H. Garry Gardner

Policy Statement—Prevention of Drowning

Drowning is a leading cause of injury-related death in children. In 2006, fatal drowning claimed the lives of approximately 1100 US children younger than 20 years. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.

Home care: The next frontier of pediatric practice

An overview of pediatric home care issues reveals the breadth and scope of services available to permit pediatricians to provide care at home. This care option has undergone explosive growth and represents one of the fastest-growing health expenditures. Paradoxically, direct physician involvement in the home has been limited during this expansion because of the way home care has been designed and organized with inadequate reimbursement for physician participation, and lack of awareness by, and education of, physicians concerning their roles and responsibilities. The rationale for physician involvement in home care includes the need for determination and reevaluation of the medical necessity of home care services. Future changes in health care delivery and payment will encourage even more consideration of alternative care sites. Physician participation in program and protocol design will facilitate and encourage the appropriate use of the home as a care setting. For the pediatrician to know about home care requires the development of a curriculum to be implemented in academic centers for physicians-in-training and in professional associations for continuing medical education. This curriculum should enable physicians to become primary participants in home care and should lead to research opportunities to evaluate the benefits of home care.

Clinical report - Intimate partner violence

The American Academy of Pediatrics and its members recognize the importance of improving the physicians ability to recognize intimate partner violence (IPV) and understand its effects on child health and development and its role in the continuum of family violence. Pediatricians are in a unique position to identify abused caregivers in pediatric settings and to evaluate and treat children raised in homes in which IPV may occur. Children exposed to IPV are at increased risk of being abused and neglected and are more likely to develop adverse health, behavioral, psychological, and social disorders later in life. Identifying IPV, therefore, may be one of the most effective means of preventing child abuse and identifying caregivers and children who may be in need of treatment and/or therapy. Pediatricians should be aware of the profound effects of exposure to IPV on children.American Academy of Pediatrics and its members recognize the importance of improving the physicians ability to recognize intimate partner violence (IPV) and understand its effects on child health and development and its role in the continuum of family violence. Pediatri- cians are in a unique position to identify abused caregivers in pediatric settings and to evaluate and treat children raised in homes in which IPV may occur. Children exposed to IPV are at increased risk of being abused and neglected and are more likely to develop adverse health, behavioral, psychological, and social disorders later in life. Identifying IPV, therefore, may be one of the most effective means of preventing child abuse and identifying caregivers and children who may be in need of treatment and/or therapy. Pediatricians should be aware of the profound effects of exposure to IPV on children. Pediatrics 2010;125:1094-1100

Policy statement - Prevention of choking among children

Choking is a leading cause of morbidity and mortality among children, especially those aged 3 years or younger. Food, coins, and toys are the primary causes of choking-related injury and death. Certain characteristics, including shape, size, and consistency, of certain toys and foods increase their potential to cause choking among children. Childhood choking hazards should be addressed through comprehensive and coordinated prevention activities. The US Consumer Product Safety Commission (CPSC) should increase efforts to ensure that toys that are sold in retail store bins, vending machines, or on the Internet have appropriate choking-hazard warnings; work with manufacturers to improve the effectiveness of recalls of products that pose a choking risk to children; and increase efforts to prevent the resale of these recalled products via online auction sites. Current gaps in choking-prevention standards for childrens toys should be reevaluated and addressed, as appropriate, via revisions to the standards established under the Child Safety Protection Act, the Consumer Product Safety Improvement Act, or regulation by the CPSC. Prevention of food-related choking among children in the United States has been inadequately addressed at the federal level. The US Food and Drug Administration should establish a systematic, institutionalized process for examining and addressing the hazards of food-related choking. This process should include the establishment of the necessary surveillance, hazard evaluation, enforcement, and public education activities to prevent food-related choking among children. While maintaining its highly cooperative arrangements with the CPSC and the US Department of Agriculture, the Food and Drug Administration should have the authority to address choking-related risks of all food products, including meat products that fall under the jurisdiction of the US Department of Agriculture. The existing National Electronic Injury Surveillance System–All Injury Program of the CPSC should be modified to conduct more-detailed surveillance of choking on food among children. Food manufacturers should design new foods and redesign existing foods to avoid shapes, sizes, textures, and other characteristics that increase choking risk to children, to the extent possible. Pediatricians, dentists, and other infant and child health care providers should provide choking-prevention counseling to parents as an integral part of anticipatory guidance activities.