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.


Teaching Children Cultural and Racial Pride

​For generations, immigrant parents in this country have taught their children to love their roots. They have passed down their language, their values, their beliefs, and traditions to their children with the same love they were passed down to them.

WATCH: In this video, click here, AAP Pediatrician Edith Bracho-Sanchez, MD offers important advice to parents about the importance of teaching children to honor differences in others, and to celebrate the way in which we all contribute to American society. 9

LISTEN: Teaching Empathy & Compassion

Empathy starts with understanding other people’s emotions and feelings. Kids have to get in touch with their own emotions and feelings first. You can’t understand emotions unless you communicate face-to-face. Talk through what could help others feel better so your child understands how others feel. Then, expand your child’s experiences through travel and reading, and encourage community involvement.

Want to learn more? CLICK HERE to listen to podcast with host Melanie Cole, MS.

 

Talking to Children about Racial Bias

By Ashaunta Anderson, MD, MPH, MSHS, FAAP & Jacqueline Dougé, MD, MPH, FAAP

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.

How Do Children Learn Racial Bias?

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.

  • As early as 6 months, a baby’s brain can notice race-based differences.
  • By ages 2 to 4, children can internalize racial bias.
  • By age 12, many children become set in their beliefs—giving parents a decade to mold the learning process, so that it decreases racial bias and improves cultural understanding.

But like language immersion, children exposed to society will gain fluency in racial bias even if their parents do nothing.

Strategies to Help Children Deal with Racial Bias

There are three strategies that parents can use to help their children deal with racial bias:

  • Talk to your children and acknowledge that racial differences and bias exist.
  • Confront your own bias and model how you want your children to respond to others who may be different than them.
  • Encourage your children to challenge racial stereotypes and racial bias by being kind and compassionate when interacting with people of all racial, ethnic, and cultural groups.

How Parents Can Confront Their Own Racial Bias

Parents must first confront their own biases, so that their example is consistent with messages of racial and ethnic tolerance.

  • Be a role model. Identify and correct your own racially biased thoughts, feelings, and actions. If you want your children to believe what you preach, you have to exhibit those behaviors as well. Your everyday comments and actions will say more than anything else.
  • Have a wide, culturally diverse social network. Encourage your children to have diverse circles of friends, as well. This lends itself to engagement in multicultural activities and experiences.
  • Travel and expose your children to other communities. This can help them understand that there is diversity in the world that might not be represented in the community that you live in.
  • Do not reverse stereotype police officers and other groups or talk about law enforcement in a negative way.
  • Get involved in your child’s school, your place of worship, and politics. Parents who are involved in this way are better able to advocate for fair treatment of racially marginalized groups and raise awareness of race issues in other groups.

Tips for Talking About Racial Differences & Racism

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.

  • For preschoolers: At this age, your child may begin to notice and point out differences in the people around you (i.e., at the grocery store, at the park, etc.). If your child asks about someone’s skin tone, you might say, “Isn’t it wonderful that we are all so different!” You can even hold your arm against theirs to show the differences in skin tones in your family.
  • For gradeschoolers: This is the age that is important to have open talks with your child about race, diversity, and racism. Discussing these topics will help your child see you as a trusted source of information on the topic, and he or she can come to you with any questions. Point out stereotypes and racial bias in media and books such as villains or “bad guys” in movies.
  • If your child makes comments or asks you questions about race based on school incidents or something they read or watched: Further the discussion with questions such as, “How do you feel about that?” and “Why do you think that?” This is also helpful if your child heard something insensitive or if your child experienced racial bias themselves. Before responding to his or her statement or question, figure out where it came from and what it means from his or her perspective.

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.

Remember:

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.


Author: Ashaunta Anderson, MD, MPH, MSHS, FAAP & Jacqueline Dougé, 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.


Heart Disease: Reduce Your Child’s Risk

Heredity is clearly an important risk factor for conditions such as heart disease, cancer, and diabetes. However, researchers are steadily gathering strong evidence about how diet influence development of diseases. Experts agree that healthy eating habits from an early age can lower the risk of developing several deadly diseases later on. A diet designed to lower the risk of heart disease, diabetes, and other serious diseases is one that benefits the whole family, adults and children alike.

Risk Factors for Heart Disease
Heart disease is the number one killer of men and women in the United States and most industrialized countries. The chief risk factors are:

  • Smoking
  • High blood pressure
  • Diabetes
  • High blood level of cholesterol
  • Physical inactivity
  • Obesity
  • Family history of early-onset heart disease

Following a Heart-Healthy Diet From an Early Age
American children and adolescents, on average, eat more saturated fat and have higher blood cholesterol levels than young people their age in most other developed countries. The rate of heart disease tends to keep pace with cholesterol levels. One study found early signs of hardening of the arteries (atherosclerosis) in 7% of children between ages 10 and 15 years, and the rate was twice as high between ages 15 and 20.

According to the American Heart Association, a heart-healthy diet from an early age lowers cholesterol and if followed through adolescence and beyond, should reduce the risk of coronary artery disease in adulthood.

All children older than 2 years should follow a heart-healthy diet, including low-fat dairy products. For children between the ages of 12 months and 2 years with a family history of obesity, abnormal blood fats, or cardiovascular disease, reduced-fat milk should be considered.

Is There a Family History?
When you and your children first saw your pediatrician, you were probably asked if there was a history of heart or vascular disease in your family. If your children were young, their grandparents were probably relatively young as well and may not have had a heart attack or stroke (even though they may have been headed for one). If heart disease in the grandparents becomes apparent later on, be sure to bring it to your pediatrician’s attention at the next checkup.

Cholesterol Testing for Adopted Children
Complete biological family medical histories are not usually available to adopted children and their parents, even for those adopted in open proceedings. To prevent the development of diseases linked to high blood cholesterol levels, adopted children should be screened periodically for blood lipid (fat) levels throughout childhood.


Source: Nutrition: What Every Parent Needs to Know (Copyright © American Academy of Pediatrics 2011). 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.

Communicating Beyond the Family

The communication skills your child learns will affect the way he interacts not only with you but with the world at large. These skills will help your youngster to negotiate, solve problems, and learn from others. Communication can also be used to praise, punish, express feelings, and provide insights and under­standing.

The way you communicate is part and parcel of what you communicate. Done well, communication is how you convey love, acceptance, respect, and approval to your child. Providing praise, for example, is not just saying words. It requires that you understand how your child thinks about himself and his behavior, and knowing when and in what way you can share with him your pride, so that he is best able to hear you and accept what you are trying to say. Successful communication is a two-person process, not merely one person saying something to another. If you consistently communicate well with your child, he will know that you think well of him. Not only will this nurture your relationship with him, but it can help him grow, develop, and live up to his ca­pabilities as a person.

Unfortunately, too many parents do a poor job of expressing this accep­tance. They may think: If I tell my son that in my eyes he is just fine the way he is, he won’t be motivated to work harder and do better in life. But in fact, chil­dren do better once they feel relieved of the pressure of having to win their parents’ approval. Rather than constantly judging and criticizing your child, let him know that you accept and love him. In turn, he will begin to like him­self more, and his self-esteem will grow.

Make an effort to communicate this acceptance through both words and ac­tions. Yes, you can demonstrate your feelings in nonverbal ways through your body language, including your facial expressions, hugs, and gestures. But you also need to say it.

Too often, parents choose ineffective, nonaccepting ways to communicate verbally with their children. They might give commands (“You’re going to do it as I say or else!”), lecture (“When I was a boy, I had twice as many chores as you”), or preach (“You must never behave that way again”). Or they might crit­icize (“You are doing everything wrong today”), ridicule (“You looked silly when you struck out”), or belittle (“Someone your age should know better”).

Be positive and accepting in the way you talk with your child. Offer praise often and be as specific as you can (“You did a wonderful job solving that dif­ficult problem in your math homework tonight”). Let him know how much you appreciate him as he is, without his having to struggle to resemble your own preconceived notions of how you want him to be (“I was so proud just watch­ing you run in the track meet today”).

You can also demonstrate acceptance by not involving yourself in some of your child’s activities. For example, if you just let him paint without giving him advice on what colors to mix together, this will convey the message that he is doing just fine on his own. In much the same way, you can listen quietly to your child at times, without interjecting your own thoughts and comments that might contradict or correct him.



Source: Caring for Your School-Age Child: Ages 5 to 12 (Copyright © 2004 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.


Energy Out: Daily Physical Activity Recommendations

​Physical activity in children and adolescents improves strength and endurance, builds healthy bones and lean muscles, develops ​ motor skills and coordination, reduces fat, and promotes emotional well-being (reduces feelings of depression and anxiety). Activities should be appropriate for their age and fun, as well as offer variety.

The daily recommendation for physical activity for children 6 years and older is at least 60 minutes per day. Active play is the best exercise for younger children.

The types of physical activity should be moderate to vigorous. Vigorous activity is activity that makes you breathe hard and sweat. During vigorous activity, it would be difficult to have a talk with someone. Some activities, such as bicycling, can be of moderate or vigorous intensity, depending upon level of effort.

The 60 minutes does not need to be done all at once. Physical activity can be broken down into shorter blocks of time. For example, 20 minutes walking to and from school, 10 minutes jumping rope, and 30 minutes at the playground all add up to 60 minutes of physical activity. If your child is not active, start from where you are and build from there.

Here are some types of sports and activities for children and teens (and parents, too!)

Aerobic Exercises

  • Use body’s large muscle groups
  • Strengthen the heart and lungs
  • Examples of moderate-intensity aerobic exercises include: brisk walking, Bicycle riding, dancing,hiking, rollerblading, skateboarding, martial arts such as karate or tae kwon do (can be vigorous too)
  • Examples of vigorous-intensity aerobic activities include: basketball, bicycle riding, games such as tag, ice or field hockey, jumping rope, martial arts, running, soccer, swimming, tennis

Muscle-Strengthening (or Resistance) Activities

  • Work major muscle groups of the body (legs, hips, back, abdomen, chest, shoulder, arms)
  • Examples of muscle-strengthening activities include: games such as tug-of-war, push-ups or modified push-ups (with knees on the floor), resistance exercises using body weight or resistance bands, rope or tree climbing, sit-ups (curl-ups or crunches), swinging on playground equipment/bars

Bone-Strengthening (Weight-Bearing) Activities

  • Tone and build muscles and bone mass
  • Can be aerobic exercises and muscle-strengthening activities
  • Examples of bone-strengthening activities include: basketball, hopping, skipping, jumping, gymnastics, jumping rope, running, tennis, volleyball, push-ups, resistance exercises using body weight or resistance bands

About Strength Training

Strength training(or resistance training) uses a resistance to increase an individual’s ability to exert force. It involves the use of weight machines, free weights, bands or tubing, or the individual’s own body weight. This is not the same as Olympic lifting, power lifting, or body building, which are not recommended for children. Check with your child’s doctor before starting any strength training exercises.


Source: Energy In Energy Out: Finding the Right Balance for Your Children (Copyright © 2014 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.


Healthy New Year’s Resolutions for Children & Teens

The start of the new year is a great time to help your children focus on forming good habits. The American Academy of Pediatrics (AAP) provides the following list of ideas for you to talk to your children about trying, depending on their age. ​

Preschoolers

  • I will try hard to clean up​ my toys by putting them where they belong.
  • I will let my parents help me brush my teeth twice a day.
  • I will wash my hands after going to the bathroom and before eating.
  • I will learn how to help clear the table when I am done eating.
  • I will be friendly to all animals. I will learn how to ask the owners if I can pet their animal first.
  • I will do my best to be nice to other kids who need a friend or look sad or lonely.
  • I will talk with my parent or a trusted adult when I need help or am scared.

Kids, 5 to 12 years old

  • I will drink reduced-fat milk​ and water most days. Soda and fruit drinks are only for special times.
  • I will take care of my skin by putting on sunscreen before I go outdoors on bright, sunny days. I will try to remember to stay in the shade whenever possible and wear a hat and sunglasses, especially when I’m playing sports.
  • I will try to find a sport (like basketball or soccer) or an activity (like playing tag, jumping rope, dancing or riding my bike) that I like and do it at least three times a week!
  • I will always wear a helmet when riding a bike, scooter or skateboard.
  • I will wear my seat belt every time I get in a car. I’ll sit in the back seat and use a booster seat until I am tall enough to use a lap/shoulder seat belt.
  • I’ll try to be friendly to kids who may have a hard time making friends by asking them to join activities such as sports or games.
  • I will tell an adult about bullying that I see or hear about to do what I can to help keep school safe for everyone.
  • I will keep my personal info safe and not share my name, home address, school name or telephone number on the Internet. Also, I’ll never send a picture of myself to someone I chat with on the computer without asking my parent if it is okay.
  • I will try to talk with my parent or a trusted adult when I have a problem or feel stressed.
  • I promise that I’ll do my best to follow our household rules for videogames and internet use.

Kids, 13 years old and older

  • I will try to eat two servings of fruit and two servings of vegetables every day. I will drink sodas only at special times.
  • I will do my best to take care of my body through fun physical activity and eating the right types and amounts of foods.
  • When I have some down time for media, I will try to choose educational, high-quality nonn-violent TV shows and video games that I enjoy. I will spend only one to two hours each day – at the most – on these activities. I promise to respect out household rules for videogames and internet use.
  • I will do what I can to help out in my community. I will give some of my time to help others, working with community groups or others that help people in need. These activities will make me feel better about myself and my community.
  • When I feel angry or stressed out, I will take a break and find helpful ways to deal with the stress, such as exercising, reading, writing in a journal or talking about my problem with a parent or friend.
  • When faced with a difficult decision, I will talk about my choices with an adult whom I can trust.
  • When I notice my friends are struggling, being bullied or making risky choices, I will look for a trusted adultso that we can attempt to find a way to help.
  • I will be careful about whom I choose to date. I will treat the other person with respect and not force them to do something they do not want to do. I will not use violence. I will expect to be treated the same way in return.
  • I will resist peer pressure to try tobacco-cigarettes, drugs, or alcohol. I will also avoid the use of e-cigarettes.
  • I agree not to use a cell phone or text message while driving and to always use a seat belt.

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.


The Greatest Gift You Can Give Your Child

For you to care for your child properly, you need to be OK.​ In this video, pediatrician and adolescent specialist Ken Ginsburg, MD, FAAP discusses that the greatest gifts you can give your child are to live a balanced life and to show that when life offers us challenges, we take active steps to get back on track.​


Source: Building Resilience in Children and Teens: Giving Kids Roots and Wings, 3rd Edition (Copyright © 2015 Kenneth R. Ginsburg, MD, MS Ed, FAAP, and Martha M. Jablow). 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.