ACPeds Papers
ACPeds Papers
Alphabetical Index
The American College of Pediatricians (ACPeds) produces position and policy statements on matters unique to the child and the family. It is the goal of the ACPeds that these statements be based upon the best available research, and unencumbered by political or societal opinion. This information will assist parents, policymakers, legislators and society in advocating for that which is best for children, adolescents and their families.
ABSTRACT: Can sexual activity, alcohol and drug use, violent video games, pornography and other activities, including use of social media, damage adolescent minds? In a word – yes. Early high-risk behaviors are powerful influences and appear to be harmful to the brain’s development. The hormones and neural patterns triggered can lead to addictive, high-risk behaviors, social withdrawal, and depression. Compounding this concern is the fact that the decision-making processes during adolescence are immature. Fortunately, parents can positively impact the brain development of adolescents as they assist in decision-making, provide structure to the adolescent’s environment, and monitor the adolescent’s activities.
ABSTRACT: Research confirms that parents play a vital role in helping teens make healthy choices. Pediatricians therefore serve the best interests of their adolescent patients and their families by forging a strong alliance with both parents and adolescents while doing everything possible to foster open parent-teen communication. If a pediatrician wishes to talk one-on-one with an adolescent patient in order to encourage increasing responsibility for self-care, that conversation can be approached in a way that does not undermine the parent-child relationship. This paper describes a process for building a strong partnership with parents, including sharing scientific information with both teens and parents regarding how to maintain optimal sexual health during the adolescent years.
ABSTRACT: The American College of Pediatricians affirms adoption as the best option for children who cannot be raised within their natural families. An appropriate adoptive family provides a child with love, permanency, stability, and the same legal rights as a child born into that family.
ABSTRACT : Over the last several decades, many countries have legalized euthanasia and physician assisted suicide for adult patients. The Netherlands was the first to legalize euthanasia for emancipated minors in 2002. More recently, the Netherlands, Belgium and several other countries have expanded their euthanasia laws to include all minors. The American College of Pediatricians decries this trend and calls upon the Medical profession in the United States to reject euthanasia and assisted suicide for minors and return to its pro-life Hippocratic roots to uphold the ancient medical ethics principle of first, do no harm. It is the role of the physician to care for all patients, including terminally ill patients, with compassion and the best available medical treatments. The intentional killing of human life is not healthcare. It violates the dignity of the human person and is always unethical.
ABSTRACT: The custom of regularly eating together as a family is common to most cultures. There are proven benefits to every member when mealtime is a family affair. Families today, however, are less likely to gather at meal times than in the past. Given the protective factors that are conveyed to children and adolescents, pediatricians should encourage parents to make every effort to regularly gather around the “Family Table” for meals.
ABSTRACT: No child should be harassed for his or her unique characteristics. Schools should encourage an environment of respectful self-expression for all students, and no group should be singled out for special treatment. Parental involvement should be a school’s primary method of resolution with programs emphasizing general respectfulness serving to set the tone in the classrooms.
ABSTRACT: Children are the world’s future. Child trafficking, as with few other threats to their well-being, undermines the future of children, families, and societies. In the United States, it is estimated that up to 300,000 children are victims of sex trafficking, also known as Domestic Minor Sex Trafficking (DMST). Countless others are victims of additional forms of exploitation, especially forced labor. Some of these children have been brought to the United States illegally, while thousands are US citizens as young as 12, who have been recruited, abducted, abused, or exploited into the sex trade or forced servitude.
ABSTRACT: Chemical abortions, otherwise known as “medication-induced” abortions, were approved by the FDA in September 2000, and now account for over 50% of abortions in the United States. Women are being encouraged to order and carry out their own abortion, without in-person supervision by health care professionals, contributing to increased risks of complications. This paper describes the use of synthetic chemicals to induce abortion and the complications faced by women who obtain care in a medical setting, including hemorrhage and incomplete abortions that may require surgical intervention. Additionally, it describes the increased risks for those women who use telemedicine or the Internet to obtain their chemical abortion, especially when those abortions are completed without physician supervision (self-managed). The risks may include an undiagnosed ectopic pregnancy, Rh isoimmunization, and undiagnosed infection. Intimate partner violence and human trafficking are also less likely to be suspected in the absence of an in-person medical evaluation. The American College of Pediatricians strongly encourages health care professionals, policy makers, and women of all ages and their families to understand the serious risks associated with chemical abortions, especially when self-managed. Additionally, pregnant women with regrets after starting chemical abortions need to be informed about the potential for abortion pill reversal.
ABSTRACT: Contrary to the current perception of many adolescents and young adults who view cohabitation as a substitute for marriage or as a stepping stone to a more secure marriage, studies show that cohabiting unions are more likely to dissolve than marriages and that marriages preceded by cohabitation are more likely to dissolve than marriages that were not preceded by cohabitation. Cohabiting unions are more likely to involve infidelity and also more likely to involve violence. Furthermore, children, whether born prior to, during, or after parental cohabitation, are at increased risk for negative sequelae including premature birth, school failure, lower education, more poverty during childhood and lower incomes as adults, more incarceration and behavior problems, single parenthood, medical neglect and chronic health problems both medical and psychiatric, more substance, alcohol and tobacco abuse, and child abuse. Cohabiting women are also more likely to choose to end their child’s life prior to birth.
ABSTRACT: Effects of non-marital sexual activity involve not just the children who may be conceived through it, but also involve children who were born in prior relationships (marital or non-marital) and future children born after the current relationship either dissolves or progresses to marriage, as well as the children of those children and continuing future generations. The divorce or separation of a couple (and divorce or separation is more common when the couple has a history of non-marital sex including cohabitation) may even affect their nieces and nephews or their children’s friends who then worry that their own parents will separate. Compared to couples married at the birth of a child, those cohabiting at the child’s birth were more than four times as likely to separate in the following three years (Table 1). The increased risk varied from double among African-Americans, to triple among Mexican-Americans to nearly 8-fold among European-Americans.
ABSTRACT: The American College of Pediatricians (ACPeds) recognizes that adolescent depression is a serious public health concern. The most recent epidemiological data show that nearly 13 percent of youth will experience at least one episode of major depression by age 17. Depressive episodes are associated with negative consequences later in adolescence. These include academic difficulties, risky behavior engagement, self-injury and suicide. The purpose of this paper is to present evidence-based lifestyle changes that may prevent and/or mitigate depressive episodes among youth.
ABSTRACT: Central to the success of childrearing is the process of child discipline. This process of training and teaching a child is influenced by many factors, some of which are controlled by the parents and others that are dependent upon the child and the environment. This paper explores the multifactorial process of child discipline.
ABSTRACT: Medical marijuana is now legal in 29 of the 50 United States. Recreational marijuana was legalized in Colorado in 2013. Various reports have revealed the short and midterm effects of this legalization process on teens and young adults. The significant detrimental effects of marijuana on teenage mental health and brain development have been documented in a previous position statement. The recent reports of the 2016 Colorado Department of Public Safety and the US 2014 National Survey on Drug Use and Health provide new information supporting the significant adverse effects of legalization on teens and young adults. Marijuana legalization in Colorado has resulted in significantly greater and more frequent usage of marijuana in adolescents and young adults. In addition, with legalization there is a perception of decreased risk of use by both teens and their parents. This process of legalization is associated with an increasing trend for many risky behaviors in youth as observed in Centers for Disease Control (CDC) reports on risky behavior in youth. Binge alcohol consumption, extramarital sexual activity, and increasing use of narcotics are among the associated behaviors. A recent surgeon general’s report suggests that how society responds to this substance use epidemic will be a “moral test” for America. This “moral test” will, of necessity, require parental education and insight for parents to provide a moral foundation that will help their children avoid harmful, risky behavior. The American College of Pediatricians agrees that efforts aimed at primary PREVENTION are essential to curbing substance abuse.
ABSTRACT: A policy of either pre-prescribing “emergency contraceptives” to adolescent patients, or making them available without prescription, carries significant medical risk and is counterproductive to the parent-adolescent and patient-physician relationships. The American College of Pediatricians recommends instead that health professionals encourage good adolescent-parental communication, and teach adolescent patients the benefits of delaying sexual activity until marriage and how to avoid early sexual debut.
ABSTRACT: The American College of Pediatricians (ACPeds) maintains that it is unethical to intentionally harm an innocent human being even in the absence of the individual’s ability to perceive pain. However, in this paper, ACPeds reviews the laboratory and clinical evidence which indicates that as early as 12 weeks gestation (and possibly earlier) exposure to noxious stimuli negatively affects immature human beings. Because of the resulting acute stress responses and subsequent potential long-term negative effects, the ACPeds holds that avoiding, mitigating, and directly treating fetal, neonatal, and pediatric pain is a medical and ethical obligation.
ABSTRACT: Pregnant women, medical professionals, and society are concerned about fetal pain. The topic is complex, and communication of accurate information requires a working knowledge of current fetal pain research. This research can broadly be categorized as follows: 1) The fetus responds to skin-breaking procedures with significant changes in behavior, facial expressions, stress hormones, and metabolism from the earliest ages studied; 2) Anatomic and behavioral evidence suggests that the fetus is capable of pain awareness by 15-20 weeks gestation and possibly by 12 weeks; 3) The brain does not need to be fully developed to experience pain. Different standards of care exist in fetal surgery, neonatology, and obstetrics regarding pain management in age-matched populations. Fetal surgeons and anesthesiologists administer direct fetal anesthesia during fetal surgery, as early as 15-16 weeks gestation. Neonatologists in the neonatal intensive care unit (NICU) provide pain management to the earliest premature infants at approximately 22 weeks gestation, and the embryology of fetal neuroanatomy demonstrates that cortical circuitry begins with thalamic connections to the cortical subplate at 12-15 weeks gestation. Despite medical practice and known fetal physiology, most obstetric associations state that during an induced abortion, the fetus is unconscious and cannot feel pain until after 24-28 weeks or later. This overlaps a substantial number of neonates in the NICU and fetal surgical patients. The 2024 Society of Family Planning (SFP) and the Society for Maternal Fetal Medicine (SMFM) update states that there is no pain capability “until at least 29-32 weeks.”1 The value-based divergence in medical recommendations for anesthetic and analgesic medical care between those who perform induced abortion and those who provide medical care for fetuses and premature neonates present a medical and ethical dilemma. This document reviews the research that informs fetal pain management and the basis for informed consent.
ABSTRACT: The World Health Organization has stated there are significant health risks and no medical benefits to female genital mutilation (FGM). The American College of Pediatricians agrees with this assessment and is therefore categorically opposed to this practice and agrees with its designation as a Federal crime. However, as people from cultures that practice FGM immigrate, over 500,000 women and girls in America are felt to be at risk for suffering from the negative sequelae of FGM. Therefore, the College has published this brief statement to educate pediatricians and other child health professionals about the negative physical and psychological impact of FGM so they can better care for patients at risk.
ABSTRACT: A healthcare professional’s freedom to practice according with his or her conscience has long been a respected and enduring privilege. Recent challenges to this principle have prompted this professional review. Health professionals, parents or patients, should not be required to provide, or participate in, any medical service that violates their conscience or causes moral distress. This includes the right to refuse to refer to a different health professional for the purpose of procuring such service. Compelling health professionals to subordinate their moral conscience (convictions often founded in religious doctrines) to the dictates of any authority such that they comply with fluctuating social norms and patient demands threatens the integrity of medical professionals and also endangers the lives of patients.
ABSTRACT: School-based comprehensive sex education (CSE) curricula chiefly emphasize the secondary public health principle of risk reduction. CSE programs in America’s schools have not demonstrated long-term effectiveness at increasing sexual abstinence among adolescents, nor have they been shown to increase long-term condom and contraceptive use among sexually active youth. School-based sexual risk avoidance (SRA) curricula, traditionally known as abstinence education, focus on the primary public health principle of risk avoidance and thereby uphold the highest attainable standard of health for all students. School-based SRA programs have been shown to significantly delay the onset of sexual debut among adolescents without diminishing condom use among those who are already sexually initiated. The American College of Pediatricians therefore recommends the adoption of sexual risk avoidance (SRA) programs by all school districts in lieu of curricula described as comprehensive sex education (CSE).
ABSTRACT: The availability and use of pornography has become almost ubiquitous among adults and adolescents. Consumption of pornography is associated with many negative emotional, psychological, sociological, and physical health outcomes. These include increased rates of depression, anxiety, acting out and violent behavior, younger age of sexual debut, sexual promiscuity, increased risk of teen pregnancy, child sex abuse, sexual trafficking, and a distorted view of relationships between men and women. For adults, pornography results in an increased likelihood of divorce which is also harmful to children. The American College of Pediatricians urges healthcare professionals to communicate the risks of pornography use to patients and their families and to offer resources both to protect children from viewing pornography and to treat individuals suffering from its negative effects.
ABSTRACT: Induced abortion is the most common surgical procedure performed on females of child-bearing age, including adolescent women. Consequently, pediatricians should be familiar with the short-term and long-term risks of induced abortion and also be able to compassionately discuss these risks with adolescents and involved family members. Some of the potential short- and long-term risks include increased mortality from suicide and other violence, as well as natural causes; increased risk of breast cancer; greater rates of substance abuse; and higher risk of morbidity and mortality for subsequent children due to premature births, especially very premature births. Patient education on the risks of induced abortion should be considered during anticipatory guidance discussions at well-child visits during the adolescent years.
ABSTRACT: The mother and unborn child impact each other’s physiology and brain restructuring to help assure adaptation and bonding. The unborn child causes changes in the mother’s nutritional status, in her immune system, and in the functioning of her brain that help assure optimal health for mother and child both before and after delivery. Conversely, the mother impacts her growing baby, in particular the baby’s brain development, through her emotional state, sleep cycles, voice, and nutritional state. ACPeds encourages all health care professionals to promote policies that respect and protect the mother-baby duo with their intricately interconnected systems.
ABSTRACT: Adverse childhood experiences are known to negatively affect the physical and emotional health of adults. Now scientific research shows that adverse childhood experiences can actually begin in utero as the unborn child is exposed to the chemical influences of maternal stress hormones. Mothers who experience anxiety, depression, or intimate partner violence while pregnant may unknowingly adversely impact the development of their unborn child. However, early recognition and prenatal intervention can help mitigate these negative consequences, so ACPeds encourages health care professionals to consider this research when caring for pregnant women and their infants after birth to assure the best health outcomes for all involved.
ABSTRACT: Parenting style has both short-term and long-term effects upon child development. The benefits of authoritative parenting have been documented for many years, and now research demonstrates that responsive parenting, a crucial component of authoritative parenting, may actually help alleviate the effects of toxic stress experienced in utero and during childhood. Other documented benefits range from improved language development in toddlers to a decreased risk of metabolic syndrome in young adults. The American College of Pediatricians encourages all health care professionals to consider this research in advising parents with the care of children.
ABSTRACT: In the midst of society’s and mainstream medical organizations’ accepting if not promoting (i.e., “affirming”) false sexual identities, the American College of Pediatricians (ACPeds) is concerned that medical and public policies are denying the importance of biological sex and truth. Sex is a dimorphic, innate trait defined in relation to an organism’s biological role in reproduction. Males have inherent anatomical and physiological advantages compared to females that impact male and female sports performance beginning in early childhood and continuing through adulthood. The use of puberty blockers and cross sex hormones in males does little to change the inherent advantage they have in sports that require muscular strength, power, aerobic endurance, and speed. Therefore, males, regardless of gender identity, should not be allowed to participate in most women’s sports. This statement is not applicable to the rare individual with a disorder of sexual differentiation.
ABSTRACT: Marijuana and cannabis have been used medicinally and recreationally for 4000 years and public perception of their use has varied over time. Currently, the public considers marijuana to pose minimal risk or even beneficial effects, leading to broad legalization throughout the world. The scientific literature indicates these perceptions are incorrect and that use of cannabis and marijuana have pronounced effects on mental and physical health, particularly for heavy users. These effects are more pronounced with early use in adolescents. Adverse effects of marijuana use include reduced school, driving safety and work performance, increased risk of mental illness and schizophrenia, harm to an unborn child if used during pregnancy, and its role as a gateway to other drugs of abuse. We conclude that there is an important role for pediatricians to counsel families regarding these risks and work with the press and legislators to counter the misperceptions regarding marijuana.
ABSTRACT: Decades of research evaluating the impact of family structure on the health and well-being of children demonstrates that children living with their married, biological parents consistently have better physical, emotional, financial, and academic well-being. The emotional, physical, and financial well-being of biological parents is also enhanced when they are married to each other. With the exception of unresolvable abuse in the family, children generally fare better when they grow up with married biological parents. Biological fathers being involved and supportive of their children is especially important. Consequently, pediatricians and society should make every effort to support healthy marriages, including advocating for sexual abstinence outside of marriage and discouraging married couples from divorcing except in the case of unresolvable abuse by a parent.
ABSTRACT: All forms of media, especially visual media, play an increasing role in the lives of children, adolescents, and families in the United States. While limited use of high-quality and developmentally appropriate media may have a positive influence, excessive or developmentally inappropriate use carries grave health risks. Excessive exposure to screens (television, tablets, smartphones, computers, and video game consoles), especially at young ages, is associated with lower academic performance, sleep disturbances, obesity, attention deficit, increased aggression, lower self-esteem, depression, and increased rates of high-risk behaviors. The American College of Pediatricians (ACPeds) encourages parents to become media literate and limit screen time for their children. Parents must lead by example and restrict their own screen time to foster a healthy relationship with their children. The ACPeds encourages pediatricians to regularly warn families about the negative impact of media during well child visits, and calls upon the media industry, sponsors, educators, and policymakers to act responsibly to protect the physical and emotional health of children and families.
ABSTRACT: Adolescents who have a gender identity not congruent with their biological sex have an increased incidence of mental health issues, including depression and suicidal ideation. Both before and after “gender affirming therapy” (GAT), adolescents who have gender-identity incongruence are at higher risk for psychopathology than their peers who identify with their biological sex. Previous adverse childhood experiences may play a major role in that psychopathology and needs to be explored in helping these patients. There are no long-term studies demonstrating benefits nor studies evaluating risks associated with the medical and surgical interventions provided to these adolescents. There is no long-term evidence that mental health concerns are decreased or alleviated after “gender affirming therapy.” Many individuals who have been treated with “GAT” later regret those interventions and seek to align their gender identity with their sex. Because of the risks of social, medical, and surgical interventions, many European countries are now cautioning against these interventions while encouraging mental health therapy.
ABSTRACT: A continuing debate exists in both law and medicine regarding an adolescent’s capacity to make rational, independent decisions. This is particularly true concerning an adolescent’s capacity to make an informed decision with regard to abortion. Neuroscience research responds to the question by noting that the area of the brain involved in critical thinking and decision-making does not reach full maturity until the early to mid-twenties. Consequently, teens are more likely to act impulsively, rather than with rational and goal-oriented thought. Relying upon outdated information and decision-making research performed in a laboratory setting, medical organizations have generally maintained that most teens are fully competent to understand the risks and consequences of, and give informed consent to, medical procedures including abortion without parental knowledge, involvement, or consent. The American College of Pediatricians examines the data and challenges this position, emphasizing the important contribution of parents in advising their adolescent children about such life-changing decisions.
ABSTRACT: Breast cancer cases have risen dramatically in recent decades around the world. Many studies from multiple nations have found induced abortion (IA) to be linked to this rise. A plausible mechanism for that link is the interference by IA with normal breast cell maturation into cancer resistant cells. Influential medical organizations have relied on studies with important design flaws which obscure this link. Major risk factors for breast cancer include delayed childbearing and not breastfeeding, both of which result from IA early in a woman’s reproductive life. Choices to delay childbearing beyond 30 years of age, to limit or avoid it altogether, to abort a pregnancy rather than to carry it to term with the adoption option, and to not breast feed, all put young women at increased risk for breast cancer.
ABSTRACT: In the midst of society’s questioning of the gender binary, the American College of Pediatricians (ACPeds) is concerned that the field of medicine risks denying the reality of biological sex. Sex is a dimorphic, innate trait defined in relation to an organism’s biological role in reproduction. In humans, primary sex determination occurs at fertilization and is directed by a complement of sex determining genes on the X and Y chromosomes. This genetic signature is present in every nucleated somatic cell and is not altered by drugs or surgical interventions. Sex differences arise from at least four different genetic mechanisms, in addition to the actions of sex hormones and environmental influences. Consideration of these innate differences is critical to the practice of good medicine and to the development of sound public policy for children and adults alike.
ABSTRACT: Parents provide the foundational role of support, nurturance, and guidance for their children. That role includes the fundamental right to direct the child’s upbringing. It is essential that society support parents by respecting their natural right and present legal authority to make decisions for their children, including educational and medical decisions. Parents, in this context, include biological and adoptive parents, as well as state-appointed guardians and custodial grandparents. Nothing in this statement should be interpreted as in any way condoning the physical, sexual, or emotional abuse or neglect of children.
ABSTRACT: The field of stem cell biology has been transformed and gained extraordinary attention in light of its future in regenerative medicine. Human embryonic stem cells have fueled considerable debate across all social and ethnic backgrounds around the world. This paper reviews the various stem cell platforms with emphasis on the emerging science of bioengineered cells that offer embryonic-like properties and the unique promise of regenerative medicine applications for pediatric medicine. Bioengineered stem cells, through induced pluripotent stem cell technology, offer a viable and possibly superior alternative to the use of human embryonic stem cells. Furthermore, this advancing technology demands attention to responsible and ethical research and implementation in the field of regenerative medicine.
ABSTRACT: School-based comprehensive sex education (CSE) curricula chiefly emphasize the secondary public health principle of risk reduction. CSE programs in America’s schools have not demonstrated long-term effectiveness at increasing sexual abstinence among adolescents, nor have they been shown to increase long-term condom and contraceptive use among sexually active youth. School-based sexual risk avoidance (SRA) curricula, traditionally known as abstinence education, focus on the primary public health principle of risk avoidance and thereby uphold the highest attainable standard of health for all students. School-based SRA programs have been shown to significantly delay the onset of sexual debut among adolescents without diminishing condom use among those who are already sexually initiated. The American College of Pediatricians therefore recommends the adoption of sexual risk avoidance (SRA) programs by all school districts in lieu of curricula described as comprehensive sex education (CSE).
ABSTRACT: Adolescents are known to experiment with electronic cigarettes (e-cigarettes) and to vape them on a regular basis because they consider doing so to be safe. Unfortunately, vaping is far from harmless. Health risks include addiction to nicotine and other substances, the numerous attendant harms associated with those substances as well as exposure to other toxins, including formaldehyde. The most serious complication from e-cigarette use is e-cigarette vaping-associated lung injury (EVALI) which can be fatal. ACPeds urges health professionals, educators and policy makers to do all they can to educate parents and adolescents about these dangers, and to strongly discourage teen vaping.
ABSTRACT: The predominance of human biological research confirms that human life begins at conception—fertilization. At fertilization, the human being emerges as a whole, genetically distinct, individuated zygotic living human organism, a member of the species Homo sapiens, needing only the proper environment in order to grow and develop. The difference between the individual in its adult stage and in its zygotic stage is one of form, not nature. This statement focuses on the scientific evidence of when an individual human life begins.
