AAP Updates Recommendations to Prevent Drowning in Children

Drowning can be silent and quick, and it kills nearly 1,000 children every year. To refocus the attention of parents and physicians on one of the leading causes of death among children, the American Academy of Pediatrics is publishing updated recommendations on water safety.

“Drowning is the single leading cause of injury-related death among children ages 1 to 4,” said Sarah Denny, MD, FAAP, lead author of the policy statement, “Prevention of Drowning” published online March 15, 2019, in Pediatrics. “Many of these deaths occur when children are not expected to be swimming or when they have unanticipated access to water. Toddlers are naturally curious; that’s why we must implement other strategies, such as pool fencing and door locks.”

The second age group at highest risk of drowning deaths is teens, said Dr. Denny. Every year, about 370 children ages 10 to 19 drown. “Adolescents can be overconfident in their swimming abilities and are more likely to combine alcohol use with swimming – compounding their risk significantly. Children of color, especially African American teens are especially at risk.”

In the policy statement, the AAP lays out strategies to protect children at each stage of their life. New parents are advised to be vigilant at bath time and to empty all buckets and wading pools immediately. All children should learn to swim, and children and teens should wear life jackets while near open bodies of water. Teens can learn CPR and other water safety skills.

Injury prevention has long been a priority of pediatricians, and public health initiatives over the past 50 years have led to dramatic reductions in deaths from injuries related to motor vehicle crashes, sudden infant death syndrome, drowning, and other unintentional injuries. In the past few years, however, the rate of decline in these deaths has slowed.

Drowning remains the third leading cause of unintentional injury-related death among children ages 5-19 years. In 2017, nearly 1,000 children died from drowning and 8,700 visited a hospital emergency room because of a drowning event – with toddlers and teens at the highest risk.

The topic will be the subject of a panel presentation March 16, when leaders of the AAP will gather in Itasca, Ill., for an annual leadership conference. Family advocates, including Nicole and Jonathan Hughes, and Bode Miller, will share their experiences of losing a child to drowning. The panel will also include Sam Hanke, MD, FAAP, who lost his son to sudden infant death, and parent Greg Schell, chair of the AAP Family Partnerships Network. The panel will address recent trends in preventable child injuries, and how pediatricians can work with families to improve child health.

“We appreciate the chance to partner with these families, who have decided to channel their grief to help other parents prevent a similar tragedy. It is critically important for us to collaborate with families and communities to protect kids from drowning” said Ben Hoffman, MD, FAAP, Chair of the AAP Council on Injury, Violence & Poison Prevention. “Pediatricians should be talking about water safety routinely during well-child visits. But having families share their personal stories, we hope, will help connect with parents who may think it could ‘never happen’ to them. Tragically, it can happen to anyone.”

AAP will also publish new information for families on its website for parents, HealthyChildren.org, including water safety advice based on children’s developmental stages, and recommendations on choosing a good learn-to-swim program.

“Research has found that swim lessons are beneficial for children starting around age 1, and may lower drowning rates”, said Linda Quan, MD, FAAP, a co-author of the policy statement.

“Learning to swim is a great family activity,” said Dr. Quan. “Families can talk with their pediatrician about whether their child is developmentally ready for swim lessons, and then look for a program that has experienced, well-trained instructors. Ideally, programs should teach ‘water competency’ too – the ability to get out of the water if your child ends up in the water unexpectedly.”

Even the best swim lessons cannot “drown-proof” a child, and so AAP strongly recommends parents take steps that make a child’s environment safer. For homes with a pool, the most important safety measure is a 4-sided fence that completely surrounds the pool and isolates if from the house.

AAP also recommends:

  • Parents and caregivers should never leave children alone or in the care of another child while in or near bathtubs, pools, spas, or other open water.
  • Adults should empty water from buckets and other containers immediately after use.
  • Do not leave young children alone in the bathroom. Toilet locks can prevent drowning of toddlers.
  • When infants or toddlers are in or around the water, a supervising adult with swimming skills should be within an arm’s length, providing constant “touch supervision.”
  • Even with older children and better swimmers, the supervising adult should focus on the child and not be engaged with other distracting activities.

“Water is everywhere, and we need multiple layers to protect children from the deadly risks it poses,” said Dr. Quan. “As pediatricians, we cannot overlook this risk. Pediatricians can help by counseling families and working in their communities to improve safety, especially around pools, lakes and in boating communities.”


©The American Academy of Pediatrics, March 2019. The American Academy of Pediatrics 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 infants, children, adolescents and young adults. For more information, visit www.aap.org.

5 Questions to Ask Before a Playdate

Playdates are a fun way for children to develop friendships and learn important social skills. Visiting another family’s home will also expose your child to a new environment.

Before the playdate, it’s a good idea to talk with the other parent about household habits, rules and expectations. It’s also a great opportunity to share any important details about your child―like a food or pet allergy or other health issues.

Here are a few important questions to ask:

1. Who will be watching the children?

​Will a parent be home, or will another adult caregiver be home? Will older siblings, other adults or relatives be there? If it’s a sleepover, it’s a good idea to understand who will be in the home when your child is there, including other relatives or adults. If you feel uncomfortable with the situation, you can suggest your child have a “late over,” with fun pajama time, games or a movie, and then come home when it’s time to sleep.

2. Do you have a swimming pool, trampoline, or any other things that are potentially unsafe?

The American Academy of Pediatrics (AAP) recommends pools be surrounded by a four-foot high, four-sided fence with a self-latching gate, so that kids can’t easily enter without supervision. If swimming is planned, ask who will supervise. Whenever children under age 5 are in or around water, an adult―preferably one who knows how to swim and perform CPR―should be within arm’s length, providing “touch supervision.” Older children and teens who know how to swim should also have an adult supervising them.

​​Trampolines are popular among children and teens, but cause thousands of injuries every year, especially to children under age 6. Injuries often happen when more than one person is using the trampoline. Because injuries are so common, the AAP recommends trampolines never be used at home, but if they are used, supervising adults should limit jumpers to one at a time.

3. Do you have any guns in your house?

Roughly one-third of U.S. homes with children have a gun, and many of these are left unlocked or loaded. Just talking to a child about the dangers of firearms is not enough. Children are naturally curious. If a gun is accessible in someone’s home, there is a good chance a child will find it and play with it. Tragedies have occurred when kids found guns that parents thought were hidden.

​​If the home your child is visiting does have a gun, ask how it is stored. All guns should be stored unloaded and locked up, with the ammunition locked up separately. If you are uncomfortable with the answer, you can offer to host the kids at your house instead.

4. What are your rules about screen media use?

Families have different rules about what kind of movies or video games are allowed. If you don’t want your child to watch movies that are rated higher than PG or PG-13, or to play a video game rated higher than E, let the other parent know. You can explain you don’t think your child is ready for more mature content yet.

To research whether a particular movie or game is ok for your child, use a site like Common Sense Media, which offers detailed reviews and ratings on movies, TV shows, apps and video games.

5. What pets are in the house?

If the family has a pet, ask if it’s friendly. Let the parent know if your child is nervous or scared around animals. More than any other age group, children are the most frequent victims of animal bites.

It’s ok if the conversation feels a little awkward. The other parent is likely to be glad you asked―and you can volunteer the same information about your home for the next time the kids get together.


Source: American Academy of Pediatrics (Copyright © 2018). The information contained on this Web site 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.


Community-Based Resilience-Building

Whether the community encompasses civic groups, religious organizations, schools, sports leagues, or any and all groups that serve youth, it can promote healthy development by creating conditions in which families can thrive and by offering community-based resources including youth development and enrichment programs.

If you represent a school, community, or program that’s thinking about using a positive youth development or resilience-based strategy to transform the way young people are approached, consider organizations that will work closely with you to evaluate needs, suggest infrastructure changes, and frame interventions. Here are a few well-respected groups that can rise to meet your needs:

What Parents Can Do Within Their Community or as a Community Leader

  • Notice the acts of generosity and compassion shown by youth and spread these good news stories. Don’t notice only the heroic acts, but also the everyday acts; recognize kindness and contribution as the norm.
  • Advocate for the positive portrayal of youth in the community. Ask for a shift away from media coverage where only the highest achievers and delinquents get airtime.
  • Advocate for public health messages that don’t just tell kids what not to do but fervently tell kids what to do, and recognize that most youth are already doing the right thing.
  • Advocate for enrichment programs in communities and schools, especially in those areas most at risk that currently only have prevention programs. This doesn’t mean you should suggest that risk-based programs be cut.
  • Give youth opportunities to contribute to their communities. When they’re out serving others, their value will be noticed and they’ll receive those vital reinforcing displays of gratitude.
  • Work with the parents in your community so that young people have appropriate role models, rules, and boundaries that ensure safety. If these are seen as normal in your community, adolescents will have less reason to rebel.

Including Youth Wisdom

Young people who contribute to the well-being of their community and are noticed for their efforts will be more likely to stay engaged. We must never forget that youth are the experts on themselves. We increase the quality of the program and the benefits to the participants when we ask youth for advice in designing a program. Young people who help programs design services may become leaders in those same or future programs.

If you want to guide the youth of a community toward positive behaviors, consider creating peer educators and positive role models. Messages hold a certain resonance when transmitted from someone to whom peers can relate. At the same time, peer educators have more credibility when they’re linked with respected adult experts. Understand also who the peer opinion leaders are (not necessarily the best students or class officers) and influence them to model appropriate behaviors.


Source: Building Resilience in Children and Teens, 2nd Edition , Copyright © 2011 American Academy of Pediatrics). The information contained on this Web site 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.


Celebrate Earth Day, April 22!

Earth Day is an annual event celebrated on April 22. Worldwide, various events are held to demonstrate support for environmental protection. First celebrated in 1970, Earth Day now includes events in more than 193 countries, which are now coordinated globally by the Earth Day Network.

Here are a few ways you and your family can celebrate in Connecticut:

For more, try a Google search on “Earth Day 2019 events in CT.”

A Guide to Reading With Your Child

Start talking, singing, and reading with your child from the beginning. He will learn that reading is a fun activity you share together.

  • Point to words as you read them, showing your child that the print carries the story.
  • Ask your child to name things she sees in the pictures. Talk about how the pictures relate to the story.
  • Reading doesn’t have to be a huge project. Even a 3 minute story every night before bedtime will help your child learn.

Discuss Healthy Active Living using The Very Hungry Caterpillar:

  • Teach your child that apples, pears, plums, strawberries, and oranges are all fruits. Ask him if he can name other fruits.
  • Talk to her about how fruits are good for the body.
  • Talk about how when the caterpillar overeats, he gets a stomachache— so it is important to stop eating when you feel full.
  • Talk about how some foods are “sometimes” foods—like cake and ice cream—and how it is not a good idea to eat them all the time.
  • After reading the page where the caterpillar eats the green leaf and feels better, talk to your child about how you too eat green leaves (lettuce, spinach, cabbage, etc.) and how it is good for your body.
  • Teach your child that is important to eat healthy foods, so he can grow up healthy and active like a butterfly.

Download a printable guide that contains healthy eating tips and a reader’s guide to using The Very Hungry Caterpillar to encourage conversations about healthy eating. Print it out and share it with family and friends.


The information contained on this web site 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.


Healthy Active Living for Families

Healthy nutrition starts as early as infancy with breastfeeding. Once your baby begins eating solid foods, introduce nutritious foods early on and often. Sometimes toddlers need to try a food 10 times before they actually accept and enjoy it. It is also important to encourage play time as soon as they start crawling and walking. As your children grow, continue to help them live a healthy active lifestyle.

To lead a healthy active life, families can strive to reach these goals:

  • 5 fruits and vegetables a day,
  • 2 hours or less of screen time (TV, computer, video games) per day,
  • 1 hour of physical activity a day, and
  • 0 limit sugar-sweetened drinks.

To help children live healthy active lives, parents can:

  • be role models themselves by making healthy eating and daily physical activity the norm for their family.
  • create a home where healthy choices are available and encouraged.
  • make it fun – find ways to engage your children such as: playing a game of tag, cooking healthy meals together, creating a rainbow shopping list to find colorful fruits and vegetables, go on a walking scavenger hunt through the neighborhood, or grow a family garden.

In addition to 5, 2, 1, 0, families can make small changes in their family routines to help everyone lead healthier active lives. Try:

  • Eating breakfast every day;
  • Eating low-fat dairy products like yogurt, milk, and cheese;
  • Regularly eating meals together as a family;
  • Limiting fast food, take out food, and eating out at restaurants;
  • Preparing foods at home as a family;
  • Eating a diet rich in calcium; and
  • Eating a high fiber diet.

Help your children form healthy habits now. Healthy active children are more likely to be healthy active adults!


Source: American Academy of Pediatrics (Copyright © 2010). The information contained on this Web site 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.


Food Additives: What Parents Should Know

Food additives have been used for thousands of years, ever since people realized salt could keep meat from spoiling. Today, there are more than 10,000 additives approved by the U.S. Food and Drug Administration (FDA) to preserve, package, or modify the taste, look, texture, or nutrients in foods. But increasing evidence suggests some chemicals used as food additives should be avoided―especially for children.

Food Additives Effects on Kids

The American Academy of Pediatrics (AAP) policy, “Food Additives and Child Health,” explains that a rising number of studies suggest some food additives may interfere with hormones, growth, and development Some may also raise a child’s risk of obesity. Children may be particularly susceptible to the effects of these additives, given that they have more exposure than adults due to their size and dietary intake.

Below is a list of the most commonly used food additives and the current health concerns. This list includes indirect additives, which are used in processing or packaging, as well as direct additives that are put directly into foods.

How to Reduce Your Family’s Exposure to Food Additives

  • Buy fresh or frozen. It’s best to buy and serve fresh or frozen fruits and vegetables when possible.
  • Eat fewer processed meats. Try to avoid processed meats, such as hot dogs, ham and meats in pre-packaged meals, especially during pregnancy.
  • Wash plastic food containers and utensils by hand, rather than in the dishwasher. Heat can cause plastics to leak BPA and phthalates into food. Avoid microwaving food or beverages―including infant formula and breastmilk―in plastic, if possible.
  • Use glass and stainless steel. Especially when cooking or serving hot foods, use alternatives to plastic, such as glass or stainless steel, when possible.
  • Learn plastic recycling codes. Look at the recycling code on the bottom of products to find the plastic type. Try to avoid plastics with recycling codes 3 (phthalates), 6 (styrene), and 7 (bisphenols) unless plastics are labeled as “biobased” or “greenware,” which means they are made from corn and do not contain bisphenols.
  • Wash your hands. Because chemicals from plastics are so common in items we touch throughout the day, be sure to wash your hands thoroughly before and after handling food.
  • Speak out. Join the AAP and other organizations calling for more research into food additives’ safety, including improvements to the U.S. food additive regulatory program and retesting some previously approved additives. A recent review of nearly 4,000 food additives showed that 64% of them had had no research showing they were safe for people to eat or drink. While some change to the current law could be achieved by the FDA, some may require congressional action.

Common Questions from Parents About Food Additives

How do I find out which additives are in foods? Additives that are put directly in foods are listed on ingredient labels, but often with their chemical names. For example, salt may be listed as sodium chloride, sugar as sucrose, vitamin C as ascorbic acid, and vitamin E as alpha-tocopherol. Artificial colors are usually listed by their numbers, such as Blue #2 or Yellow #5. However, there are also indirect additives from processing or packaging materials that are not listed on the ingredient labels. These can include chemicals from plastic, glues, dyes, paper, cardboard, and different types of coatings.

Are additives a problem in any baby products? The FDA recently banned BPA from baby bottles and sippy cups, but the chemical is still used in some food and beverage containers. Many companies have voluntarily removed BPA from their products, but in many cases replaced it with chemicals such as bisphenol S (BPS) that may have similar health effects. In 2017, the Consumer Product Safety Commission banned the use of some phthalates in child-care products such as teething rings.

Do artificial food colors cause childhood hyperactivity? More research is needed to better understand how artificial food colors (AFCs) may or may not impact a child’s behavior. This is because much of the original research on these additives were animal studies that did not include behavioral affects. For some children with attention-deficit/hyperactivity disorder (ADHD) and other problem behaviors, the AAP says that until we know more, it may be helpful to eliminate AFCs from their diet if they seem to worsen symptoms.

The Future of Food Additives

Many new techniques are being researched that will improve how additives are produced. One approach is the use of biotechnology, which can use simple organisms to produce food additives. These additives are the same as food components found in nature.

Remember..aAlthough there are ways to limit the amount of potentially harmful food additives in your family’s diet, stronger federal food safety requirements will help keep all children healthy


Last Updated 7/23/2018. Source: American Academy of Pediatrics (Copyright © 2018). The information contained on this Web site 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.


5 Great Reasons to Cook with Your Kids

When it comes to raising an adventurous eater, it is not just about coaxing kids to eat their veggies. Bringing up a child who can enjoy a cantaloupe as much as a cupcake takes patience and persistence, but it does not have to feel like a chore.

Kids may need to have frequent joyful experiences involving food to overcome the anxiety they may have around tasting the unfamiliar. Over time, cooking with your children can help build that confidence—and provide rich sensory experiences.

Here are five ways to enjoy cooking with your children while raising an adventurous eater along the way.

  1. Engage other senses. For a hesitant eater, tasting an unfamiliar food can sometimes be intimidating. You can help your child explore foods when cooking using other senses besides taste. This helps to build positive associations with food. Kneading dough, rinsing vegetables, and tearing lettuce all involve touching food and being comfortable with texture. The complex flavors we experience when eating food come from both taste sensations from the tongue AND smelling with the nose. While cooking with new ingredients, some children may feel too overwhelmed to taste. If this happens, you can try suggesting smelling a food first; this may provide a bridge to tasting in the future.
  2. Use cooking to raise smart kids. There are so many lessons that can be taught while cooking. Math concepts like counting, measurement, and fractions naturally unfold when navigating a recipe with kids. Explaining how food changes with temperature or how certain foods can help our body be healthy provide great lessons in science. While cooking with your child, practice new vocabulary as you describe how food looks, feels, and tastes. Following a recipe from start to finish helps build the skills for planning and completing projects.
  3. Make cooking part of the family culture. The family meal can start in the kitchen as you cook together. Family meal preparation is an opportunity to celebrate your cultural heritage by passing down recipes. Help your kids find new, seasonal recipes to add to your repertoire and family cookbook. Cooking together and prioritizing health over the convenience of processed food are great ways to lead by example and help your children buy into a culture of wellness. Building daily and seasonal traditions around cooking together helps strengthen your family’s commitment to a healthy lifestyle.
  4. Keep it safe. Teach kids the importance of staying safe while cooking by showing them how to hold kitchen tools safely, how to use oven mitts to protect hands from heat, and how to turn appliances on and off safely. Always supervise children when cooking to ensure they are sticking with safe and age-appropriate tasks. The best way to keep cooking safe is to know your child’s abilities and his or her stage of development. A four-year-old child, for example, may not be ready to sauté vegetables over a hot pan, but may have the fine motor skills to rinse fruits or tear salad leaves. Keeping safety in mind, it is not difficult to get kids—even toddlers—involved in the kitchen.
  5. Ask for input. Children feel more included in mealtime when they are asked to be a part of meal preparation. Collaborate with your kids when selecting recipes for main dishes or sides. Let them help you make the shopping list and find groceries in the store or farmers market. When cooking together, let children offer a critique of the foods you are preparing. Together you can decide what ingredients you should add to enhance the flavor. Talk about how people enjoy different tastes, and share your preferences with each other. Letting children be “in charge” of details like how to set the table will help them feel invested in mealtime.

Over many years, cooking as a family will help develop a happy, adventurous eater with some pretty valuable life skills—and plenty of happy memories in the kitchen. With enough practice, your child will someday be able to cook YOU a delicious meal!


Author: Nimali Fernando, MD, MPH, FAAP. Source: American Academy of Pediatrics (Copyright © 2016). The information contained on this Web site 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.


March is National Nutrition Month

Choosing nutritious foods and getting enough physical activity can make a real difference in your health. For National Nutrition Month® 2019, in March, the Academy of Nutrition and Dietetics encourages people to make informed food choices and develop sound eating and activity habits.

Each March, the Academy focuses attention on healthful eating through National Nutrition Month®. “Through the campaign, we share good eating tips such as how to keep nutritious meals simple, the importance of making food safety a part of your everyday routine, the value of preparing meals with foods you have on hand to avoid wasting food, and how to select nutritious food options when dining away from home,” says registered dietitian nutritionist Robin Foroutan, a New York-based spokesperson for the Academy.

“Eating right doesn’t have to be complicated,” Foroutan says. “Think about what you want your plate to look like and ask if it’s incorporating all the major food groups. Select a mix of lean protein foods, vegetables, whole grains and fruits to enjoy a healthful meal.”

The Academy recommends balancing nutritious foods with physical activity most days of the week. According to the U.S. Department of Health and Human Services’ physical activity guidelines, adults should participate in at least 150 minutes of moderate-intensity aerobic physical activity per week, including at least two days of muscle-strengthening activities. Being physically active up to 300 minutes per week has even greater health benefits.

“Look into incorporating physical activity into your daily routine,” Foroutan says. “Walk to work or take a walk during your lunch hour. Do something physical during the weekend, such as playing basketball with your kids or going dancing with your friends. The goal is to get moving; every little bit helps.”

Initiated in 1973 as National Nutrition Week, National Nutrition Month® became a month-long observance in 1980 in response to growing interest in nutrition.

As part of National Nutrition Month®, the Academy’s website includes articles, recipes, videos and educational resources to spread the message of good nutrition and the importance of an overall healthy lifestyle for people of all ages, genders and backgrounds.

Consumers can also follow National Nutrition Month® on the Academy’s social media channels including Facebook and Twitter using #NationalNutritionMonth.