American Academy Of Pediatrics Statement Research Articles

Current Patterns of Probiotic Use in U.S. Neonatal Intensive Care Units: A Multi-Institution Survey.

Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States. A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact. Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation. Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use. · Probiotic use in preterm infants is likely increasing in U.S. NICUs, but clinical variability exists.. · The AAP statement on probiotic use in preterm infants had a modest impact on current practices.. · There's a need for better product regulation and consensus guidelines to ensure standardized use..

Options Counseling for the Pregnant Adolescent Patient.

Although teenage pregnancy rates have decreased over the past 30 years, many adolescents become pregnant every year. It is important for pediatricians to have the ability and the resources to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental counseling that includes the full range of pregnancy options. Counseling includes an unbiased discussion of the adolescent's options to continue or terminate the pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. It is important for pediatricians to be familiar with laws and policies impacting access to abortion care, especially for minor adolescents, as well as laws that seek to limit health care professionals' provision of unbiased pregnancy options counseling and referrals, either for abortion care or continuation of pregnancy in accordance with the adolescent's choice. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling that includes the full range of pregnancy options. Pediatricians should be aware of and oppose policies that restrict their ability to provide pregnant adolescents with unbiased counseling that includes the full range of pregnancy options. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.

Physician Compliance with Bronchiolitis Guidelines in Pediatric Emergency Departments

An online survey was administered through the American Academy of Pediatrics (AAP) Section of Emergency Medicine Survey Listserv in Fall, 2017. Overall compliance was measured as never using chest X-rays, viral testing, bronchodilators, or systemic steroids. Practice compliance was measured as never using those modalities in a clinical vignette. Chi-square tests assessed differences in compliance between modalities. t tests assessed differences on agreement with each AAP statement. Multivariate logistic regression determined factors associated with overall compliance. Response rate was 47%. A third (35%) agreed with all 7 AAP statements. There was less compliance with ordering a bronchodilator compared with chest X-ray, viral testing, or systemic steroid. There was no association between compliance and either knowledge or agreement with the guideline. Physicians with institutional bronchiolitis guidelines were more likely to be practice compliant. Few physicians were compliant with the AAP bronchiolitis guideline, with bronchodilator misuse being most pronounced. Institutional bronchiolitis guidelines were associated with physician compliance.

Navigating Privacy Laws to Deliver STI Health Services in High Schools.

* Abbreviations: FERPA — : Family Educational Rights and Privacy Act HIPAA — : Health Insurance Portability and Accountability Act PHI — : protected health information STI — : sexually transmitted infection In the American Academy of Pediatrics statement “Role of the School Nurse in Providing School Health Services,” the authors acknowledge that misinformation about federal privacy laws can be problematic,1 creating misunderstandings among pediatricians and school nurses that impact student care. Confusion arises when clinicians, covered by the Health Insurance Portability and Accountability Act (HIPAA), work collaboratively with school nurses, covered by the Family Educational Rights and Privacy Act (FERPA), to conduct health programs. The majority of school nurses report working with their local health department2 but are unsure about what procedures to follow for documenting and communicating health information, and existing federal guidance does not speak adequately to the complications arising from cross-sector collaboration.3 In this article, we use an example of a school-based sexually transmitted infection (STI) screening program to highlight the 2 main federal privacy laws that impact school and health provider collaboration: FERPA and HIPAA. State privacy laws and institutional policies impose restrictions beyond federal law. These local laws and policies vary, as does their intersection with federal law. School and health department collaborators must negotiate this complex web when they plan joint projects. Passed in 1974, FERPA is designed to protect students’ educational records.4 Any educational institution receiving funding from the US Department of Education must allow parents or an eligible student (>18 years of age or has begun postsecondary education) to access the student’s … Address correspondence to Patricia A. Elliott, DrPH, Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Ave, Room 440, Boston, MA 02118. E-mail: pelliott{at}bu.edu

To Forgo or Not to Forgo: Nutrition and Hydration in a Child Perceived to Be Suffering Inordinately by Parents (TH366)

•Attendees will be able to describe the American Academy of Pediatrics (AAP) position on forgoing medically administered nutrition and hydration (MANH) for pediatric patients.•Attendees will gain an appreciation for the ethical, religious, spiritual ,and cultural dimension of the question at hand: whether it is ever appropriate to forgo MANH in a seriously ill child who is neither actively dying nor unaware, though is suffering.•Attendees will develop practical skills to mitigate circumstances in which the loving values and preferences of parents for their child conflict with the child's best interest, as perceived by some healthcare professionals. The American Academy of Pediatrics (AAP) has deemed forgoing medically administered nutrition and hydration (MANH) for pediatric patients ethically acceptable in selected circumstances, when there is consensus that the provision of fluids and nutrition do not confer a net benefit to the child. The practice, for instance, might be permissible for a child who permanently lacks awareness and ability to interact with the environment or a child in the dying process for whom nutrition/hydration simply may prolong and add morbidity. It is common practice, for instance, in hospice patients to forgo MANH at the end of life to avoid harmful side effects (respiratory distress, edema, skin breakdown) and mitigate suffering (through uremia and ketosis). But what about the case of a child who is neither actively dying nor unaware, whose parents perceive them to be experiencing inordinate suffering? In this interactive, case-based session, a multidisciplinary panel (including the AAP statement's first author) will explore how to navigate situations where loving parents' values and preferences for their child, which we usually strive to honor and uphold, conflict with the child's best interest, as perceived by some healthcare professionals. Several pediatric palliative medicine physicians and pediatrician-ethicists will analyze the AAP position with special attention to what makes this decision especially complex for children, including the emotional resonance of feeding, the inability of infants to feed themselves, and the best interest standard. A pediatric chaplain will review the religious and spiritual dimensions of this decision, with specific reference to the Ethical and Religious Directives of the Roman Catholic Church, which directly address this issue. Attendees will leave with a deeper understanding of this complex issue as well as practical tools for working through real-life cases in a culture that is increasingly suffering-averse.

A Call to Action: Screening Fathers for Perinatal Depression.

* Abbreviations: AAP — : American Academy of Pediatrics PPD — : postpartum depression In early 2019, the American Academy of Pediatrics (AAP) released a policy statement1 recognizing that “maternal depression affects the whole family” and urging pediatric providers to “incorporate recognition and management of perinatal depression into pediatric practice.” Soon after, the US Preventive Services Task Force issued new recommendations on interventions to prevent perinatal depression.2 The convergence of these 2 statements from nationally recognized bodies of experts in evidence-based medicine underscores the urgency of a heightened focus on screening and making referrals for perinatal depression in pediatric practice. The new recommendations do not go far enough and risk being out of touch with contemporary American families. The US Preventive Services Task Force evidence review and recommendations are focused exclusively on interventions to prevent maternal depression. The AAP statement acknowledged paternal postpartum depression (PPD) as an established clinical problem yet called for pediatricians to screen solely mothers at the 1-, 2-, 4-, and 6-month well-child visits and “consider screening the partner as well” at the 6-month visit. We believe it is inadequate to treat the recognition and management of paternal depression as extra or optional. To promote optimal outcomes for children, pediatric providers must assess the mental health and adjustment to parenting of all new parents, regardless of gender or marital status, and make appropriate referrals for needed care. Fathers’ time spent with children has nearly tripled since 19653; even among unmarried couples, fathers typically want to be and are involved with their children. … Address correspondence to Tova B. Walsh, PhD, School of Social Work, University of Wisconsin, 1350 University Ave, Madison, WI 53706. E-mail: tbwalsh{at}wisc.edu

Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policy

The American Academy of Pediatrics (AAP) recently published a policy statement: Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Although almost all clinics and professional associations in the world use what’s called the watchful waiting approach to helping gender diverse (GD) children, the AAP statement instead rejected that consensus, endorsing gender affirmation as the only acceptable approach. Remarkably, not only did the AAP statement fail to include any of the actual outcomes literature on such cases, but it also misrepresented the contents of its citations, which repeatedly said the very opposite of what AAP attributed to them.

Pediatric Assent and Treating Children Over Objection.

* Abbreviation: AAP — : American Academy of Pediatrics More than 20 years ago, the pioneering pediatric ethicist William Bartholome1 wrote a fiery letter to the editor of this journal because he thought a recently published statement on pediatric assent, from the Committee on Bioethics of the American Academy of Pediatrics (AAP), showed insufficient respect for children.2 That AAP statement, like its 2016 update, asserts that pediatric assent should be solicited only when a child’s dissent will be honored.3,4 Bartholome1 objected that pediatricians should always solicit children’s assent and that they should acknowledge and apologize when they treat children over their objections even when they must do so to promote children’s best interests. We think Bartholome1 was right. In this brief commentary, we elaborate on his perspective about the moral value of pediatric assent, and we suggest improvements to the corresponding clinical guidance. The AAP grounds the moral value of pediatric assent by noting, “We are obliged to act out of fundamental respect for other persons by virtue of their personal autonomy.” But in drawing on the concept of autonomy, the AAP invokes too narrow a conception of respect. Indeed, the AAP acknowledges that many children “lack the agency required to be truly autonomous agents.”3 If respect is grounded … Address correspondence to Jason Adam Wasserman, PhD, William Beaumont School of Medicine, Oakland University, ODH 412, 586 Pioneer Dr, Rochester, MI 48371. E-mail: wasserman{at}oakland.edu

Physical Punishment and Child Externalizing Behavior: Comparing American Indian, White, and African American Children.

This study examined if, compared to White and African American children, maternal spanking of American Indian children was associated with child externalizing behavior problems. Using a community-based sample of 3,632 children (1,183 White, 2,183 African American, 266 American Indian), multiple-group autoregressive cross-lagged models examined the associations between maternal spanking and child externalizing behavior across the first 5 years of life. Rates of spanking for American Indian and White children were similar at all three time points (age 1, age 3, and age 5). When comparing White and American Indian groups, maternal spanking at age 1 predicted child externalizing behavior at age 3 (White: β = .10, p < .001; American Indian: β = .08, p < .01), and maternal spanking at age 3 predicted child externalizing behavior at age 5 (White: β = .09, p < .05; American Indian: β = .08, p < .01). When comparing African American and American Indian groups, maternal spanking at age 1 predicted child externalizing behavior at age 3 (African American: β = .08, p < .01; American Indian: β = .06, p < .001), and maternal spanking at age 3 predicted child externalizing behavior at age 5 (African American: β = .08, p < .001; American Indian: β = .07, p < .001). Structural invariance tests suggested that the associations observed among American Indian children were not distinguishable from those observed among White and African American children. Results of this study can be interpreted in light of the recent American Academy of Pediatrics statement that encourages pediatricians to counsel parents against the use of physical punishment. Similar to White and African American families, American Indian families may benefit from reducing or eliminating the use of physical punishment.

Physician Compliance With Bronchiolitis Guidelines in Pediatric Emergency Departments.

An online survey was administered through the American Academy of Pediatrics (AAP) Section of Emergency Medicine Survey Listserv in Fall, 2017. Overall compliance was measured as never using chest X-rays, viral testing, bronchodilators, or systemic steroids. Practice compliance was measured as never using those modalities in a clinical vignette. Chi-square tests assessed differences in compliance between modalities. t tests assessed differences on agreement with each AAP statement. Multivariate logistic regression determined factors associated with overall compliance. Response rate was 47%. A third (35%) agreed with all 7 AAP statements. There was less compliance with ordering a bronchodilator compared with chest X-ray, viral testing, or systemic steroid. There was no association between compliance and either knowledge or agreement with the guideline. Physicians with institutional bronchiolitis guidelines were more likely to be practice compliant. Few physicians were compliant with the AAP bronchiolitis guideline, with bronchodilator misuse being most pronounced. Institutional bronchiolitis guidelines were associated with physician compliance.

Do Professional Society Advocacy Campaigns Have an Impact on Pediatric Orthopaedic Injuries?

The American Academy of Orthopaedic Surgeons (AAOS) and the American Academy of Pediatrics (AAP) both advocate for childhood injury prevention by publishing recommendations to orthopaedic surgeons, pediatricians, and the public. Popular topics of advocacy campaigns have included trampolines, all-terrain vehicles (ATVs), and lawnmowers. The purpose of this study was to investigate the temporal relationship between AAOS/AAP advocacy and pediatric orthopaedic injury rates, using these topics as examples. We hypothesized that pediatric orthopaedic injury rates decline in years, following related AAOS/AAP recommendations. A retrospective review of fractures associated with trampolines, lawnmowers, and ATVs among patients aged 2 to 18 years from 1991 to 2014 was performed using the National Electronic Injury Surveillance System (NEISS). Fracture rates and percent changes year-to-year were calculated. A timeline of AAOS and AAP advocacy statements published on the products was created. Trampoline-related fractures rose 14% yearly from 1991 to 1999, reached a plateau from 1999 to 2003, corresponding with a 1999 AAP statement. Injury rates dropped 4.3% from 2006 to 2010 after 2005 and 2006 statements, and reached another plateau thereafter, as 2010 and 2012 statements were published. ATV-related fractures rose 14% yearly between 1997 and 2002, then dropped 15% from 2007 to 2010 following yearly AAP or AAOS statements from 2004 to 2007. From 2010 to 2014, the injury rate held constant during which time 2010, 2013, and 2014 statements were published. Lawnmower injury rates did not fall despite statements in 1998 and 2001 and a poster campaign in 2001. A 25% drop from 2007 to 2008 coincided with an AAOS statement in 2008. Fracture rates further dropped 31% from 2009 to 2011 and 21% from 2012 to 2014, amidst 2012 and 2014 statements. For ATV-related and lawnmower-related injuries, more male individuals were affected than female individuals, and for ATVs alone, injury rates increased with age. Although AAOS/AAP statements did not universally coincide with dropping fracture rates, statements often were associated with substantial decreases in following years. This is likely because injury prevention messages are dispersed from providers to the public over time and outcomes depend on highly variable patient behaviors. Level V-systematic review of descriptive data.

Cardiovascular health supervision for Duchenne Muscular Dystrophy; data from the MD STARnet

BackgroundIn 2005, the American Academy of Pediatrics (AAP) published a policy statement on cardiovascular health supervision for Duchenne Muscular Dystrophy (DMD). Data is lacking on its effect on cardiovascular care. MethodsUsing the infrastructure of the Muscular Dystrophy Surveillance, Tracking and Research Network, we examined a population-based sample of individuals with DMD, focusing on cardiac testing and prescription of cardiac medication. Comparisons were made pre- (2000–2005) and post- (2006–2011) publication Results731 cases were studied; mean age of diagnosis 3.8 years and mean duration of follow-up 9.3 years. There was a significant decrease in time from diagnosis to first electrocardiogram (ECG) and echocardiogram (ECHO) from pre- to post-publication; 1047 (95% CI: 905–1188) days to 411 (95% CI: 324–498) days for ECG (p < 0.01) and 1153 (95% CI: 1022–1284) days to 352 (95% CI: 280–424) days for ECHO (p < 0.01). Only 4.5% and 8.2% of those ≥10 years of age met the recommendation for yearly ECG and ECHO respectively. Prescription of a cardiac medication with an abnormal ECHO increased post-publication 91/125, 72.8% versus pre- 47/77, 61.0% (p = 0.08). After 2005, cases with a normal ECHO were 2.3 (95% CI 1.23–4.31) times more likely to be prescribed a cardiac medication (p < 0.01). ConclusionsSince publication of the AAP statement, DMD patients are having cardiac testing sooner and cardiac medication is prescribed more often. However, the majority are not having testing with recommended frequency. Overcoming barriers to recommended cardiac care may lead to a better understanding of the natural history of cardiomyopathy in DMD and better treatment strategies.

Options Counseling for the Pregnant Adolescent Patient.

Each year, more than 500 000 girls and young women younger than 20 years become pregnant. It is important for pediatricians to have the ability and the resources in their offices to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental pregnancy options counseling. Counseling includes an unbiased discussion of the adolescent's legal options to either continue or terminate her pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.

Depression Is a Deadly Growing Threat to Our Youth: Time to Rally.

In this month’s issue of Pediatrics , Mojtabai and colleagues1 sound an alarm with 2 critical public health updates; depression is significantly on the rise in adolescents, with a 12-month prevalence of 11.3% in 2014 versus 8.7% in 2005. Furthermore, despite this disturbing development, the percentage of young people with a history of past-year major depressive episodes seen by primary care providers for depression care is only ∼10% and has not appreciably budged in the past decade. The second point is disappointing because it occurs despite a 2007 American Academy of Pediatrics statement,2 which could have possibly had an impact on the comparison between 2005 and 2014. This statement strongly encouraged all pediatricians to recognize and identify the risk factors for suicide, then the third leading cause of death for adolescents 15 to 19 years old, of which depression was and remains … Address correspondence to Anne Glowinski, MD, MPE, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Washington University in St Louis, 4444 Forest Park Ave, St Louis, MO 63108. E-mail: glowinsa{at}wustl.edu

Recommendations for the Use of Inhaled Nitric Oxide Therapy in Premature Newborns with Severe Pulmonary Hypertension

Recommendations for the Use of Inhaled Nitric Oxide Therapy in Premature Newborns with Severe Pulmonary Hypertension

The Current and Ideal State of Mental Health Training: Pediatric Resident Perspectives

Phenomenon: Mental health (MH) problems are prevalent in the pediatric population, and in a setting of limited resources, pediatricians need to provide MH care in the primary medical home yet are uncomfortable doing so citing a lack of training during residency as one barrier. Approach: The purpose of this study is to describe pediatric residents’ experiences and perspectives on the current and ideal states of MH training and ideas for curriculum development to bridge this gap. A qualitative study using focus groups of pediatric residents from an urban academic medical center was performed. Audio recordings were transcribed and analyzed using a grounded theory approach. Findings: Twenty-six residents participated in three focus groups, which is when thematic saturation was achieved. The team generated five major themes: capabilities, comfort, organizational capacity, coping, and education. Residents expressed uncertainty at every step of an MH visit. Internal barriers identified included low levels of comfort and negative emotional responses. External barriers included a lack of MH resources and mentorship in MH care, or an inadequate organizational capacity. These internal and external barriers resulted in a lack of perceived capability in handling MH issues. In response, residents reported inadequate coping strategies, such as ignoring MH concerns. To build knowledge and skills, residents prefer educational modalities including didactics, experiential learning through collaborations with MH specialists, and tools built into patient care flow. Insights: Pediatric residency programs need to evolve in order to improve resident training in MH care. The skills and knowledge requested by residents parallel the American Academy of Pediatrics statement on MH competencies. Models of collaborative care provide similar modalities of learning requested by residents. These national efforts have not been operationalized in training programs yet may be useful for curriculum development and dissemination to enhance trainees’ MH knowledge and skills to provide optimal MH care for children.

Not just little adults: a review of 102 paediatric ethics consultations.

The American Academy of Pediatrics statement on institutional ethics committees highlights the importance of paediatric ethics consultation. However, little has been published on actual experience with ethics consultation in paediatrics. The objective of this study was to review and describe topics covered by a large retrospective sample of clinical ethics consultations in paediatric medicine. We reviewed ethics consultations involving patients of <18years of age from January 2005 to July 2013 at one institution. Descriptive statistics of the patient population, the reason for the ethics consultation and the consultant's perceived contribution to the case were generated. Subgroups of patients were compared based on demographic and clinical characteristics using Wilcoxon's rank sum tests, chi-square tests and logistic regression models. Most of the 102 eligible consultations originated from intensive care units and were requested by attending physicians. The most frequent topic leading to consultation was end-of-life issues. Both younger age and male sex were associated with consults for end-of-life issues (p<0.001 and p=0.010). This analysis provides important information describing the type of consults requested in paediatric medicine, which is necessary given the movement towards professionalising clinical ethics consultation. Further empirical research is needed on ethics consultation in paediatrics.

AAP Principles Concerning Retail-Based Clinics

The American Academy of Pediatrics views retail-based clinics (RBCs) as an inappropriate source of primary care for pediatric patients, as they fragment medical care and are detrimental to the medical home concept of longitudinal and coordinated care. This statement updates the original 2006 American Academy of Pediatrics statement on RBCs, which flatly opposed these sites as appropriate for pediatric care, discussing the shift in RBC focus and comparing attributes of RBCs with those of the pediatric medical home.

Planned Home Birth: A Violation of the Best Interests of the Child Standard?

* Abbreviations: AAP — : American Academy of Pediatrics The American Academy of Pediatrics (AAP) has long and consistently championed the best interests of the child standard as the foundation of pediatric ethics.1 This standard obligates pediatricians to protect and promote the biopsychosocial interests of children who are patients, as these interests are determined in deliberative (evidence-based, rigorous, transparent, and accountable) clinical judgment and practice. The interests of parents do not play a direct role in the conceptualization of this standard, although the ability and willingness of parents to participate in the health care of their child can become ethically relevant considerations in some cases. It is worth noting that, in pediatric ethics, the best interests of the child standard generates the ethical obligation of parents to protect and promote the biopsychosocial interests of their children when their children are patients. The recent AAP statement, “Planned Home Birth,” endorses the ethical position of the American College of Obstetricians and Gynecologists in its statement on planned home birth2: “The American Academy of Pediatrics concurs with the recent statement of the American College of Obstetricians and Gynecologists affirming that hospitals and birthing centers are the safest settings for birth in the United States while respecting the right of women to make an informed decision about delivery.”3 The AAP statement also recommends that “there should be at least 1 person present at every delivery whose primary responsibility is the care of the newborn infant.”3 The AAP can take these positions only if they are consistent with the best interests of the child standard. The purpose of this article is to call into question whether the AAP statement is indeed consistent with this foundational standard of pediatric ethics. The resolution of this question depends directly on the preventable, increased perinatal risks of planned home birth. … Address correspondence to Frank A. Chervenak, MD, New York Presbyterian Hospital, 525 East 68th St, M-724, Box 122, New York, NY 10065. E-mail: fac2001{at}med.cornell.edu

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

The goal of this statement was to review the available literature on surveillance, screening, evaluation, and management strategies and put forward a scientific statement that would comprehensively review the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population. A writing group appointed by the American Heart Association and American Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles were also searched. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and management of developmental disorder or disability has been constructed to serve as a supplement to the 2006 American Academy of Pediatrics statement on developmental surveillance and screening. The proposed algorithm is designed to be carried out within the context of the medical home. This scientific statement is meant for medical providers within the medical home who care for patients with CHD. Children with CHD are at increased risk of developmental disorder or disabilities or developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.