Address correspondence to Sharon J. Levy, MD, Adolescent Substance Use and Addiction Program, 300 Longwood Ave, Boston, MA 02115. E-mail: sharon.levy{at}childrens.harvard.edu

1513. Medically Attended Respiratory Syncytial Virus Hospitalizations (RSVH) and All-Cause Bronchiolitis Hospitalizations (BH) Among Children Aged ≤ 24 Months at RSV Season Start With Higher-Risk Congenital Heart Disease (CHD) Before and After the 2014 American Academy of Pediatrics (AAP) Policy

BackgroundIn 2014, the AAP stopped recommending palivizumab for use in children with hemodynamically significant CHD (hs-CHD) aged 12 to 24 months at the RSV season start. This analysis investigates the impact of the 2014 AAP policy on the contemporary burden of RSVH and BH in children with CHD for whom palivizumab immunoprophylaxis is no longer recommended.MethodsAll children with CHD aged ≤ 24 months at the start of the RSV season and hospitalized for RSV or BH during the 2010-2017 RSV seasons (November-March) were studied. RSVH and BH were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. As there are no ICD codes for hs-CHD, we evaluated the effect of the guidance on higher-risk CHD as defined by ICD codes.1 Frequency and characteristics of RSVH and BH and disease severity (including intensive care unit [ICU] admission and mechincal ventilation) for these children before and after the 2014 AAP guidance using the Children’s Hospital Association’s Pediatric Health Information System® (PHIS) data set were described. SAS version 9.4 was used for statistical analysis of this data, with z-tests method used to determine statistical significance.ResultsRSVH significantly increased after 2014 for all higher-risk CHD children aged ≤ 24 months (3.4% [1992 RSVH CHD/59,217 RSVH] before the 2014 guidance and 4.0% [1798 RSVH CHD/45,470 RSVH] after; P< 0.0001) and for the subgroup of children aged 12 to 24 months at the start of the RSV season (0.5% before the guidance and 0.8% after; P< 0.0001). Disease severity as measured by ICU admissions in the 12 to 24 months subgroup also significantly increased after the 2014 guidance (0.2% before the guidance and 0.3% after; P< 0.0001). Mechanical ventilation usage was not statistically significantly increased after the 2014 guidance (P=0.188). A similar pattern of results was found for BH.ConclusionRSVH, BH, and associated disease severity significantly increased among higher-risk CHD children aged 12 to 24 months, within the PHIS health system, after the 3 RSV seasons following the 2014 AAP RSV immunoprophylaxis recommendations.DisclosuresJaime Fergie, MD, AstraZeneca (Speaker’s Bureau)Sobi, Inc. (Speaker’s Bureau) Tara Gonzales, MD, Sobi, Inc. (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Xiaohui Jiang, MS, EpidStrategies (Employee) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Adam Bloomfield, MD, FAAP, Sobi, Inc. (Employee)

1520. Respiratory Syncytial Virus Hospitalizations (RSVH) and All-Cause Bronchiolitis Hospitalizations (BH) Among Children Aged ≤ 24 Months at the Start of RSV Season With Bronchopulmonary Dysplasia/Chronic Lung Disease of Prematurity (BPD/CLDP) Before and After the 2014 American Academy of Pediatrics (AAP) Policy

BackgroundThe AAP, in 2014, stopped endorsing palivizumab for use in children with BPD/CLDP born at < 32 weeks’ gestational age (wGA) between the ages of 12 to 24 months not requiring medical support during the 6 months before the start of RSV season and all children with BPD/CLDP born at > 32 wGA. We sought to understand the impact of the guidance change on RSVH and BH in children no longer advised for RSV immunoprophylaxis with palivizumab.MethodsChildren with BPD/CLDP aged ≤ 24 months at the RSV season start and hospitalized for RSV or bronchiolitis during the 2010-2017 RSV seasons (November-March) were studied. RSVH, BH, and BPD/CLDP were defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes. ICD-9 codes for wGA combine 31 and 32 wGA into one code. Therefore, for BPD/CLDP, we classified group 1 as children aged 12 to 24 months who were born at < 31 wGA and group 2 as those born at ≥ 31 wGA. The Children’s Hospital Association’s Pediatric Health Information System® (PHIS) data set was used to describe frequency and characteristics of RSVH and BH and disease severity (including intensive care unit [ICU] admission and mechanical ventilation [MV]) before and after the 2014 AAP policy. Statistical analyses were done using z-tests; SAS version 9.4.ResultsAmong children with BPD/CLDP, RSVH rates were 1.7% (1035/59,217) before 2014 and 2.1% (973/45,470) after 2014 (P< 0.0001). RSVH rose after the policy change vs before among children with BPD/CLDP in both group 1 (0.40% vs 0.26%; P< 0.0001) and group 2 (0.22% vs 0.14%; P=0.002). Similarly, BH also increased for both group 1 (P< 0.0001) and group 2 (P=0.002) after the guidance change vs before. Although ICU admissions increased significantly for children with BPD/CLDP in both group 1 (P< 0.0001) and group 2 (P=0.0004), use of MV (P=0.002) increased after 2014 for children with BPD/CLDP in group 1 only. Similar results were observed for BH.ConclusionThis analysis highlights the increase in RSVH, BH, and associated severity among BPD/CLDP subgroups within the PHIS health system after 2014. Further study of long-term complications associated with RSVH in these children is warranted.DisclosuresJaime Fergie, MD, AstraZeneca (Speaker’s Bureau)Sobi, Inc. (Speaker’s Bureau) Tara Gonzales, MD, Sobi, Inc. (Employee) Mina Suh, MPH, International Health, EpidStrategies (Employee) Xiaohui Jiang, MS, EpidStrategies (Employee) Jon Fryzek, PhD, MPH, EpidStrategies (Employee) Adam Bloomfield, MD, FAAP, Sobi, Inc. (Employee)

Update on respiratory syncytial virus hospitalizations among U.S. preterm and term infants before and after the 2014 American Academy of Pediatrics policy on immunoprophylaxis: 2011-2017

ABSTRACT Palivizumab is the only licensed respiratory syncytial virus (RSV) immunoprophylaxis (IP) available to prevent severe RSV disease in high-risk pediatric populations, including infants born at 29–34 weeks’ gestational age (wGA). In 2014, the American Academy of Pediatrics (AAP) stopped recommending RSV IP use for otherwise healthy 29–34 wGA infants and stated that 29–34 wGA infants and term infants have similar RSV hospitalization (RSVH) rates. This study aimed to compare RSV IP use and RSVH rates in 29–34 wGA infants and term infants during the 3 RSV seasons before and after the 2014 AAP policy change. RSV IP use in otherwise healthy infants 29–30, 31–32, and 33–34 wGA was estimated from pharmacy or outpatient medical claims for palivizumab. RSVH rates in the first 6 months of life were calculated per 100 infant-seasons. RSVH rate ratios were used to compare preterm infants and term infants before and after the policy change. Across infant cohorts (29–34 wGA) and chronologic age groups (<3 months and 3-<6 months), absolute decreases in RSV IP use between the combined 2011–2014 seasons and 2014–2017 seasons ranged from 7% to 38% and from 68% to 97%, respectively. Compared with 2011–2014, the RSVH risk increased 2.09-fold (P< .001) and 1.76-fold (P< .001) in 2014–2017 for infants born at 29–34 wGA and aged <6 months with commercial and Medicaid insurance, respectively. Overall, RSV IP use declined in the RSV seasons following the 2014 RSV IP policy change, and RSVH increased among 29–34 wGA infants aged <6 months.

Vascular Access in Children to Prevent and Treat Infectious Diseases.

* Abbreviations: CLABSI — : central line–associated bloodstream infection CVAD — : central venous access device miniMAGIC — : Michigan Appropriateness Guide for Intravenous Catheters in pediatrics PICC — : peripherally inserted central catheter PN — : parenteral nutrition PIVC — : peripheral intravenous catheter Although central venous access devices (CVADs) have become essential for the delivery of modern pediatric care, they are associated with serious, even life-threatening, complications. The most common serious complication is central line–associated bloodstream infection (CLABSI), in which bacteria or fungi enter the bloodstream through the lumen or the exit site of the CVAD. Approximately 10% of pediatric CLABSI episodes are associated with severe sepsis, causing organ damage or dysfunction that requires ICU-level care or results in death.1 An estimated 50% of children with CLABSI have persistent or recurrent infections that require catheter removal or replacement.1,2 In addition to the direct clinical impact, CLABSI adds to the expense of pediatric care, with each episode costing ∼$55 000 in the United States.3 The guidelines/recommendations in this article are not American Academy of Pediatrics policy, and publication herein does not imply endorsement. Clinicians face complex decisions when balancing risks and benefits of venous access devices, such as the benefit … Address correspondence to Joshua Wolf, MBBS, PhD, FRACP, Department of Infectious Diseases, St Jude Children’s Research Hospital, Mailstop 320, 262 Danny Thomas Pl, Memphis, TN. E-mail: joshua.wolf{at}stjude.org

Vascular Access in Hospitalized Children.

* Abbreviations: miniMAGIC — : Michigan Appropriateness Guide for Intravenous Catheters PICC — : peripherally inserted central catheter PIVC — : peripheral intravenous catheter VAD — : vascular access device Most hospitalized infants and children require a vascular access device (VAD). These devices, although essential, come with risks. The pediatric-focused version of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) provides guidance for pediatric hospitalists selecting the most appropriate VAD for specific clinical situations on the basis of what is currently known as well as the experience of experts regarding risks and benefits of various options.1 The guidelines/recommendations in this article are not American Academy of Pediatrics policy, and publication herein does not imply endorsement. A common decision point for many hospitalists is whether to place a peripherally inserted central catheter (PICC) in a hospitalized infant or child for a defined duration of peripherally compatible therapy, … Address correspondence to Erin E. Shaughnessy, MD, MSHCM, Division of Hospital Medicine, Phoenix Children’s Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016. E-mail: eshaughnessy{at}phoenixchildrens.com

Vascular Access in Children With Blood Disorders or Cancer.

* Abbreviations: CVAD — : central venous access device miniMAGIC — : Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics PICC — : peripherally inserted central catheter Children with disorders of blood and cancer frequently require long-term central venous access devices (CVADs) for recurrent blood draws, blood transfusions, and infusion of caustic medications, such as chemotherapy, immunotherapy, and biological agents. Their diagnosis puts them at increased risk for other comorbidities, such as systemic infection from neutropenia, along with thrombosis secondary to malignancy, immobility, chemotherapeutic agents (eg, steroids and asparaginase), or the underlying thrombogenic state of sickle cell disease.1–3 Therefore, careful consideration is needed when choosing a CVAD that is best for these patients. The guidelines/recommendations in this article are not American Academy of Pediatrics policy, and publication herein does not imply … Address correspondence to Julie Jaffray, MD, Division of Hematology, Oncology, and Bone Marrow Transplant, Department of Pediatrics, Children’s Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #54, Los Angeles, CA 90027. E-mail: jjaffray{at}chla.usc.edu

Screening for Problematic Internet Use.

Problematic Internet use (PIU) by adolescents is of growing concern among both parents and pediatricians. Early controversies may have contributed to challenges in defining and measuring PIU. A variety of screening tools have evolved, aligned with different constructs of PIU, although a validated screening tool does exist. Current data and American Academy of Pediatrics policy reflect evidence-driven screening for PIU for all youth.

Weight Management in Primary Care for Children With Autism: Expert Recommendations.

Research suggests that the prevalence of obesity in children with autism spectrum disorder (ASD) is higher than in typically developing children. The US Preventive Services Task Force and the American Academy of Pediatrics (AAP) have endorsed screening children for overweight and obesity as part of the standard of care for physicians. However, the pediatric provider community has been inadequately prepared to address this issue in children with ASD. The Healthy Weight Research Network, a national research network of pediatric obesity and autism experts funded by the US Health Resources and Service Administration Maternal and Child Health Bureau, developed recommendations for managing overweight and obesity in children with ASD, which include adaptations to the AAP's 2007 guidance. These recommendations were developed from extant scientific evidence in children with ASD, and when evidence was unavailable, consensus was established on the basis of clinical experience. It should be noted that these recommendations do not reflect official AAP policy. Many of the AAP recommendations remain appropriate for primary care practitioners to implement with their patients with ASD; however, the significant challenges experienced by this population in both dietary and physical activity domains, as well as the stress experienced by their families, require adaptations and modifications for both preventive and intervention efforts. These recommendations can assist pediatric providers in providing tailored guidance on weight management to children with ASD and their families.

Considerations for Addressing Low HIV Testing Rates Among Adolescent Men Who Have Sex With Men.

* Abbreviations: AAP — : American Academy of Pediatrics AMSM — : adolescent men who have sex with men PrEP — : preexposure prophylaxis SRH — : sexual and reproductive health In “Factors Associated with HIV Testing in Teenage Men Who Have Sex with Men,” Mustanski et al1 explore individual, family, school, and health care factors associated with lifetime receipt of an HIV test in a sample of adolescent men who have sex with men (AMSM) ( n = 699) between ages 13 to 18. The authors report low testing rates (23.3%) in this sample but found the following factors to be significant predictors of HIV testing: older age; sexual experience; HIV-related information, motivation, and behavioral skills; and discussions with a doctor about sexual orientation or male partners. Mustanski et al1 conclude with important recommendations for pediatricians to improve physician–patient communication about sex and sexuality with adolescent patients. The individual and practice-level changes suggested by Mustanski et al1 are important for pediatric providers and consistent with American Academy of Pediatrics (AAP) recommendations.2,3 There are numerous AAP policy statements and clinical reports emphasizing importance of sexual and reproductive health (SRH) services for adolescents as well as specific guidelines for the care of sexual and gender minority youth issued by the AAP2,4 and Society for Adolescent Health and Medicine, … Address correspondence to Errol L. Fields, MD, PhD, MPH, Department of Pediatrics, Johns Hopkins School of Medicine, 200 N Wolfe St #2027, Baltimore, MD 21287. E-mail: errol.fields{at}jhmi.edu