From the Guidelines
The American Academy of Pediatrics (AAP) provides comprehensive guidelines for the care of children across different developmental stages, prioritizing morbidity, mortality, and quality of life as the primary outcomes. For neonates (0-28 days), the AAP recommends exclusive breastfeeding when possible, proper positioning during sleep (on back), routine screening for jaundice, hearing loss, and congenital heart disease, as well as hepatitis B vaccination at birth 1. Vitamin K administration is recommended at birth to prevent bleeding disorders. For infants (1-12 months), the AAP advises continued breastfeeding for at least 12 months, introduction of solid foods around 6 months, regular well-child visits for growth monitoring and vaccinations according to the recommended schedule, and continued safe sleep practices.
Key Recommendations
- For toddlers (1-3 years), guidelines focus on developmental screening, limiting screen time to less than 1 hour of high-quality programming daily, establishing healthy eating habits, and promoting physical activity.
- For adolescents (12-21 years), the AAP recommends annual comprehensive health visits including confidential time with providers, screening for depression, substance use, and risky behaviors, comprehensive sexuality education, HPV vaccination by age 13, and attention to mental health needs.
- Throughout all stages, the AAP emphasizes the importance of age-appropriate safety measures (car seats, helmets, water safety), dental care beginning with the first tooth, and maintaining up-to-date immunizations.
Preventive Care
- The AAP recommends annual influenza immunization for everyone 6 months and older, including children and adolescents, with a preference for inactivated influenza vaccine (IIV) over live attenuated influenza vaccine 1.
- Urinary tract infection (UTI) diagnosis and management guidelines for febrile infants and young children (2-24 months) have been revised to include clinical criteria for collecting urine specimens and to reduce the criterion for a positive culture from at least 100,000 colony-forming units per mL to at least 50,000 colony-forming units per mL 1.
Quality of Care
- The AAP supports the development and use of quality measures to improve patient care and outcomes, with a focus on important issues for children, scientific validity, feasibility, and interpretability 1.
- Quality measures should address topics of substantial impact, be based on best evidence available, and include patient and family participation.
From the Research
AAP Guidelines for Vaccination
- The American Academy of Pediatrics (AAP) recommends that infants receive several vaccines directed against various infectious diseases, including hepatitis B, diphtheria, tetanus, pertussis, pneumococcus, rotavirus, poliovirus, and Haemophilus influenzae type b 2.
- The first dose of the hepatitis B vaccine is recommended to be administered at birth, with subsequent doses given at 2 and 6 months of age 2.
- For preterm infants, the timing of the first dose of the hepatitis B vaccine varies between countries and regions, with some guidelines recommending a birth dose for all preterm infants and others recommending it only for infants with a birth weight of more than 2000-2200 g 3.
- The AAP recommends administration of the hepatitis B vaccine within 24 hours of birth for infants with a birth weight >2 kg 4, 5.
Vaccine Schedules
- The recommended vaccine schedule for infants includes:
- Hepatitis B vaccine at birth, 2 months, and 6 months
- Diphtheria, tetanus, pertussis, pneumococcus, rotavirus, poliovirus, and Haemophilus influenzae type b vaccines at 2,4, and 6 months
- Influenza vaccine at 6 months, with a second dose 28 days later 2
- A liquid hexavalent combined vaccine against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type B, and hepatitis B has been shown to be highly immunogenic and safe for primary and booster vaccination of infants and toddlers 6.
Special Considerations
- Preterm infants may require special consideration when it comes to vaccine administration, with some guidelines recommending a delayed vaccine schedule 3.
- The AAP recommends that all newborns receive the hepatitis B vaccine within 24 hours of birth, with a goal of achieving a vaccination rate of at least 90% within this timeframe 4, 5.