American Academy of Pediatrics

The AAP has changed positions on their age limit throughout the years. In 1988, the American Academy of Pediatrics published a statement on the age limit of pediatrics that identified the upper age limit of pediatrics as age 21. The policy had a note that exceptions could always be made when the doctor and family jointly agree to an older age.[12]

Recent studies have shown that the age of 21 years is just an arbitrary line for adolescence because brain development has not reached adult levels of functioning until their early 30s. In a 2017 policy update, AAP changed their policy to discourage age limits of pediatric providers and instead have families reach an agreement with their pediatric provider as when to transition care.[13]

In 2009, the national office and four of its State chapters provided training support to 49 pediatric practices to improve adherence to well-established asthma care guidelines. The percentage of patients at participating practices with well-controlled asthma (as defined by the National Heart, Lung, and Blood Institute) rose from 58 to 72 percent.[14]

The AAP periodically issues guidance for child passenger safety, including policy recommendations for transitioning between rear-facing car seats, front-facing car seats, belt-positioning booster car seats, and vehicle safety belts.[15] These recommendations are typically published in the peer-reviewed scientific journal Pediatrics,[16][17] and tend to attract attention and controversy in popular press and social media.[18][19]

Previously, the AAP recommended that children remain rear-facing until they are 2 years of age.[16] In response to updated crash test, simulation, and field data, the AAP revised their guidance to exclude the age guideline entirely.[20] Current AAP Child Passenger Safety recommendations (as of August 30, 2018) state that children should remain in a rear-facing car seat for as long as possible, until they meet the maximum height or weight dictated by the car seat manufacturer.[17] The full recommendations state that:

1. Infants, toddlers and children should remain rear-facing as long as possible. Currently available car seats provide weight and height limits that allow children to be rear-facing beyond their second birthday.
2. Once children are transitioned to forward-facing, they should use a car safety seat equipped with a 5-point harness for as long as the manufacturer recommends (i.e., until they reach the manufacturer's weight or height limit). Currently available convertible car seats and combination car seats support the use of a 5-point harness until a child is 65 pounds (29 kg) or more.
3. Once children are transitioned to a belt-positioning booster car seat, they should continue to use the booster until the vehicle's lap and shoulder belt fit properly, which typically occurs when a child is over 4 feet 8 inches (142 cm) tall, and approximately 8–12 years of age.
4. Once children are transitioned to the vehicle's lap and shoulder seat belt, they should always use the vehicle's seat belt to maximize protection in the event of an accident.
5. Children under 13 years of age should be seated in the rear passenger seat (not the front seat) to maximize protection in the event of an accident.

On June 29, 2020, AAP stated that it "strongly advocates that all policy considerations for the coming school year should start with a goal of having students physically present in school" as remote learning makes it more difficult for education professionals to notice learning deficits, physical and sexual abuse, depression and suicidal ideation. The AAP argued that masks are probably not practical for children younger than middle school unless they can wear a mask without increased face touching. Teachers unions opposed the AAP statement, however, saying "Our educators are overwhelmingly not comfortable returning to schools...They fear for their lives, the lives of their students and the lives of their families."[21] Two weeks later, the AAP walked back its support, under political pressure from teachers and other groups.[22] President Donald Trump had cited AAP's original statement repeatedly, pressuring school leaders to reopen schools.[22]

In its 2020 statement in Pediatrics, the AAP called for banning all digital advertising targeted to children under the age of 7 and urged limits to advertising aimed at people under 17.[23]

In 1999, the academy said that the health benefits of the procedure outweigh the risks, and supports having the procedure covered by insurance.[24][25][26]

In a 2012 position statement, the academy stated that a systematic evaluation of the medical literature shows that the "preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure" and that the health benefits "are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns," but "are not great enough to recommend routine circumcision for all male newborns". The academy takes the position that parents should make the final decision about circumcision, after appropriate information is gathered about the risks and benefits of the procedure.[27]

After the release of the position statement, a debate appeared in the journal Pediatrics and the Journal of Medical Ethics.[28][29][30] In 2013, a group of 38 Northern European pediatricians, doctors, surgeons, ethicists and lawyers co-authored a comment stating that they found the AAP's technical report and policy statement suffered from cultural bias, and reached recommendations and conclusions different from those of physicians in other parts of the world;[28] in particular, the group advocated instead a policy of no-harm towards the infants and respect for their rights of bodily integrity and age of consent.[28] An opinion by two authors stated that, in their view, the AAP's analysis was inaccurate, improper and incomplete.[29] The AAP received further criticism from activist groups that oppose circumcision.[31][32] The AAP responded to these criticisms in the Journal of Medical Ethics, calling for respectful and evidence-based debate.[33]

The AAP policy regarding its statements is to give each statement a five-year life, after which the statement expires unless it is reaffirmed. The 2012 Circumcision Policy Statement has not been reaffirmed, so it expired in 2017. As of 2019, the AAP has no official circumcision policy.

In April 2010, the academy revised its policy statement on female genital cutting, with one part of the new policy proving controversial. Although condemning female genital cutting overall, this statement suggested that current federal law banning the practice had the unintended consequence of driving families to perform the procedures in other countries, where these girls faced increased risk. As a possible compromise, this policy statement suggested that physicians have the option to perform a ceremonial "nick" on girls as a last resort to prevent them from being sent overseas for full circumcision. This particular position proved controversial to advocates for a full ban on female genital cutting under any circumstances[34] and concern from other medical groups[35] that even a "nick" would be condoning this widely rejected procedure. One month later, the academy retracted this policy statement.[36][37]

The American Academy of Pediatrics AGCM posted guidelines in dealing with the ethical issues in pediatric genetic testing.[38]

The American Academy of Pediatrics says that although U.S. firearms-related deaths have dropped since the 1990s, guns were responsible for over 80 percent of teen homicides in 2009 and were the most common suicide method among teens.[39] The AAP believes pediatricians should discuss guns and gun safety with parents before babies are born and at children's annual exams.[40] It also advocates for, among other things, more background checks, an assault weapons ban, and federal research on gun violence.[41][42]

The AAP warns of possible marijuana damage to children and adolescents.[43] In states that have already legalized marijuana, the Academy recommends that pediatricians and regulators treat it as they would with tobacco. The Academy does support "decriminalization" of marijuana—reductions in the penalties for its use and possession—in combination with an increased commitment to substance-abuse treatment. The Academy also recommends changing marijuana from a DEA Schedule 1 to a DEA Schedule 2 to facilitate research into pharmaceutical uses.[44]

Recognizing that insufficient sleep in adolescents is an important public health issue that significantly affects the health and safety, as well as academic success, the American Academy of Pediatrics strongly supports efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times no earlier than 8:30 a.m. to allow students the opportunity to achieve optimal levels of sleep (8.5–9.5 hours) and to improve physical and mental health, safety, academic performance, and quality of life. Although the AAP acknowledges that numerous factors may impair the amount and/or quality of sleep in adolescents—among them, biological changes in sleep associated with puberty, lifestyle choices, and academic demands—it considers school start times before 8:30 a.m. ("earlier school start times") to be a key modifiable contributor to insufficient sleep, together with circadian rhythm disruption. It also recognizes that a substantial body of research has demonstrated that delaying the start of the school day is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to the physical and mental health, safety, and academic achievement of students—including reduced obesity risk, rates of depression, and drowsy driving crashes as well as improved academic performance and quality of life.[45] Later start times also result in less frequent tardiness.[46]

There is limited medical controversy surrounded the AAP regarding "Abusive head trauma".[47] The current skepticism is not whether violent shaking, or shaking with slamming, is dangerous to infants or children, but of how the scientific information is used in the legal processes. The AAP updated its policy paper in 2020. In the updated policy paper, the APP states " The AAP continues to affirm the dangers and harms of shaking infants, continues to embrace the “shaken baby syndrome” diagnosis as a valid subset of the AHT diagnosis, and encourages pediatric practitioners to educate community stakeholders when necessary."[48]

AAP and the American Heart Association recommended statins for children as young as 8 years with high lipid concentrations and for children as young as 2 years with major cardiovascular risk factors. The AAP was criticized for "fear that it will open the way for drug companies to bombard anxious parents with ads promoting these and other products and increase the number of parents insisting on prescriptions for their children. The ease of popping pills should not distract parents, health professionals, or policy makers from the more arduous tasks of cutting back on junk foods, promoting healthy diets, and putting physical education back into the schools.”[49]

In 2018, the AAP issued a policy endorsing "gender affirmation" as the only acceptable response to a child expressing transgender feelings[50][51] The claims made in that policy were fact-checked by sex researcher James Cantor, who listed multiple factual inaccuracies and key information to be missing, however.[52]