Pediatric Medical Subspecialists Research Articles

Pediatric Medical Subspecialist Use in Outpatient Settings

A first step toward understanding whether pediatric medical subspecialists are meeting the needs of the nation's children is describing rates of use and trends over time. To quantify rates of outpatient pediatric medical subspecialty use. This repeated cross-sectional study of annual subspecialist use examined 3 complementary data sources: electronic health records from PEDSnet (8 large academic medical centers [January 1, 2010, to December 31, 2021]); administrative data from the Healthcare Integrated Research Database (HIRD) (14 commercial health plans [January 1, 2011, to December 31, 2021]); and administrative data from the Transformed Medicaid Statistical Information System (T-MSIS) (44 state Medicaid programs [January 1, 2016, to December 31, 2019]). Annual denominators included 493 628 to 858 551 patients younger than 21 years with a general pediatric visit in PEDSnet; 5 million beneficiaries younger than 21 years enrolled for at least 6 months in HIRD; and 35 million Medicaid or Children's Health Insurance Program beneficiaries younger than 19 years enrolled for any amount of time in T-MSIS. Calendar year and type of medical subspecialty. Annual number of children with at least 1 completed visit to any pediatric medical subspecialist in an outpatient setting per population. Use rates excluded visits in emergency department or inpatient settings. Among the study population, the proportion of girls was 51.0% for PEDSnet, 51.1% for HIRD, and 49.3% for T-MSIS; the proportion of boys was 49.0% for PEDSnet, 48.9% for HIRD, and 50.7% for T-MSIS. The proportion of visits among children younger than 5 years was 37.4% for PEDSnet, 20.9% for HIRD, and 26.2% for T-MSIS; most patients were non-Hispanic Black (29.7% for PEDSnet and 26.1% for T-MSIS) or non-Hispanic White (44.9% for PEDSnet and 43.2% for T-MSIS). Annual rates for PEDSnet ranged from 18.0% to 21.3%, which were higher than rates for HIRD (range, 7.9%-10.4%) and T-MSIS (range, 7.6%-8.6%). Subspecialist use increased in the HIRD commercial health plans (annual relative increase of 2.4% [95% CI, 1.6%-3.1%]), but rates were essentially flat in the other data sources (PEDSnet, -0.2% [95% CI, -1.1% to 0.7%]; T-MSIS, -0.7% [95% CI, -6.5% to 5.5%]). The flat PEDSnet growth reflects a balance between annual use increases among those with commercial insurance (1.2% [95% CI, 0.3%-2.1%]) and decreases in use among those with Medicaid (-0.9% [95% CI, -1.6% to -0.2%]). The findings of this cross-sectional study suggest that among children, 8.6% of Medicaid beneficiaries, 10.4% of those with commercial insurance, and 21.3% of those whose primary care is received in academic health systems use pediatric medical subspecialty care each year. There was a small increase in rates of subspecialty use among children with commercial but not Medicaid insurance. These data may help launch innovations in the primary-specialty care interface.

Preterm Babies: At the Hospital

Preterm Babies: At the Hospital

COVID: How to Prepare for Your Child’s COVID Vaccination

COVID-19 virus is still spreading. That's why getting the vaccine is the best thing to do for your child's health. It also helps make sure that your kids can keep attending school and other activities that are so important for their physical and mental health.The COVID-19 vaccine is available to kids 5 years old and up. The COVID shot for children 5 years to 11 years old is a lower dose than the dose recommended for people 12 years and older. The only COVID-19 vaccine presently available for children older than 5 years in the U.S. is the Pfizer BioNTech mRNA vaccine.It's time for eligible children to get the COVID vaccine, get protected and protect the health of their families and friends!The American Academy of Pediatrics (AAP) recommends that all eligible children and adults 5 years and older should get the COVID-19 vaccine as soon as they can. Your child is considered up to date if they have received all recommended doses for their age.Encourage your child to keep doing their part to protect others by wearing a face mask and following other steps to keep people with a high risk of infection safe. Then they can get back to activities they enjoy like sports, choir, plays and parties with some added confidence that they are protected!American Academy of Pediatricswww.aap.org and www.HealthyChildren.orgAdapted from the HealthyChildren.org article COVID Vaccine Checklist for Kids Age 5-11 (1/7/2022).The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Circumcision: What You Need to Know

Parents have different opinions about newborn male circumcision based on medical, religious, cultural, and ethnic traditions and personal reasons. Some parents choose circumcision. Some parents do not choose circumcision. Parents who are undecided should talk with their child’s doctor before their baby is born. They can learn about the benefits and risks of circumcision to help them choose what is best for their baby. Here is more information from the American Academy of Pediatrics (AAP) about circumcision.At birth, males have skin that covers the end of the penis, called the foreskin. Circumcision is the surgical removal of the foreskin, exposing the tip of the penis. Circumcision is usually performed by a doctor in the first few days after birth. The surgery should be done under sterile conditions with adequate pain management. (See Is circumcision painful?) A newborn must be stable and healthy to safely be circumcised. Because circumcision may be riskier if done later in life, parents should decide before or soon after their baby is born if they want it done.Yes. However, there are pain medicines that are safe and effective. The AAP recommends that they be used to reduce pain from circumcision.After the circumcision, the tip of the penis may seem raw or yellowish. If there is a bandage, it should be changed with each diapering to reduce the risk of infection. Use petroleum jelly to keep the bandage from sticking. Sometimes a plastic ring is used instead of a bandage. This should drop off within 5 to 8 days. The penis should be fully healed in about 1 week to 10 days after circumcision.Problems after a circumcision are very rare. However, call your child’s doctor right away if If you choose not to have your baby circumcised, talk with your child’s doctor about how to keep the penis clean. Keep in mind that the foreskin will not fully retract for several years and should never be forced. When your child is old enough, they can learn how to keep their penis clean just as they will learn to keep other parts of their body clean. Female genital mutilation has sometimes been called female circumcision, although it has no known medical benefits and causes many known harms, both medical and psychological. It involves removing part or all of a female’s clitoris. It may also include sewing up the opening of the vagina. It is often done without any pain medicine. The purpose of this practice is to prove that a female is a virgin before marriage, reduce the ability to experience sexual pleasure, and promote marital fidelity. There are many serious side effects, includingThe AAP is absolutely opposed to this practice in all forms because it is disfiguring and has no medical benefits.Visit HealthyChildren.org for more information.The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Head Lice: What You Need to Know

Head Lice: What You Need to Know

Get Fit, Stay Healthy

Patient Education| 2022 Get Fit, Stay Healthy Pediatric Patient Education (2022) https://doi.org/10.1542/peo_document075 Connected Content Translation: Logra un buen estado físico y mantente saludable Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Get Fit, Stay Healthy. Pediatric Patient Education 2022; 10.1542/peo_document075 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsPediatric Patient EducationAll AAP Sites Search Advanced Search Topics: aerobic exercise, exercise, healthy lifestyle, heart, physical activity, sleep, sports, stairs, oxygen, bone diseases Any type of regular physical activity can improve your fitness and your health—even walking, taking the stairs, or mowing the lawn. The most important thing is that you keep moving! Being physically active can help To be fit, you might find it helpful to work on all aspects of fitness, including Physical activity should be a regular part of your day, like brushing your teeth, eating, and sleeping. It can be done in gym class, on a sports team, or as a workout on your own. In addition to physical activity, here are some other ways to live a healthy lifestyle. American Academy of Pediatrics www.aap.org and www.HealthyChildren.org The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults. In all aspects of its publishing... You do not currently have access to this content.

Face Masks for Children During COVID-19

Masks remain a simple but powerful tool to help prevent the spread of COVID-19. They are especially important for children who are too young for the vaccine. Read on for answers to some frequently asked questions about masks, children, and COVID-19.A well-fitting high quality face mask reduces the chance of contracting COVID-19, as well as spreading COVID-19 infection to others. Face masks should not be worn by children if they are under 2 years old. Face masks are strongly encouraged for:Note: Infants and children under 2 years old are too young for the vaccine and too young to wear face masks. To protect them, people who have close contact with infants and young children should wear face masks.Well-fitting face masks worn by everyone 2 years old and older and adults, including child care teachers, regardless of vaccination status protects them as well as others—especially if they are not vaccinated.In K-12 schools, students, teachers, staff and visitors should be supported if they continue wearing masks. The same is true for anyone who continues wearing masks for sports.Face masks have been around for a couple of years, but mask wearing is still new to a child who is turning 2. Here are a few ideas that might help make your child more comfortable when they are getting used to wearing a mask:It may be challenging for very young children not to fidget with their face mask. Expect to give your child plenty of gentle reminders not to touch their face mask. When mask-wearing is reinforced by adults and peers, they will learn to follow directions. Just like children understand that they must wear bicycle helmets and buckle into their car seats, they will learn to wear masks correctly and routinely when needed.For children under 3, it's best to answer their questions simply in language they understand. If they ask about why people are wearing face masks, explain that sometimes people need to wear them to stay healthy.For children over 3, try focusing on germs. Explain that germs are special to your own body. Some germs and good and some are bad. The bad ones can make you sick. Since we can't always tell which are good or bad, the face masks help make sure you keep those germs away from your own body.Children with weakened immune systems or who have health conditions or special health care needs that put them at high risk for infections are encouraged to wear an N95 mask for protection. Those with medical conditions that interfere with cognitive or lung function may have a hard time tolerating a face mask. For these children, special precautions may be needed. Families are encouraged to have a plan and discuss appropriate masks and precautions with their pediatrician.Look for a well-fitting comfortable face mask that fits your child's face. The mask should fit securely under the chin but not impair vision, and cover the mouth and nose. It should fit snugly along the sides of the face without any gaps. Remember to wash hands before and after wearing it and avoid touching it once it's on. When back home, avoid touching the front of the face mask by taking it off from behind.Note: Face masks should not be worn when eating or drinking. Also, make sure the mask has no choking or strangulation hazards for young children.Along with COVID-19 vaccination and boosters, mask wearing when recommended and other safety measures such as physical distancing, testing and hand washing are key to reducing SARS-CoV-2 infection and spread. If you have any concerns about your child's health, talk with your pediatrician.American Academy of Pediatricswww.aap.org and www.HealthyChildren.orgAdapted from the HealthyChildren.org article Face Masks for Children During COVID-19 (4/21/22).The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Suicide Prevention: Safety Plan

If your child is feeling depressed and having suicidal thoughts, help your child create a safety plan. Click on the PDF icon above to download a safety plan that you and your child or teen can fill out.Adapted from the AAP patient education brochure, Suicide Prevention: What Parents Need to Know. The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults. In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Books for Parents From the American Academy of Pediatrics

The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.As part of the AAP mission, the AAP publishes a number of books for parents. All are written in straightforward language and are based on sound medicine and commonsense advice from the nation’s top pediatricians. Having these on your bookshelf is like having a pediatrician on call 24 hours a day, 7 days a week!Check out a book, if available, from your local library, or purchase your own copy. You can order directly online from the AAP bookstore or place an order with AAP Member and Customer Care.AAP Member and Customer CareHours : 7:30 am–5:00 pm (CST), Monday–FridayPhone: 888/227-1770 toll-free in the United States and Canada; 630/626-6000 outside the United States and CanadaEmail: mcc@aap.orgWebsite: https://shop.aap.org/parenting-resources

Guidance for Structuring a Pediatric Intermediate Care Unit

The purpose of this policy statement is to update the 2004 American Academy of Pediatrics clinical report and provide enhanced guidance for institutions, administrators, and providers in the development and operation of a pediatric intermediate care unit (IMCU). Since 2004, there have been significant advances in pediatric medical, surgical, and critical care that have resulted in an evolution in the acuity and complexity of children potentially requiring IMCU admission. A group of 9 clinical experts in pediatric critical care, hospital medicine, intermediate care, and surgery developed a consensus on priority topics requiring updates, reviewed the relevant evidence, and, through a series of virtual meetings, developed the document. The intended audience of this policy statement is broad and includes pediatric critical care professionals, pediatric hospitalists, pediatric surgeons, other pediatric medical and surgical subspecialists, general pediatricians, nurses, social workers, care coordinators, hospital administrators, health care funders, and policymakers, primarily in resource-rich settings. Key priority topics were delineation of core principles for an IMCU, clarification of target populations, staffing recommendations, and payment.

Clinical Judgment and Child Development, Revisited.

Child development is the clinical process that distinguishes pediatrics from all other medical specialties, and concerns about development, learning, and behavior are among the most prevalent clinical issues encountered by all pediatricians. Thus, clinical judgment in child development should be highly valued. Instead, pediatrician clinical judgment has been widely criticized, shifting recent focus to parent-completed developmental screening.1,2 The article by Zubler et al3 in this issue of Pediatrics may provide an opportunity to reassert clinical judgment into the medical developmental assessment process.The sensitivity and positive predictive value (PPV) of developmental screens drops considerably when moving from research to real-world clinical settings. For example, recent studies of the use of the Modified Checklist for Autism (M-CHAT) for screening in large health care networks in the United States have reported sensitivities ranging from only 33% to 39% and PPVs ranging from only 15% to 18%.4,5 A population-based study in Norway reported the PPV of the M-CHAT to be only 1.5%, which is equivalent to the PPV of a coin flip.6 Similarly, general developmental screening using instruments such as the Ages and Stages Questionnaire has been shown to have variable utility with very young children and children in low-resource settings.7 It seems, then, that rather than focusing exclusively on parent-completed screens, the clinical judgment and accumulated clinical experiences of pediatricians should be taken advantage of in the developmental assessment process.Developmental screening certainly has an important role in the developmental assessment process; standardized parent-completed screens are clearly a quick and efficient way to identify the chief complaint of a developmental concern. The most recent American Academy of Pediatrics clinical report on developmental surveillance and screening recommends consideration of referring those children who fail screening to a pediatric medical subspecialist, such as a neurodevelopmental pediatrician, developmental-behavioral pediatrician, pediatric neurologist, or pediatric physiatrist, for developmental evaluation and diagnosis.8 However, the severe discrepancy between the nearly 20 million children in the United States with concerns about development, learning, and/or behavior and the low numbers of pediatric medical subspecialists to whom to refer (including <800 practicing board-certified developmental-behavioral pediatricians) makes this recommendation unfeasible for the vast majority of children who fail screening.9 It seems more achievable to remodel pediatric training (beyond the current 4-week rotation in developmental–behavioral pediatrics) and practice to improve clinical developmental assessment, and the work of Zubler et al is a first step in this direction.3Zubler et al have established evidence-informed developmental milestones across motor, cognitive, language/communication, and social-emotional domains that are easily observed in natural settings for use in developmental surveillance at specific health supervision visit ages.3 Developmental surveillance is all about clinical judgment, and it contains the essence of medical training: taking a history and performing an examination (in this case, taking a developmental history and performing a developmental examination). The evidence-informed developmental milestones provided by Zubler et al provide some standardization to this clinical process of developmental surveillance.3 These evidence-informed milestones can be used to obtain a developmental history that identifies both perturbations in development (delay, dissociation, and deviation) that characterize specific developmental diagnoses and the pattern of developmental delay (static, acute, or progressive) that is critical for medical workup and recommendations for therapeutic intervention. Such historical information based on evidence-informed milestones, combined with the clinical judgment of well-trained and experienced pediatricians, should provide far more robust developmental information than a pass/fail score from a screen.Given the number of children with concerns about development, learning, and behavior, and the performance of developmental screens in real-world practice, attempts to validate clinical developmental assessment in primary care may be the best solution to the gross mismatch between the demand for and supply of pediatric medical subspecialists; although, to be truly successful, efforts to improve clinical developmental assessment must be linked to efforts to ensure access to early intervention. Zubler et al have provided milestones to inform clinical judgment in developmental history-taking, so the next step might be to design a similar evidence-informed developmental examination process that pediatricians can use to confirm the historical information provided by parents. In this way, all pediatricians may be able to practice their basic science of child development10 using valid and reliable clinical tools such as those suggested by the work of Zubler et al.3

Diverse and Inclusive Books For Children

Reading diverse and inclusive books is a wonderful way to allow children to see themselves reflected, learn about other people and their experiences, imagine themselves in another place or time, imagine themselves in another person's experiences, recognize our similarities, and celebrate differences.Reading is more than fundamental. It provides the opportunity to teach our children about kindness, compassion, and empathy for others and that diversity of stories matter. All kids should be able to see themselves as the stars of their own stories. As there is not one type of child, there should not be one type of story. Read on for a sampling of favorite titles collected by pediatricians to help families select and share books with young children. This list was created in collaboration between Reach Out and Read and the American Academy of Pediatrics (AAP) Section on Minority Health, Equity and Inclusion, the Book List Committee of the AAP Council on Early Childhood, and the Reach Out and Read Book Committee.Adapted from the HealthyChildren.org article Recommended Reading: Diverse & Inclusive Books For Children by the American Academy of Pediatrics Section on Minority Health, Equity and Inclusion, Book List Committee of the AAP Council on Early Childhood, and Reach Out and Read Book Committee (9/15/2021). The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults. In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion. Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Talking With Your Children About Racism: Start, Continue the Conversation

Racism and discrimination harms everyone in our communities.As a parent, you must assume children of almost any age may experience racism first-hand or are exposed to racism. Children may be called names or bullied. They may also overhear adult conversations, see online videos, or watch news coverage of actions ranging from unfair treatment or unkind words to violent protests or hate crimes. Some actions may make children feel afraid for their own safety or their family's safety. They might have questions about why people are hurting other people.Ideally you can talk with them first, in ways they can understand, before they hear about it from other sources. When talking to your children, keep the following tips in mind:It's OK to acknowledge that people are treated differently based on the color of their skin and where they live and share examples of this happening. But this is also an opportunity to show your children how to make a positive difference. For example, perhaps your family can call your city council person or superintendent to advocate for issues faced by communities of color. Think about how you might confront your own biases and show how you want your children to respond to others who may be different than them.If we are to progress in this country, it's going to be because we help our children, adolescents and young adults learn not just that racism exists, but that it is something all of us can work together to dismantle.Adapted from the HealthyChildren.org article Talking to Children about Racism: The Time is Now by Nia Heard-Garris, MD, MSc, FAAP, and Jacqueline Dougé, MD, MPH, FAAP (1/7/2021).The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Protecting Your Child With the COVID-19 Vaccine

The American Academy of Pediatrics recommends COVID-19 vaccines for all eligible children 5 years and older.Millions of kids and teens already have been safely vaccinated.Vaccination protects your child from becoming seriously ill or dying from COVID. The vaccine was found to be 90.7% effective in children ages 5-11 and 100% effective in children ages 12- 15.The COVID-19 vaccine is remarkably effective and safe. About 8.7 million children ages 5-11 have safely had at least one dose. The vaccines are continuously monitored for safetyJust like with every vaccine your child has received, they may have mild, temporary side effects like fatigue, chills or a headache. Some children have no vaccine side effects.Children under 18 years of age receive two doses, 21 days apart, with a dose approved for their age. Kids 12 and older should get a booster at least five months after the second dose.Children who have recovered from COVID should still get vaccinated. It is unknown how long your child's immunity will last, and the vaccine will strengthen their immune response to variants.Ask your pediatrician. We are here to answer your questions and help you with your decision.Source: COVID-19 Vaccine Campaign ToolkitThe American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Talking to Children About Racial Bias

Given the tragic and racially-charged current events, many parents are wrestling with their own feelings, the hopes they have for their children, and the difficulty of helping those children thrive in a world full of racial bias.Parents may better face today's challenges with an understanding of how racial bias works in children, as well as strategies to help them deal with and react to racial differences.Children learn about racial differences and racial bias from an early age and learn from their first teachers—their parents—how to deal with and react to these differences.The process of learning racial bias is a lot like learning a new language (e.g., a child raised bilingual vs. a child who starts learning Spanish in junior high). Biology determines a critical early learning period as well as a later window where learning is much harder.But like language immersion, children exposed to society will gain fluency in racial bias even if their parents do nothing.There are three strategies that parents can use to help their children deal with racial bias:Parents must first confront their own biases, so that their example is consistent with messages of racial and ethnic tolerance.Talking about race is not racist. It's OK—and important. From a young age, children may have questions about racial differences and parents must be prepared to answer them. But, it's important to keep your child's developmental readiness in mind.These conversations begin to lay the groundwork for your child to accept and respect everyone's differences and similarities. As children mature, the answers to questions will become more complex. These are moments to learn what your child understands or is struggling to understand about racial bias.To create a culture of inclusiveness, we all must look at and acknowledge our biases, so we can do something about the ones that are unfair or cause harm to others—like racial bias. Understanding the way people feel about and behave toward those outside their own group can help communities heal after a tragedy, as well as prevent future ones.Adapted from the HealthyChildren.org article Talking to Your Children About Racial Bias by Ashaunta Anderson, MD, MPH, MSHS, FAAP, and Jacqueline Dougé, MD, MPH, FAAP (6/25/20).The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

COVID-19: What Families Need to Know

COVID-19, discovered in December 2019, quickly became a global pandemic. Doctors and researchers continue to learn more about it every day. Now, safe and effective vaccines and boosters are recommended for many children and teens. While the virus continues to spread, everyone should stay up to date with their vaccines. COVID-19 vaccines work to protect you from getting sick. Based on what is known about COVID-19 vaccines and other recommended vaccines for kids, people who are up to date with their vaccines are well protected from getting seriously sick or having other health problems. Here's what we know now and how you can protect your family and others.Symptoms of COVID-19, which is caused by the SARS-CoV-2 virus, range from mild to severe and generally begin 2-14 days after being exposed to the virus. Someone with these symptoms may have COVID-19:According to the U.S. Centers for Disease Control (CDC), unvaccinated children seem to be at higher risk for getting severely ill with COVID-19. Some children with special health care needs also may be at higher risk, including those with chronic medical conditions such as:If you are concerned about your child's symptoms, call your pediatrician right away.Many children with COVID-19 have mild symptoms or have no symptoms at all, and most children with COVID-19 infection have recovered. However, some have become severely ill and have been hospitalized, and some have died. In addition, like adults, some children and teens with COVID-19, even with few or no symptoms, have developed post-COVID conditions such as long-haul COVID.Here are a few things you can do to keep your family healthy:The Food and Drug Administration has given emergency use authorization for monoclonal antibody therapies to treat mild to moderate COVID symptoms in some adults, adolescents, children or infants. They may help block the SARS-CoV-2 virus from entering cells and make it easier for the body to destroy the virus.Only one monoclonal antibody therapy for children (sotrovimab) may be effective against the omicron variant. There is a very limited supply of this medicine. To be considered for sotrovimab, adolescents must be age 12 or older and weigh at least 88 pounds; have had symptoms of SARS-CoV-2 infection and a positive COVID test for less than 10 days; and be at high risk of getting very sick from COVID-19, but not yet hospitalized.Some children at high risk for severe illness from COVID-19 may be eligible for monoclonal antibody treatment to protect them before they are exposed to the virus. If your child is high risk and you are concerned about them being exposed to COVID, call your pediatrician to discuss if this is an option.Another option that is authorized for people at high risk of severe COVID illness is oral antiviral medication (paxlovid and molnupiravir). One of these antivirals is authorized for children as young as 12 years, but it is too soon to know how well it works in children.Home remedies families may hear about on social media, such as ivermectin, azithromycin and hydroxychloroquine/chloroquine are NOT proven effective against COVID-19 and can be toxic if used incorrectly.People who are mildly ill with COVID-19 are usually able to isolate at home during their illness. However, it may be recommended to take these additional steps:In children, the goal should be to improve their overall comfort, monitor their activity, look for signs of serious illness, and make sure they drink enough liquids.For questions about over-the-counter medication such as ibuprofen or acetaminophen, call your pediatrician. As with any medication, be sure to use the syringe or dropper that came with the product to measure the correct amount. Never use a kitchen measuring spoon to dose liquid medicine.News coverage and disinformation posted online about COVID-19 can be frightening to kids. Parents and other adults who work closely with children to filter information and talk about it in a way that their child can understand. These tips can help:American Academy of Pediatricswww.aap.org and www.HealthyChildren.orgAdapted from the HealthyChildren.org article COVID-19: What Families Need to Know (1/7/2022).The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Sleeping Well: Tips for Parents of Babies and Young Children

It’s important for children to develop good sleep habits early on. Sleeping well is important to children’s development and well-being. Here is information from the American Academy of Pediatrics to help ensure a good night’s sleep for children—and parents too! Remember that children differ in how much sleep they need, how long it takes them to fall asleep, and how easily they wake up. If you have any questions about your child’s sleep habits, ask your child’s doctor.Babies do not have regular sleep cycles until about 4 months of age. Although newborns sleep about 16 to 17 hours per day, they may sleep for only 1 or 2 hours at a time. As babies get older, they need less sleep. Keep in mind that your baby’s sleep needs and patterns may differ from those of other babies.Many parents find their toddler’s bedtime to be the hardest part of the day. Children this age often resist going to sleep, especially if they have older siblings who are still awake.American Academy of Pediatrics www.aap.org and www.HealthyChildren.orgAdapted from the American Academy of Pediatrics (AAP) brochure Sleep Problems in Children.The AAP is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Tips for Parents of Adolescents: Common Concerns

Adolescence is the time between childhood and adulthood that children go through many physical and emotional changes. Here is information from the American Academy of Pediatrics about common concerns during adolescence. Teen is used in this publication to refer to adolescents, teenagers, preteens, and tweens. Many teens try extreme diets or exercise programs because they want their bodies to look like those of the models, singers, actors, or athletes they see in the media, or they have a misguided understanding of what is “healthy.” Be aware of any diet or exercise program your teen is following. Many diets are unhealthy for teens because they do not have the nutritional value that bodies need during puberty. If you have questions about your teen’s nutritional needs, ask their doctor. If you are concerned about rapid weight loss or suspect your teen has an eating disorder, contact your teen’s doctor right away. Eating disorders like anorexia nervosa and bulimia nervosa can be very dangerous, and treating them promptly is critical for recovery. If your teen wants to train with weights, they should check with their doctor, as well as a trainer, coach, or physical education teacher. Also, help create a positive self-image by praising teens for their strengths and not focusing on their appearance. Set a good example by making eating right and exercising a part of your daily routine. Avoid negative self-talk or dieting. At home, stock up on healthy snacks like fruit, raw vegetables, whole-grain crackers, and yogurt, and limit unhealthy snacks like candy, cookies, chips, and soda pop. Teens are naturally curious about sex. This is completely normal and healthy. However, teens may be pressured into having sex too soon by their peers or the media. Talk with your teen to understand their feelings and views about sex. Start early, and provide them with access to accurate and appropriate information. Making healthy decisions about sex is important. Before your teen becomes sexually active, make sure you discuss Teens may try or use tobacco like vaping devices, e-cigarettes, or chewing tobacco, and alcohol, or other drugs, out of curiosity or to deal with peer pressure. Help build self-confidence or self-esteem in your teen. Ask your teen about any concerns and problems they are facing, and help them learn how to deal with strong emotions and cope with stress in healthy ways. If you suspect your teen is using drugs, talk with your teen’s doctor. Note: If you or someone else in the household smokes, now is a good time to quit. Watching a parent struggle through quitting can be a powerful message for a teen who is thinking about starting. It also shows you care about your health as well as your teen’s. Alcohol is not only the most socially accepted drug in our society but also one of the most abused and destructive. Even small amounts of alcohol can impair judgment, provoke risky and violent behavior, and slow down reaction time. An intoxicated teen (or anyone else) behind the wheel of a car makes it a lethal weapon. Alcohol-related car crashes are the leading cause of death for teens and young adults aged 15 to 24 years. Although it’s illegal for people younger than 21 years to drink, we all know most teens are not strangers to alcohol. Many of them witness alcohol use throughout their childhood, and many begin alcohol use as teens. If you choose to use alcohol in your home, be aware of the example you are setting. Well-child visits (annual health supervision visits) are especially important during adolescence. Your teen’s doctor will make sure your teen is on a healthy track and suggest necessary changes to get on track and how to stay on track. American Academy of Pediatrics www.aap.org and www.HealthyChildren.orgThe American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults. In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Tips for Coping with a New Baby During COVID-19

All babies cry. Most babies cry a lot from two weeks to two months of age. Some cry more than others, and some cry longer than others. For many new parents, crying is one of the most stressful parts of coping with a newborn.In some cases, extreme stress and a temporary lapse of emotional control in a caregiver can lead to actions that result in abusive head trauma. In fact, the most common trigger for abusive head trauma is simply a crying baby. As an American Academy of Pediatrics policy statement points out, actions that lead to abusive head trauma often happen when caretakers experience stress and get to the end of their rope.However, there is a bright side: The key to preventing abusive head trauma is to understand how common feelings of frustration, isolation, and exhaustion are during the first few months of an infant’s life.Usually, new parents can seek out social supports and external help—but what when we are all restricted in our movements and our contacts? What happens when families face child care challenges and more ongoing fallout from the COVID-19 pandemic? Here are a few suggestions:American Academy of Pediatricswww.aap.org and www.HealthyChildren.orgAdapted from the HealthyChildren.org article Tips for Coping with a New Baby During COVID-19 by Robert Sege, MD, PhD, FAAP (1/13/2022).The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.In all aspects of its publishing program (writing, review, and production), the AAP is committed to promoting principles of equity, diversity, and inclusion.The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Telehealth: Improving Access to and Quality of Pediatric Health Care

All children and adolescents deserve access to quality health care regardless of their race/ethnicity, health conditions, financial resources, or geographic location. Despite improvements over the past decades, severe disparities in the availability and access to high-quality health care for children and adolescents continue to exist throughout the United States. Economic and racial factors, geographic maldistribution of primary care pediatricians, and limited availability of pediatric medical subspecialists and pediatric surgical specialists all contribute to inequitable access to pediatric care. Robust, comprehensive telehealth coverage is critical to improving pediatric access and quality of care and services, particularly for under-resourced populations.