American Academy of Pediatrics reverses long-standing ban on breastfeeding for mothers with HIV WION
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Category Archives: 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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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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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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Thousands of bike helmets to be distributed to Ohio children | 10tv.com – 10TV
Since the program's launch in 2011, more than 100,000 free helmets have gone to Ohio children.
COLUMBUS, Ohio Thousands of bike helmets will be handed out to children across the state this year as part of theOhio American Academy of Pediatrics bike helmet safety awareness campaign.
This is the ninth year that the Ohio Department of Transportation has teamed up with AAP to distribute helmets during Bike Helmet Safety Awareness Month in May. This year, 10,000 bike helmets were passed out to law enforcement agencies and community-based groups in Ohio.
Since the program's launch in 2011, more than 100,000 free helmets have gone to Ohio children.
The Honda USA Foundation provided a $25,000 grant for the helmets this year.
ODOT Press Secretary Matt Bruning said groups and agencies apply to get the helmets that they can then distribute to their community. Those groups will also get educational resources and a helmet-fitting demonstration.
Its something were proud of and happy to do because we know that biking is very important. We want kids to go out and do that, but we want to make sure theyre safe when they do it," Bruning said.
More than 150 law enforcement agencies and community organizations traveled to Columbus to pick up their allotment of helmets on Tuesday.
Wearing a helmet can reduce the risk of head injury by 85%, helping prevent unnecessary trips to hospitals, said Melissa Wervey Arnold, Chief Executive Officer of the Ohio AAP. We are incredibly grateful for ODOTs support of our Put a Lid on It program. Through this partnership, we are protecting kids and creating a safer environment for them to thrive.
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Thousands of bike helmets to be distributed to Ohio children | 10tv.com - 10TV
Sang Pediatrics: When to see the doctor for a fever – YourCentralValley.com
Sang Pediatrics: When to see the doctor for a fever YourCentralValley.com
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Sang Pediatrics: When to see the doctor for a fever - YourCentralValley.com
How to talk to your teenaged patient about pregnancy and contraception – Contemporary Pediatrics
How to talk to your teenaged patient about pregnancy and contraception | Image Credit: JPC-PROD - JPC-PROD - stock.adobe.com.
Here is some sobering news: Teenaged mothers are twice as likely to experience postpartum depression (PPD) as adults.1 For this population who are still maturing on a cognitive level and have not yet fully developed their basic coping skills, the impact of PPD can be crippling. Additionally, the stress that a pregnancy adds to this population group can lead to other increased mental health concerns, including severe depression and anxiety.2 Furthermore, parenthood is the leading reason why teenaged girls drop out of school, with more than half of teenaged mothers never graduating from high school.3
Although the national teen pregnancy rates for girls aged 15 to 17 years and 18 to 19 years (the number of pregnancies per 1000 females in the specified age group) have declined almost continuously for the past 30 years,4 the teen birth rate in the United States is still higher than in many developed countries, including Canada and the United Kingdom.5 At the same time, sexual intercourse among adolescents has become the norm: by age 19, approximately 70% of teenagers have had sexual intercourse at least once.6
For these and other reasons surrounding sexual health, initiating discussion of sexual activity, pregnancy, and contraception is a necessity for health care providers. According to the American Academy of Pediatrics (AAP), Pediatricians [should] spend one-on-one time with adolescents starting at the 11- to 13-year-old checkups. The pediatrician will ask about sexual behaviorsand, if indicated, talk with the young person about birth control and ways to prevent sexually transmitted infections [STIs].7 The question is how to broach issues of pregnancy and contraception with this patient population to produce optimal outcomes.
Initiating the discussion As the Nike ad says, just do it. Jessica Peck, DNP, APRN, CPNP-PC, CNE, CNL, FAANP, FAAN, clinical professor of nursing at Baylor University Louise Herrington School of Nursing in Dallas, Texas, says to simply start a discussion, honestly and plainly. Having an established relationship with a primary care provider makes it easier to initiate conversation on both sides. As girls progress into the teen years, its important to give anticipatory guidance before any risk-taking behaviors occur.
Additionally, with the current laws on abortion having changed dramatically, Peck notes, It is critical to know your state laws and your scope of practice according to your education, training, licensure, and certification, and providers should adhere to those boundaries, referring when necessary. She adds, Its important to emphasize regular well childcare, where questions about reproductive health are easier to ask in the context of health promotion.
A recent paper published in Frontiers in Pediatrics8 discusses the actions that health care providers can take in the prevention of unplanned pregnancy. Study authors note it is crucial to be empowering young adolescents to become more aware and capable of making informed decisions about their sexual life, health, and future.8
The paper cites several factors contributing to adolescent pregnancy, including personal vulnerability, family context, lack of information, poor access to contraception, and religious and cultural background. Adolescents, especially under the age of 16 or 17 years, lack a long-term vision of the consequences of their behavior and are driven by experimentation and emotions. Therefore, although they cognitively know about contraception and the risk of pregnancy, they may choose to ignore these aspects of their behavior as a kind of denial (it cannot happen to me). This explains why, even in high-income countries with a good coverage of health care needs, some adolescents find themselves pregnant, the authors state.8
What the discussion should include The authors developed several recommendations for health care providers in terms of discussing pregnancy and contraception with their teenaged patients and educating them about it (Table). Key elements that impact on the quality and effectiveness of service provisions are, among others, easy access to health services, including sexual and reproductive health (SRH); confidential, respectful empathetic care; communication and counseling skills; [and] easy link with specialized colleagues and the community, the investigators note.8
Birth control recommendations When it comes to counseling teenagers on methods of birth control, the AAP continues to recommend long-acting reversible contraceptives (LARCs), which include contraceptive implants and intrauterine devices, as the most effective contraceptives to prevent pregnancy. They also recommend that teenagers who use LARCs should also use a condom or other type of barrier protection during sexual activity to prevent sexually transmitted infections (STIs).
Additionally, the AAP notes that hormonal contraceptivescombined oral contraception pills, progestin-only contraception pills, patches, injections, and vaginal ringsare more than 90% effective in preventing infection. They recommend use of a condom here as well to prevent STIs.
The progestin-only pill containing norgestrel (Opill) is the first nonprescription birth control approved by the FDA and is now being sold over the counter (OTC).
Finally, should a teenager decide they want to see their pregnancy through and become a parent, the AAP affirms that all pregnant adolescents should be counseled in a nonjudgmental, developmentally appropriate manner about their full range of pregnancy options.9
Click here for more from the May issue of Contemporary Pediatrics.
References:
1. Ladores S, Corcoran J. Investigating postpartum depression in the adolescent mother using 3 potential qualitative approaches. Clin Med Insights Pediatr. 2019;13:1179556519884042. doi:10.1177/1179556519884042
2. Hodgkinson S, Beers L, Southammakosane C, Lewin A. Addressing the mental health needs of pregnant and parenting adolescents. Pediatrics. 2014;133(1):114-122. doi:10.1542/peds.2013-0927
3. Teen moms. American Society for the Positive Care of Children. 2024. Accessed March 26, 2024. https://americanspcc.org/teen-moms/
4. About teen pregnancy. CDC. November 15, 2021. Accessed March 26, 2024. https://www.cdc.gov/teenpregnancy/about/index.htm
5. About teen pregnancy and childbearing. US Department of Health and Human Services. Accessed March 27, 2024. https://opa.hhs.gov/adolescent-health/reproductive-health-and-teen-pregnancy/about-teen-pregnancy-and-childbearing
6. Lindner J. Sexually Active Teen Statistics: Market Report & Data. Gitnux. Updated December 20, 2023. Accessed March 27, 2024. https://gitnux.org/sexually-active-teen-statistics/
7. Ott MA, Alderman EM. Contraception explained: birth control options for teens & adolescents. HealthyChildren.org. Updated March 8, 2024. Accessed March 26, 2024. https://www.healthychildren.org/English/ages-stages/teen/dating-sex/Pages/Birth-Control-for-Sexually-Active-Teens.aspx
8. Martins MV, Karara N, Dembiski L, et al. Adolescent pregnancy: an important issue for paediatricians and primary care providers-a position paper from the European Academy of Paediatrics. Front Pediatr. 2023;11:1119500. doi:10.3389/fped.2023.1119500
9. American Academy of Pediatrics; Committee on Adolescence. Options counseling for the pregnant adolescent patient. Pediatrics. 2022;150(3):e2022058781. doi:10.1542/peds.2022-058781
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Adult RSV Shots Given to More Than 30 Babies by Mistake – Medpage Today
Nearly three dozen babies and young children have received respiratory syncytial virus (RSV) vaccines, which are only approved for adults, according to a brief CDC report.
Data from the Vaccine Adverse Event Reporting System (VAERS) revealed 27 reports of the Pfizer RSV vaccine (Abrysvo) and seven reports of the GSK RSV vaccine (Arexvy) being mistakenly administered to children under the age of 2 between Aug. 21, 2023 and March 18, 2024, Pedro Moro, MD, MPH, of the CDC in Atlanta, and colleagues detailed in Pediatrics.
"While rare, vaccine administration errors are known to occur and may increase after a new vaccine or product is introduced," Moro told MedPage Today in an email.
Thirty-one of the children who received the vaccines were infants under 8 months of age. In 21 of the cases, the vaccines were given in family medicine practices.
"Healthcare facilities that provide preventive care for children and adults might store and administer Pfizer and GSK RSV vaccines, other routine vaccines, and nirsevimab [Beyfortus]," Moro and colleagues wrote in the report. "Thus, the potential exists for Pfizer or GSK RSV vaccines to be administered in error to infants and young children."
Eric Simes, MD, a pediatric infectious diseases expert at Children's Hospital Colorado in Aurora, told MedPage Today that he was "not surprised" by the vaccine errors. "Mistakes will happen, especially with COVID vaccines being given to [both] adults and children, with pneumococcal vaccines being first given to children and now to adults, etc."
Simes said that he did not personally know of any cases where the RSV vaccines had been administered to children, but emphasized that "adult RSV vaccines should absolutely not be given to children."
The Pfizer vaccine is approved for use in pregnant individuals at 32 through 36 weeks gestational age, to prevent serious RSV cases in infants, and both the Pfizer vaccine and GSK vaccine are approved and recommended for adults 60 years of age and older.
Twenty-seven of the reports noted no adverse health events associated with the erroneous vaccines, but the remaining seven described at least one adverse event. One of those events occurred in an infant with a history of congenital heart disease who received the GSK RSV vaccine in combination with routine childhood vaccinations. That child required hospitalization for cardiorespiratory arrest within 24 hours after vaccine receipt. The remaining six reports described injection site reactions or systemic reactions, such as irritability, after receiving the RSV vaccines.
"Administration errors are preventable with proper education and training," the authors of the report emphasized. They suggested several strategies to prevent vaccine administration errors, including only ordering products that are approved for the patient population a facility serves, electronic health record alerts or warnings, close attention to labeling, and best practices for vaccine storage.
"To prevent mix-ups, CDC reached out to clinicians to educate them about the proper administration of the RSV vaccines," Moro said. "Education and additional vigilance will reduce the likelihood of errors."
The CDC and FDA will continue to monitor VAERS for vaccine administration errors, and clinicians are encouraged to report errors to VAERS.
The report was published several months after a notice was sent to healthcare providers that the CDC and FDA had received reports of 25 cases of the RSV vaccines being administered in error to young children in outpatient settings. At that time, there were also 128 reports of the GSK RSV vaccine being administered in error to pregnant people in outpatient settings and pharmacies. However, the CDC noted that, overall, these were a small number of cases relative to an estimated 1 million infants protected from RSV either through vaccination of pregnant individuals or infant receipt of nirsevimab -- a monoclonal antibody recommended for all infants under 8 months of age entering their first RSV season or born during it.
In instances when an RSV vaccine is given in error to children, no special monitoring is needed, according to the CDC. However, because the efficacy of the adult RSV vaccines in infants and young children has not been evaluated, children who receive an RSV vaccine in error should receive nirsevimab to prevent severe RSV disease, if otherwise eligible.
Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.
Disclosures
Moro and other study co-authors reported no potential conflicts of interest.
Simes reported consulting for GSK and has received grants for research and consulting from Pfizer.
Primary Source
Pediatrics
Source Reference: Moro PL, et al "Incorrect administration of adult RSV vaccines to young children" Pediatrics 2024: DOI: 0.1542/peds.2024-066174.
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Adult RSV Shots Given to More Than 30 Babies by Mistake - Medpage Today
Pediatric Health Care Teams Can Help Prevent Youth Suicide – The Pew Charitable Trusts
After losing a young patient to suicide in early 2023, Dr. Edward Salzberg, a pediatrician at Roswell Pediatrics Center in Georgia, found himself looking for solutions.
I had a teenager who died by suicide within 30 minutes of leaving their wellness visit, Salzberg recalled. After that, I thought to myself, How can we do better? Until it happens to you, until you have a really close encounter, you may not know what to do.
Suicide is the second-leading cause of death for young people ages 10 to 24. In 2021, the suicide rate for ages 20 to 24 was 19.4 deaths per 100,000, and the rate for 10- to 14-year-olds was 2.9 deaths per 100,000. In 2021, more than 7,000 young people died by suicide, accounting for 15% of all suicides in the United States that year. Between 2000 and 2021, suicide rates for this entire age group increased 52%, with 9% of high school students in 2021 reporting that they had attempted suicide in the past 12 months.
As the rate of youth experiencing suicide risk continues to increase, evidence-based strategies can help support pediatricians in identifying, assessing, and connecting at-risk young people to appropriate suicide care. In response to these trends, the American Foundation for Suicide Prevention (AFSP) and the American Academy of Pediatrics (AAP) began a partnership in 2021 to support pediatric providers in advancing equitable youth suicide prevention in all settings where those in this age group live, learn, work, and spend time.
AAP and AFSPs Suicide Prevention Project ECHO (Extension for Community Healthcare Outcomes) program engages pediatricians, other pediatric health providers, and community members to integrate recommendations from the partnerships Blueprint for Youth Suicide Prevention. That resource provides evidence-based strategies and tools to identify and support youth at risk for suicide in clinical and community settings.
Project ECHO uses a telementoring model that promotes knowledge-sharing and learning through virtual lectures, de-identified patient case studies, and real-time problem solving to teach providers to implement best practices for suicide prevention. A team of seven faculty members with expertise in pediatric suicide prevention, family medicine, public health research and practice, and effective clinical care pathways for suicide prevention facilitates the process. Participants then work with faculty and each other to measure clinical outcomes to help foster change.
Early last year, Salzberg participated in the first cohort for this program as a provider. [The program] was enlightening. I wasnt aware there were standard screenings that could be used, he said. I didnt realize there we so many resources available.
This cohort launched in January 2023 with support from AFSP, The Pew Charitable Trusts, and CVS Aetna. By December, more than 40 pediatric providers from urban, suburban, and rural communities across 17 primary care practices in 11 states had adopted universal suicide screening for all patients, regardless of the reason for their visit. Since then, this program has continued to engage and educate hundreds of providers and community members across more than 40 states.
There was definitely a sense of communityan instant connection with people, Salzberg said. They asked, How are you doing?, and I honestly hadnt even thought about ithow I was doing after losing a patient. The resources for providers who lose a patient were also so helpful.
Other participants shared Salzbergs sentiments in post-program surveys, highlighting the relevance and applicability of the content to what they are experiencing in their practices. Another provider remarked on the impact and benefits of the actual concrete suggestions as to how to implement suicide prevention in primary care, such as how to conduct a safety assessment and identify next steps for care for a patient who has screened positive for suicide risk.
AAP-AFSP surveys found that 85% of participants in the initial cohort reported afterward that they had increased their knowledge about suicide prevention (including risk factors and warning signs for suicide); 77% reported increased confidence in their ability to apply the information presented; and nearly all (93%) said they were committed to implementing the skills learned in practice.
In the months since, Salzberg has continued to apply those skills. He has worked to train staff on best practices in suicide prevention and treatment and provide suicide care resources to families.
Were at the beginning stages of implementing, and there are three projects: Were creating a list of reliable resources for patients and families, were training our staff on how to screen patients for suicide risk, and were looking into how we can incorporate these processes into our daily visits. We cant create a perfect system right away, but we can try, Salzberg said.
Models such as Project ECHO that bring partners together are key to implementing and scaling evidence-based mental health care. Just as health care providers are trained to respond to physical health problems, they have a key role to play in identifying and helping treat pediatric patients mental health needs.
Were always prepared for the asthma attack or seizure or a kid who isnt breathing, Salzberg said. Now we have a mechanism for assessing suicide risk and feel more confident managing these critical encounters.
Seven more Suicide Prevention Project ECHO cohorts are planned this year, including groups focused on school-based health centers and emergency departments, to ensure that more providers in these and other settings have the support they need to better address the growing risk of youth suicide.
Kristen Mizzi Angelone directs The Pew Charitable Trusts suicide risk reduction project, Corbin J. Standley is director of impact communication and continuous improvement at AFSP, and Jessica Leffelman is a program manager for Project ECHO suicide prevention initiatives at AAP.
To learn more about Project ECHO and upcoming opportunities to participate, contact [emailprotected].
Learn more about the Blueprint for Youth Suicide Prevention at aap.org/suicideprevention.
A version of this piece also was published on the American Foundation for Suicide Prevention website on April 22.
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Pediatric Health Care Teams Can Help Prevent Youth Suicide - The Pew Charitable Trusts
Small patients, big discoveries | Penn Today – Penn Today
Pediatrics is often thought of as cute people doing cute things for cute children, says Kerry Shields. Its so much more than that. Our work is highly complex. As a lecturer in the department of family and community health at Penns School of Nursing, Shields has a front row to the panoply of pediatrics innovations coming out of the school. She says, Childhood illness is often lifelong illness. Were not just treating whats in front of you, but changing the trajectory of someones entire life, as well as the lives of their siblings, parents, and community.
Penns faculty are leading the field of pediatric nursing science and research. Their work ranges from large-scale international studies to creating data models that are poised to advance the discipline and question accepted practices. Their queries are uniquely poised through the lens of nurses, meaning, with an eye toward empathy and equality. We partner with parents, we stand beside them at the bedside, we stay with patients around the clock and address their physical and emotional needs, says Martha A.Q. Curley,Ruth M. Colket Endowed Chair in Pediatric Nursing. Nursing is a discipline that requires its own science to support it. Her work also extends beyond the hospital doors. She recently finished enrollment on a cohort study looking at pediatric post-intensive care syndrome. Shes not just assuming that a patient is OK once they leave the ICU.
Advancements arent only coming from research. Faculty and nurse scientists are also thinking about how to better prepare students for clinical practice. Weve adjusted and structured the curriculum to focus on the lifespan of a patients health, says assistant professor Amanda Bettencourt. Its key to clear out a path where students see themselves as really making a difference in the lives of children and families. Bettencourt, a clinical nurse specialist, has a particular interest in implementation science. She figures out ways to help nurses adapt to necessary changes in the hospital, something that can be overwhelming to many. She does that by partnering with local pediatric clinicians for different research studies.
Faculty and nurse scientists are tackling such issues as burnout, nutrition in critically ill children, and shifting standard practices to improve outcomes. They also confront how data is collected and how it is used, and the changing cultural and political landscape in medical care. Nursing experts examine critical aspects of high-risk maternal-fetal care, and how the decisions and outcomes for this patient population are impacted by changing cultural beliefs and reproductive health laws, and partnering with community organizations to address the unique experiences and needs of individuals who have been largely missing from the evidence in high-risk maternal and fetal care.
This story is by Ashley Primis. Read more at Penn Nursing.
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