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American Academy of Pediatrics

 


NEWS HIGHLIGHTS


Below are releases on studies appearing in the September issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).

For Release: Monday, August 30, 2010 12:01 am (ET)

AAP ADVICE ABOUT SEX MESSAGES IN THE MEDIA

Today there are more reasons than ever to pay attention to media messages about sexuality and contraception. Teens spend more than seven hours a day on average with various forms of media, often without adults around. Television shows and Web sites that are popular with teens—and the way sex is portrayed in those venues—could be important factors in the initiation of sexual intercourse. The U.S. has the highest teen pregnancy rate in the Western hemisphere, and a recent study from the Centers for Disease Control and Prevention (CDC) revealed that 1 in 4 teenagers has had a sexually transmitted infection. Just as inappropriate media messages can be detrimental to teens, socially responsible programming can be a powerful vehicle for sexual health education.  A revised policy statement from the American Academy of Pediatrics, “Sexuality, Contraception, and the Media,” published in the September 2010 print issue of Pediatrics (published online Aug. 30), includes updated recommendations for pediatricians and parents. Among the new recommendations since 2001:

  • Pediatricians can help parents and teens recognize the importance of this issue by asking at least two media-related questions during office visits: 1) How much time do you spend daily with entertainment media? 2) Is there a TV or Internet access in your bedroom?
  • In addition to supervising their children’s traditional media use, parents (as well as pediatricians) should understand social networking sites and counsel kids about using them.
  • The entertainment industry should be encouraged to produce more programming that contains responsible sexual content and that focuses on the interpersonal relationship in which sexual activity takes place. Meanwhile, advertisers should stop using sex to sell products.
  • Pediatricians and the government should urge and encourage the broadcast industry to air advertisements for birth control products.
  • Ads for erectile dysfunction drugs, which can be confusing to young viewers, should not air until after 10 p.m.
  • Parents can use media story lines as teachable moments to discuss sex with their teens instead of doing “the big talk.”

The statement also calls for creation of a national task force on children, adolescents and the media to be convened by child advocacy groups in conjunction with the CDC or National Institutes of Health.

AAP UPDATES GUIDELINES ON SPORT-RELATED CONCUSSION

Athletes often joke about “getting your bell rung” after taking a hit on the playing field, but adolescent concussions can cause serious long-term injury or death, and should always be taken seriously. The American Academy of Pediatrics (AAP) is publishing a new clinical report, “Sport-Related Concussion in Children and Adolescents,” in the September 2010 print issue of Pediatrics (published online Aug. 30). Young athletes are more susceptible to the effects of a concussion because their brains are still developing, and appropriate management is essential for reducing the risk of long-term complications. Although preventing all concussions is unlikely, there are several ways to reduce the risk, including protective gear (such as helmets and mouth guards), adhering to the rules of the sport, identifying athletes at risk, and educating parents, teachers, athletes, school administrators and trainers about the dangers of concussions. Football has the highest incidence of concussion, but girls have higher concussion rates than boys in similar sports. Better understanding of the symptoms and risk of long-term complications have prompted the following recommendations from the AAP:

  • Children or adolescents who sustain a concussion should always be evaluated by a physician and receive medical clearance before returning to play.
  • After a concussion, all athletes should be restricted from physical activity until they are asymptomatic at rest and with exertion. Physical and cognitive exertion, such as homework, playing video games, using a computer or watching TV may worsen symptoms.
  • Symptoms of a concussion usually resolve in 7 to 10 days, but some athletes may take weeks or months to fully recover.
  • Neuropsychological testing can provide objective data to athletes and their families, but testing is just one step in the complete management of a sport-related concussion.
  • There is no evidence proving the safety or efficacy of any medication in the treatment of a concussion.
  • Retirement from contact sports should be considered for an athlete who has sustained multiple concussions, or who has suffered post-concussive symptoms for more than three months.

YOUNGER ATHLETES SUFFERING MORE SPORT-RELATED CONCUSSIONS

The number of sport-related concussions is highest in high-school aged athletes, but the number in younger athletes is significant and on the rise. In the study, “Emergency Department Visits for Concussion in Young Child Athletes,” in the September 2010 issue of Pediatrics, (published online August 30), concussion-related emergency department (ED) visits were analyzed for patients between the ages of 8 and 19 years from 1997 to 2007. From 2001 to 2005, U.S. children aged 8 to 19 years had an estimated 502,000 ED visits for concussion. Approximately half of all ED visits were sport-related concussions, and the 8- to 13-year-old age group accounted for 40 percent of these. ED visits for concussions in organized team sports were highest in ice hockey and football, and the most ED visits for concussion in individual and recreation sports were in snow skiing, bicycling, and playground activities. Although organized team sport participation declined from 1997 to 2007, ED visits for concussions in 8- to 13-year-olds doubled, and they more than doubled in the 14- to 19-year-old group. Study authors suggest that additional research and injury prevention strategies are needed in order to protect young athletes.

AAP CLINICAL REPORT: THE GYNECOLOGIC EXAM

Pediatricians who provide primary care to adolescent girls will often address gynecologic issues, including questions related to puberty, menstrual disorders, contraception, sexually-transmitted infections and other infections. The American Academy of Pediatrics (AAP) promotes the inclusion of the gynecologic exam in the primary care setting. A new AAP clinical report, “Gynecologic Examination for Adolescents in the Pediatric Office Setting,” published in the September 2010 print issue of Pediatrics (published online Aug. 30,) reviews the gynecologic examination, including when a pelvic exam is indicated. Most adolescents do not need an internal examination, but when they do, the best setting is often in the primary care office with a pediatrician who has established a trust and rapport with the patient. The report also covers when a referral to a gynecologist is indicated.

AAP ISSUES FLU VACCINE RECOMMENDATIONS

The American Academy of Pediatrics (AAP) has issued updated recommendations for the use of trivalent seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children. The AAP policy statement, “Recommendations for Prevention and Control of Influenza in Children, 2010-2011,” will be published in the October 2010 print issue of Pediatrics and released early online on August 30.

The AAP recommends annual trivalent seasonal influenza immunization for all children and adolescents 6 months of age and older. Special efforts should be made to immunize all family members, household contacts, and out-of-home care providers of children who are younger than 5 years; children with high-risk conditions (e.g., asthma, diabetes, or neurologic disorders); health care personnel; and pregnant women. These groups are most vulnerable to influenza-related complications.

Although two influenza vaccines were recommended last year, only a single trivalent vaccine is being manufactured for the current 2010-2011 seasonal influenza vaccine schedule. The 2009 pandemic influenza A (H1N1) strain has replaced last year’s influenza A (H1N1) strain in the 2010-2011 trivalent seasonal influenza vaccine, which also includes two other strains of flu virus.

The AAP policy includes a concise flow chart to simplify decision-making about the number of influenza vaccine doses a child needs, which depends on the child’s age at the time of the first dose and vaccine history:

  • Children younger than 6 months are too young to receive influenza vaccine.
  • Children 9 years of age and older need only 1 dose.
  • Children younger than 9 years need a minimum of 2 doses of 2009 pandemic H1N1 vaccine. If they did not receive the H1N1 vaccine during last year’s flu season, they will need two doses of seasonal influenza vaccine this year.
  • Children younger than 9 years who have never received the seasonal flu vaccine before will need 2 doses.
  • Children younger than 9 years who received seasonal flu vaccine before the 2009-2010 flu season need only one dose this year if they received at least 1 dose of the H1N1 vaccine last year. They need 2 doses this year if they did not receive at least 1 dose of the H1N1 vaccine last year.
  • Children younger than 9 years who received seasonal flu vaccine last year for the first time, but only received 1 dose, should receive 2 doses this year.
  • Children younger than 9 years who received a flu vaccine last year, but for whom it is unclear whether it was a seasonal flu vaccine or the H1N1 flu vaccine, should receive 2 doses this year.
  • All children who need 2 doses should receive the second dose at least 4 weeks after the first dose.

Editor’s note: The September print issue of Pediatrics also includes the AP Policy Statement, “Child Fatality Review.” The statement will be published online August 30. For a copy of the statement, contact the AAP Department of Communications.

The American Academy of Pediatrics is an organization of 60,000 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.