AAP Policy Statement. Child passenger safety

This Policy Is A Revision Of The Policy In

 127(4):788 

109(3):550 

97(5):761

PediatricsAugust 2018
From the American Academy of PediatricsPolicy Statement

http://pediatrics.aappublications.org/content/early/2018/08/28/peds.2018-2460 

Child Passenger Safety

Dennis R. Durbin, Benjamin D. Hoffman, COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION

Abstract

Child passenger safety has dramatically evolved over the past decade; however, motor vehicle crashes continue to be the leading cause of death for children 4 years and older. This policy statement provides 4 evidence-based recommendations for best practices in the choice of a child restraint system to optimize safety in passenger vehicles for children from birth through adolescence: (1) rear-facing car safety seats as long as possible; (2) forward-facing car safety seats from the time they outgrow rear-facing seats for most children through at least 4 years of age; (3) belt-positioning booster seats from the time they outgrow forward-facing seats for most children through at least 8 years of age; and (4) lap and shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles. It is important to note that every transition is associated with some decrease in protection; therefore, parents should be encouraged to delay these transitions for as long as possible. These recommendations are presented in the form of an algorithm that is intended to facilitate implementation of the recommendations by pediatricians to their patients and families and should cover most situations that pediatricians will encounter in practice. The American Academy of Pediatrics urges all pediatricians to know and promote these recommendations as part of child passenger safety anticipatory guidance at every health supervision visit.

Abbreviations:

AAP — 

American Academy of Pediatrics

CSS — 

car safety seat

Procedures for the Evaluation of the Visual System by Pediatricians

Donahue SP, Baker CN; Committee on Practice and Ambulatory Medicine; Section on Ophthalmology; American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology.
Pediatrics. 2016;137(1):1-9. doi: 10.1542/peds.2015-3597. Epub 2015 Dec 7
PubMed PMDI: 26644488

Vision screening is crucial for the detection of visual and systemic disorders. It should begin in the newborn nursery and continue throughout childhood. This clinical report provides details regarding methods for pediatricians to use for screening.

This clinical report supplements the combined policy statement from the American Academy of Pediatrics (AAP), American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology, and American Association of Certified Orthoptists titled “Visual System Assessment in Infants, Children, and Young Adults by Pediatricians.” The clinical report and accompanying policy statement supplant the 2012 policy statement “Instrument-Based Pediatric Vision Screening,” the 2003 policy statement “Eye Examination in Infants, Children, and Young Adults by Pediatricians,” and the 2008 AAP policy statement “Red Reflex Examination in Neonates Infants and Children.” The policy statement articulates the screening criteria and screening methods, and the clinical report explains the various evaluation procedures that are available for use by the pediatrician or primary care physician.

Visual System Assessment in Infants, Children, and Young Adults by Pediatricians

Committee on Practice and Ambulatory Medicine; Section on Ophthalmology; American Association of Certified Orthoptists; American Association for Pediatric Ophthalmology and Strabismus; American Academy of Ophthalmology.
Pediatrics. 2016;137(1):1-3. doi: 10.1542/peds.2015-3596
PubMed PMDI: 26644485

Appropriate visual assessments help identify children who may benefit from early interventions to correct or improve vision. Examination of the eyes and visual system should begin in the nursery and continue throughout both childhood and adolescence during routine well-child visits in the medical home. Newborn infants should be examined using inspection and red reflex testing to detect structural ocular abnormalities, such as cataract, corneal opacity, and ptosis. Instrument-based screening, if available, should be first attempted between 12 months and 3 years of age and at annual well-child visits until acuity can be tested directly. Direct testing of visual acuity can often begin by 4 years of age, using age-appropriate symbols (optotypes). Children found to have an ocular abnormality or who fail a vision assessment should be referred to a pediatric ophthalmologist or an eye care specialist appropriately trained to treat pediatric patients.

Missed Opportunities for Tuberculosis Screening in Primary Care.

J Pediatr. 2015 Feb 23. pii: S0022-3476(15)00084-0. doi:10.1016/j.jpeds.2015.01.037. [Epub ahead of print]
van der Heijden YF, Heerman WJ, McFadden S, Zhu Y, Patterson BL.

OBJECTIVE: 

To assess how frequently pediatric practitioners perform latent tuberculosis infection (LTBI) screening according to guidelines. We hypothesized that screening occurs less frequently among children whose parents do not speak English as the primary language.

STUDY DESIGN: 

We conducted a retrospective cohort study of patients attending well-child visits in an urban academic pediatric primary care clinic between April 1, 2012, and March 31, 2013. We assessed documentation of 3 LTBI screening identified as at high risk for LTBI. Of these, 514 (62%) did not have documented tuberculin skin test (TST) placement and documentation of results.
RESULTS: 

During the study period, 387 of 9143 children (4%) had no documentation of screening question responses. Among the other 8756 children, 831 (10%) were documentation of results, but non-Hispanic Black children were more likely to not TST placement in the appropriate time frame. Thirty-nine of 213 children (18%) who had a TST placed did not have documented results. Multivariable regression showed that parent language was not associated with TST placement or have a documented test result (aOR, 2.12; 95% CI, 1.07-4.19; P = .03) when results among high-risk children, the latter of which was associated with adjusting for age, sex, parent primary language, insurance status, day of the week, and study year of TST placement.
CONCLUSION: 

Parent primary language was not associated with LTBI testing. However, we found substantial gaps in TST placement and documentation of TST race/ethnicity. Targeted quality improvement efforts should focus on developing processes to ensure complete screening in high-risk children.