Category Archives: Pediatrics

Pediatrics

Integrating behavioral health within primary care settings – Contemporary Pediatrics

Behavioral health within the primary care setting: pressmaster - stock.adobe.com

Virginia Hatch-Pigotts, MD, FAAP, LMSW, article, "Child welfare: Now that we know better. Lets do better," is a powerful read for all pediatric health care providers to think about and collectively consider meaningful, impactful policy changes for children living within the foster care system.

Hatch-Pigott highlights the trauma children experience before and often while living within the foster care system. She states, The real problem is the lack of timely appropriate mental health services for these [foster care] children (p. 14).1

Her experiences caring for children within the foster care system, advising foster care parents, as well as her analysis of foster care statistics led her to recommend changes for funding at the macro and micro child welfare levels as well as the importance of changing the immediate evaluation of the children to focus on trauma-informed therapies. I highly recommend reading Hatch-Pigotts article.

Early in my career as a pediatric nurse practitioner (PNP), I had the pleasure of working with children within the foster care system, their foster care parents, and meeting the biological parents who were receiving therapies to improve their own behavioral issues and parenting skills.

My role was embedded within a foster care agency that provided comprehensive services from psychiatrists, psychologists, and social workers including case workers for each child and family, nursing care, with medical care provided by PNPs and pediatricians. The overarching goals were family healing and returning the children safely to their biological parents. We understood the importance of integrating mental health and behavioral health services within the primary care visits to enable the children to emerge as healthy individuals from the trauma they experienced prior to admission.

Today, the integration of mental health within the primary care system is supported in the literature but how often it is operationalized, and what is the effectiveness of these systems? A literature search shows several models have been developed and implemented to support behavioral health integration into primary care systems.

A report of an 18-month pilot study in which a Developmental and Behavior Access Clinic (DBAC) was designed for pediatricians to be trained and initially mentored by developmental-behavioral pediatricians to provide developmental care to children revealed that the average wait time for children to receive the needed developmental behavioral (DB) care decreased from 218 days to 41 days. This pilot study supports opportunities to include behavioral health into primary care settings.2

A comprehensive study for the integration of behavioral health (BH) services included an educational program, Behavioral Health Learning Community (BHLC), that delivered 10 sessions (16 hours) over a 2-year period was reported for 13 pediatric practices enrolled in a statewide program that included 105 primary care providers who cared for approximately 114,000 patients.3 Study outcomes revealed increased access to quality behavioral health (BH) services, provider self-efficacy and professional satisfaction, without increasing health care costs.3

I recently published an editorial in the Journal of Pediatric Health Care discussing the integration of behavioral and mental health care in pediatric primary care populations.4 I discussed the role of Pediatric Primary Care Mental Health Specialists (PMHS) developed and offered by the Pediatric Nursing Certification Board.5 Individuals who hold the PMHS credential often practice in dual roles serving both primary health care and behavioral/mental health care needs of the pediatric populations. From my personal experiences, parents appreciate having access to pediatric and/or pediatric-focused family nurse practitioner providers who provide these comprehensive services within one practice setting.

If infants and young children living within the foster care system and all infants and young children could speak for themselves, what would they say to policy makers? Help me please, I need to be safe, cared for, and loved.School-age children and adolescents can inform their healthcare providers of their concerns while living in the foster care system, but do we, the professionals, speak with policymakers on their behalf? The mental health of the pediatric population is in crisis. As mentioned, Dr. Hatch-Pigott supports funding at the macro and micro levels within the child welfare system to improve the outcomes for children within the foster care system. Funding for mental health services for all children also needs to be a legislative priority. PNPs need to continue their advocacy efforts through collaboration with all pediatric providers, remain actively engaged in helping children and families by supporting timely and appropriate health policy initiatives, and through continued support for legislative initiatives offered by the National Association of Pediatric Nurse Practitioners (NAPNAP).

References

1. Hatch-Pigott, V. Child welfare: Now that we know better, lets do better. Contemporary Pediatrics. 2014;40(04):13-19. https://www.contemporarypediatrics.com/journals/contemporary-peds-journal/may-2024

2. Jeung J, Talgo J, Sparks A, Martin-Herz SP. Expanding developmental and behavioral health capacity in pediatric primary care. Clin Pediatr (Phila). 2023;62(8):919-925. doi:10.1177/00099228221147753

3. Walter HJ, Vernacchio L, Trudell EK, et al. Five-year outcomes of behavioral health integration in pediatric primary care. Pediatrics. 2019;144(1):e20183243. doi:10.1542/peds.2018-3243

4. Hallas D. Integrating Behavioral and Mental Health Care in Primary Care for Pediatric Populations. J Pediatr Health Care. 2024;38(3):293-294. doi:10.1016/j.pedhc.2024.01.004

5. Pediatric Nursing Certification Board. The Pediatric Primary Care Mental Health Specialist (PMHS) role, settings, and ethics. Accessed May 20, 2024. https://www.pncb.org/pmhs-role

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Integrating behavioral health within primary care settings - Contemporary Pediatrics

Pediatrics

Phones and kids: new pediatric guidelines, expert advice and info on new school rules – Kidsburgh

Photo above by Julia Coimbra via Unsplash.

The first iPhones and Androids hit the market when todays high schoolers were babies. Theyve never known life without smartphones. And today, the Surgeon Generals office estimates that 95 percent of kids ages 13-17 and nearly 40 percent of kids ages 8-12 use social media, connect to the internet and use a massive array of interactive apps through their phones.

Until recently, the advice was to limit kids screen time to two hours per day or less. That wasnt always easy and were now discovering that it wasnt enough to just focus on the number of minutes kids spent in the glow of their screens. It matters what theyre watching and reading, and how it affects a given child or teen.

Phones connect our kids with information and ideas, but they also appear to be causing increases in anxiety, depression, bullying and other distractions, especially in the classroom.

How do parents help their kids navigate our digitally connected world?

Last month the American Academy of Pediatrics (AAP) Center of Excellence on Social Media and Youth Mental Health unveiled its 5 Cs of Media Use a guideline for parents to better understand media influences and to strive for healthy screen time habits (we break down all the details on that below). And schools have begun testing new rules and grappling with the growing issue of phones in schools at all grade levels.

Weve got all that information, along with info on how starter phones can help:

SCHOOLS TAKE ACTION

To help control negative effects from cell phone overuse, schools are increasingly invoking strict rules to eliminate phones in classrooms. And earlier this month, PA state senator Ryan Aument (RLancaster) drafted a bill to lock up student phones due to the steep decline in mental health in children since the early 2010s, according to his website.

Data from Common Sense Media also found that 97 percent of students surveyed used a phone on average for 43 minutes during school hours, and 37 percent of that time was spent on social media.

Starting this year, Sto-Rox School District banned cell phones in classrooms in all grades.

Heres how it works: Over the course of about 10 minutes, nearly 600 students in grades 7 through 12 enter their school building, hand their phones to a staff member who places it in an envelope with the childs name on it, then its put in a bin to be locked in storage for the day. The students then pass through metal detectors and head to breakfast. Phones are returned by the students last period teachers during the days final five minutes.

The process was planned carefully and has been running smoothly. We are very good at it, says Sto-Rox superintendent Megan Marie Van Fossan. Were very strategic.

And the impact? At the start of the school year, the students werent happy about the new policy. But then positive changes began surfacing.

Van Fossan says kids have begun talking to each other again in the cafeteria. Back when phones were allowed, the cafeteria was a relatively quiet place where students were focused on their phones rather than one another.Mornings in the hallway are now the same: Rather than scrolling on their phones or texting, students are greeting each other as the day begins.

Rather than revolving around social media, these students days are full of in-person interaction and connection. No parents have complained about the policy, Van Fossan says, and the rule isnt difficult to enforce.

Other school districts in the region have been taking notice.

We get phone calls and emails (from other school districts), saying, We are looking at going to this policy. Tell us about your experience, Van Fossan says.

Why ban phones?

Phones were taken out of seventh and eighth grade classrooms last year and were never permitted in kindergarten. But the choice to start a district wide ban came because of increasing safety and security concerns.

Kids were texting one another to meet, fight someone in the bathroom, hurt someone after school, Van Fossan says. We dont need that going on during the school day.

Students were also paying less attention in class.

Beyond helping with focus, the new system also helps inspire kids to be on time: Late students must drop off and retrieve their phones at the schools office, potentially adding 20 minutes to the end of their school day.

In the Pittsburgh Public Schools 54 buildings, the electronic device policy generally prohibits students from using, displaying or turning on cell phones on school grounds. And in some PPS high school buildings, student phones are sealed in pouches at the start of the day.

But in many buildings, students have traditionally kept their phones with them.

A lot of our high schools are leaning (toward) collecting phones; not every high school does, says Carrie Woodard, director of school counseling for the district.

In recent years, PPS counselors have seen increases in cyber bullying in addition to anxiety and depression symptoms in students who arrive at school upset from social media postings made after school hours.

Its something I think weve been battling for over a decade now, Woodard says.

What can help besides banning?

To help win that battle, Woodard said its important for educators and school counselors to support the whole child, academically and personally by:

Some parents, Woodard says, are anxious about phones being taken away from students. They want to have instant communication with their child in the event of an emergency.

From the school level, we can always assure them, she says, that if there is an emergency there are systems in place where the educational team will get in touch with the parent.

What is a starter phone?

Starter phones are entry-level devices that allow kids to text, call and store photos. Some have limited access to the Internet or social media. They come in many shapes and sizes, and are usually budget-friendly. Here are some options parents may want to pursue:

The Bark Android phone has parental controls included. It sends alerts about your childs texts and searches and has location tracking. Approval to download apps is necessary. You can also install a Bark parental control app on any smartphone. Plans starting at $39/month at Bark.us

Also an Android phone, the Pinwheel has parental controls built in, and there is no web browser so it has no direct access to social media. There are several models. Note that you wont receive alerts about messages that will be a potential problem. The Plus 3 is $489 on Amazon.

The iPhone SE lets parents manage how much screen time a child spends in their browser. Through Apples Family Sharing, parents set screen time permission, approve what their child buys or downloads, and can disable apps and set limits from their own device. Like almost any iPhone, it can be set up with Apples parental controls. Costs starts at $429 from Apple.

The TCL Flip 2 flip phone allows calling and messaging, and it includes simple games and a limited web browser. $100 from Amazon.

The Nokia 2780 Flip phone is easy to use for texting and calling. $90 at Best Buy.

The Gabb Phone has no internet or social media and no app store. It does include a GPS tracker, and other basics like a camera, calculator, photo album. $75 at Gabb.com.

SCREEN TIME ADVICE FOR EVERYONE

Last month the American Academy of Pediatrics (AAP) Center of Excellence on Social Media and Youth Mental Health unveiled its 5 Cs of Media Use a guideline for parents to better understand media influences and to strive for healthy screen time habits.

The AAP is looking for a way to help parents and educators understand the issues cropping up with phones and other screens, and understand how they can help the children in their lives, says Pamela Schoemer, MD of UPMC Childrens Community Pediatrics. Schoemer tells Kidsburgh she has discussions about screen time effects in about half of her patient visits.

The 5 Cs stand for:

The calm element of the guideline, Dr. Schoemer notes, typically comes up when there are issues with falling asleep something that can spill over into the ability to focus or even stay awake throughout the next school day.

Kids need the ability to calm themselves and to deal with their emotions, she said. So often I see parents, especially with younger kidsputting something (a cell phone or tablet) in front of their child to calm them.

Instead of handing kids a digital device, she suggests:

Dr. Schoemer considers that final C, communication, to be the best resource for parents. Its helpful to have discussions about time limits with devices. But communication isnt just about how many minutes a child is looking at a screen. Its also important to know what your child is looking at it and explore its impact.

Its okay to ask what your child is looking at, she says, and it might even lead to a moment of shared laughter:A TikTok can be just as funny to us as it is to them.

Valuable screen time, like exploring interests, communication with extended family or for schoolwork, is great. Healthy screen habits at home can include educational videos that help deal with emotions or those that encourage an activity, like cooking or science experiments for younger children. Anything on PBS Kids (from Mister Rogerss Neighborhood and Daniel Tigers Neighborhood to the friendship-focused show City Island) is suitable for younger children over the age of 2 or 3.

All screen time isnt equal, and you have to assess it, Schoemer says. If that young person is following an influencer or playing video games with more violence or rudeness or language that you dont approve of or, unfortunately, is being bullied, those are bad screen times.

One last note: Kids are smart and may manage to work around parental controls. So parents should check devices, and also educate themselves by consulting friends, pediatricians and other resources like the AAP website or Common Sense Media.

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Phones and kids: new pediatric guidelines, expert advice and info on new school rules - Kidsburgh

Pediatrics

Suicide: Blueprint for Youth Suicide Prevention – American Academy of Pediatrics

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Suicide: Blueprint for Youth Suicide Prevention - American Academy of Pediatrics

Pediatrics

Dr Julie Linton Addresses Disparities in Pediatric Care for Immigrant Children in the US – AJMC.com Managed Markets Network

Julie Linton, MD, FAAP, immediate past chair of the American Academy of Pediatrics (AAP) Council on Immigrant Child and Family Health, addressed disparities within health care services impacting immigrant populations in the United States. Linton discussed cultural differences, different types of immigration status, and how access to care can vary based on the state in which these patients are living.

The American Thoracic Society 2024 international conference included a keynote series where Linton and other expert speakers highlighted disparities and discussed ways to improve access to care for immigrant populations.

Transcript

What are the biggest challenges immigrant children face in accessing quality pediatric care in the US? How do these challenges differ based on the child's immigration status, country of origin, or socioeconomic background?

That's really a huge question. Before jumping in, I just want to quickly make sure we're talking about the same population I think you're asking about, which is immigrant children. The broader term of children in immigrant families refers to children who they themselves, or at least 1 parent, were born outside of the United States, and the specific population of immigrant children are children who they themselves were born outside of the United States. Those children may comprise a number of immigration statusesthat could include anything from being a US citizen who's already been naturalized, or it could include some types of humanitarian visa programs such as refugee status or having asylum status. It could include being part of a family who's come for work-related or family unification, or for some children, it could include being undocumented.

And all these different statuses, their eligibility for health coverage will vary. It will vary based on federal law. For instance, undocumented people are excluded from federal Medicaid, excluded from purchasing into the ACA [Affordable Care Act]. However, there are some states that cover children with state-sponsored Medicaid, including states like California, where we are today, as well as New York and Illinois, the District of Columbia, and I think there's 9 other states. You can actually find that information, if you're interested in knowing whether your state does or doesn't offer that coverage, on the National Immigration Law Center website. There's some maps there that are really helpful.

In terms of other factors, country of origin is relevant only in how it relates to immigration status. Certain countries, for instance, are eligible for Temporary Protected Status, meaning that if somebody is coming from Haiti, or Venezuela right now, under the current presidential administration, those families may be eligible for Temporary Protected Status, which would mean that they're eligible to buy into the Affordable Care Act and they're also, in some states, eligible to actually get state-funded Medicaid if those states took up a piece of legislation called the CHIPRA [Children's Health Insurance Program Reauthorization Act] option. Again, that map I mentioned will show you that from the National Immigration Law Center.

In terms of socioeconomic status, that really depends on the state eligibility for Medicaid in terms of how high of a poverty level that somebody could qualify for is one of the big pieces. Then there's other factors around socioeconomic status and other demographic factors that may make it more or less easy for somebody to enrolllanguage access, transportation, other things that can make it easier or more difficult for somebody to access services.

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Dr Julie Linton Addresses Disparities in Pediatric Care for Immigrant Children in the US - AJMC.com Managed Markets Network

Pediatrics

CAR T-Cell Therapies Move Ahead in Pediatric and Adult ALL – OncLive

The treatment paradigm for acute lymphoblastic leukemia (ALL) has made significant progress in recent years for both adult and pediatric patients with the addition of cellular therapies; however, significant unmet needs remain for these patients that investigators are working to address, according to Carrie L. Kitko, MD.

There is a certain amount of effort [that is required] to be able to offer these products to our patients, Kitko said. [When physicians] are [wondering whether] their patient might be able to qualify for one of these emerging therapies, [whether the agent is] FDA approved or [the physician must] reach out to find out if we have the latest clinical trial available for some of these agents, [time is critical]. The earlier we put these patients on the radar, the earlier well be able to help them navigate the system to be able to get that innovative treatment.

In August 2017, the FDA approved the CAR T-cell therapy tisagenlecleucel (tisa-cel; Kymriah) for the treatment of patients up to age 25 years with B-cell precursor ALL that is refractory or in second or later relapse. The approval was based on findings from the phase 2 ELIANA trial (NCT02435849), which showed that patients with relapsed/refractory pediatric precursor B-cell ALL who received tisa-cel (n = 63) achieved an overall remission rate (ORR) of 82.5% (95% CI, 70.9%-91.0%); 63% of patients experienced complete remission (CR) and 19% experienced a complete remission with incomplete hematological recovery.1

Then, in October 2021, the FDA approved another CAR T-cell agent, brexucabtagene autoleucel (brexu-cel; Tecartus) for the treatment of adult patients with relapsed/refractory B-cell precursor ALL. The regulatory decision was supported by findings from the phase 1/2 ZUMA-3 study (NCT02614066), which showed that patients with relapsed/refractory B-cell precursor ALL who were treated with brexu-cel (n = 54) achieved a 3-month CR rate of 52% (95% CI, 38%-66%).2

In an interview with OncLive, Kitko, the medical director of the Pediatric Stem Cell Transplantation Program, the Ingram Professorship in Pediatric Oncology in theDepartment of Pediatrics, and an associate professor of pediatrics in the Department of Hematology/Oncology, at Vanderbilt University Medical Center in Nashville, Tennessee, discussed a presentation she gave during the 2024 Vanderbilt Stem Cell Transplant and Cellular Therapy Symposium in May. During the presentation, Kitko outlined the current treatment landscape of pediatric and adult ALL, as well as unmet needs and future directions in the field.

Kitko: [I discussed] the pivotal trials that led to the FDA approvals of tisa-cel for patients under the age of 26 and brexu-cel for adult patients. Those [agents] have been [approved] for a bit now, but it has been helpful that theres more long-term follow-up for the ZUMA-3 trial looking at how durable remissions are and the differences in patient populations based on prior treatment or treatments received [following] CAR T-cell therapy.

Whats important with the pediatric population is the recognition that, unfortunately, a lot of the pharmaceutical companies have abandoned further trials of some of the other novel CAR T-cell products. Were relying on real-world consortium data to try and tease out the different groups of patients who do better [as well as those] who are more or less likely to experience relapse post-treatment. [Also], how do we better tackle this toxicity profile?

We are hopeful that we can have more pharmaceutical interest in pediatric oncology, and there may be some hope on that horizon. A newer product, obecabtagene autoleucel [obe-cel], was developed in the UK and is now [being explored in] more global trials. It is a slightly different CAR construct; [although] the CAR still binds to CD19, which is what drives the anti-leukemia activity, it has a lower binding affinity meaning that it has fast-on, fast-off kinetics. We believe that may lead to increased T-cell persistence and less exhaustion of T cells, and it also seems to make the product potentially safer.

A product that were excited about potentially being able to see more of is WU-CART-007 in T-cell ALL. Weve been talking a lot about B-cell, and thats where a lot of work has been done, but T-cell ALL is very common in our adolescent and young adult patient populations. Luckily, work [from groups such as] the Childrens Oncology Group has found that very intensive chemotherapy can result in CR rates of approximately 90% and approximately a 70% chance of long-term cure.

However, when patients fall into that 30% where theyve unfortunately relapsed, they are [in] a very high-risk group. Second remissions are extremely rare, and the long-term survival rate is approximately 10% to 15%. Were desperate to find emerging therapies to help these patients and thats where the trial [examining] WU-CART-007 potentially comes in.

This is an allogeneic CAR T-cell therapy and that is helpful because these patients tend to be quite sick, and it would be difficult to mobilize their own cells. [WU-CART-007] is an off-the-shelf product; you can use a healthy donor to manufacture these cells, and then do some CRISPR modification to decrease the chances of adverse effects. The T-cell receptor [is taken out] which will hopefully mitigate the risk of graft-vs-host disease by these allogeneic cells. CD7 [is also eliminated] which is a very common marker on T cell ALL; on the CAR T cells they get rid of CD7 so that theyre not killing off those cells that theyre trying to produce to treat the patients leukemia.

[Study authors] published results from a phase 1/2 [WU-CART-007 1001 (NCT04984356) trial] at the ASH Annual Meeting this past year, where several patients, including some pediatric patients as the trial went down to age 12, who had relapsed/refractory T-cell ALL or lymphoblastic lymphoma were treated. There were some encouraging results [showing] that these patients did seem to, at the highest dose that was then expanded into a phase 2 cohort, have significant responses. A few of these patients eventually [received] an allogeneic transplant for consolidation after achieving a CR. The study has since closed because [investigators] were so encouraged by those results that theyre designing a larger trial [and are] hoping to go for FDA approval [of WU-CART-007] if the follow-up study shows promising results.

One of our biggest challenges is that these are expensive therapies and were trying to work closely with our managed care group to understand the urgency of patients and to be able to go directly up the chain as fast as possible with our insurance partners to get our patients approved to get therapy. This has been an ongoing project, [but] weve come to a better place where weve been able to streamline that process of not only getting the insurance company to say yes but agreeing to pay for the treatment as well because thats critical.

There are still some critical issues to be resolved. With the CD19-[directed CAR T-cell agents] since we have FDA-approved products, [were trying] to better understand who is the most likely to respond to these treatments, who is most likely to have long-term responses, and how to improve the toxicity profile. Those are essential questions to be answered to be able to deliver these treatments in the safest way possible and to provide that long-term cure that many patients and families are hoping for. There will be a combination of efforts to be able to answer those questions. A lot of that work will come from real-world consortium [studies], potentially even through groups like the Childrens Oncology Group.

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CAR T-Cell Therapies Move Ahead in Pediatric and Adult ALL - OncLive

Pediatrics

In a Shift, Pediatricians’ Group Says Breastfeeding Safe When HIV-Positive Mom Is Properly Treated – jacksonprogress-argus

Key Takeaways

The American Academy of Pediatrics now supports breastfeeding by HIV-positive moms, if their infection is controlled

The risk of HIV transmission through breastfeeding is less than 1% if the mom is virally suppressed

That risk should be weighed against the many benefits of breastfeeding, the AAP says

MONDAY, May 20, 2024 (HealthDay News) -- The nations top pediatrics group has reversed its decades-old position on HIV-positive mothers breastfeeding their infants.

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The American Academy of Pediatrics now says its generally safe for moms with HIV to breastfeed or provide breast milk to babies if their infection is properly controlled.

The risk of HIV transmission through breastfeeding from a mother who is virally suppressed is less than 1%, according to an AAP evidence review published May 20 in the AAP journal Pediatrics.

That small risk should be weighed against the health and financial benefits of breastfeeding, the AAP says.

Research now shows that the risk of HIV transmission through breastfeeding is quite low when the lactating parent is on anti-retroviral treatment and has no detectable viral load, said Dr. Lisa Abuogi, lead author of the AAP review.

While avoiding breastfeeding is the only option to guarantee that the virus is not transmitted, pediatricians should be ready to offer family-centered and nonjudgmentalsupport for people who desire to breastfeed, said Abuogi, who is medical director for the Children's Hospital Colorado Immunodeficiency HIV Prevention Program.

Nearly 5,000 people with HIV in the United States give birth every year, the AAP says.

Without treatment, women with HIV can pass the virus to their infants during pregnancy, delivery or breastfeeding.

However, daily medications can keep people with HIV healthy and reduce their viral load below detectable levels, the AAP noted.

The AAP says it is following the lead of the U.S. Centers for Disease Control and Prevention, which starting in 1985 had recommended against breastfeeding for people with HIV. The CDC now supports breastfeeding for HIV-positive mothers after discussing the option with a doctor.

The AAP recommends that pediatricians:

Know the HIV status of pregnant women, to provide appropriate counseling and prescribe antiretroviral treatment

Be prepared to support HIV-positive women who want to breastfeed if they started antiretroviral treatment early in or prior to pregnancy and are committed to maintainingviral suppression through breastfeeding

Counsel pregnant women and new mothers at increased risk of HIV infection regarding the risk of transmitting the virus through human milk, if infection occurred while breastfeeding

Healthcare professionals, researchers and people with HIV have made amazing strides over the past few decades towards eliminating perinatal transmission of HIV in the United States, Abuogi said in an AAP news release. "We encourage families to share information with their pediatricians about HIV and discuss what will work best for them when it comes to feeding their baby.

SOURCE: American Academy of Pediatrics, news release, May 20, 2024

Moms with HIV who want to breastfeed should talk with their doctor about whether it will be safe for their baby.

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Pediatrics

US Pediatricians Group Reverses Decades-Old Ban On Breastfeeding For Those With HIV – 1340 WJOL – 1340 WJOL

(Associated Press) A top U.S. pediatricians group is making a sharp policy change about breastfeeding by people with HIV.

The group says they can breastfeed as long as they are taking medications that effectively suppress the virus that causes AIDS.

Its a reversal in a longstanding policy from the American Academy of Pediatrics.

The group made the changes on Monday, effectively overturning guidance that dated back decades.

Experts say drugs used to treat HIV can reduce the risk of passing the virus to infants to less than 1%.

About 5,000 people who have HIV give birth in the U.S. each year.

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Pediatrics

Should You Put Sunscreen on Infants? Not Usually – FDA.gov

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When you go outdoors with your infant, whether for a quick stroll in the park or a day at the beach, its important to keep your little one out of the sun. But should you put sunscreen on your baby to protect them from the suns bright rays? Not usually.

Your infants sensitive skin is vulnerable to serious burns. But sunscreen isnt the answer, according to the U.S. Food and Drug Administration. Thats because infants are at greater risk than adults of sunscreen side effects, such as a rash.

The FDA and the American Academy of Pediatrics (AAP) recommend keeping newborns and babies younger than 6 months out of direct sunlight. The best sun protection for these infants is to stay in the shade. Look for natural shade, such as under a tree. Or create your own shade under a beach umbrella, a pop-up tent, or a stroller canopy.

Its especially important to keep your baby out of the sun between 10 a.m. and 2 p.m., when the sun is at its strongest and ultraviolet (UV) rays are most intense. If you do need to be outside in the sun during those times, be sure to take extra precautions. And check with your pediatrician before applying sunscreen to children younger than 6 months.

The AAP suggests dressing infants in lightweight clothing, such as long pants and long-sleeve shirts. Babies should wear a hat with a brim that shades the neck to prevent sunburn. Not baseball caps, which dont shade the neck or ears, both of which are sensitive areas for a baby. And for fabrics, tight weaves are better than loose ones.

Summers heat presents other challenges for babies. Our sweat naturally cools us down when were hot. But younger babies dont sweat like adults do. Their bodies havent fully developed that built-in heating-and-cooling system, so they can become easily overheated and have a greater risk of becoming dehydrated.

Here are some things to keep in mind this summer when outside with infants younger than 6 months:

05/09/2024

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Should You Put Sunscreen on Infants? Not Usually - FDA.gov