Major AAP Policy Updates of the Year

No. 4: Fruit juice is off the table.
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By Anisa Arsenault, Associate Editor
Published December 28, 2017
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When you were a baby, there’s a good chance your crib was decked out with bumpers, blankets and maybe even a stuffed animal or two. But now that sleep environment is totally taboo. Wondering who makes the rules when it comes to baby safety? The American Academy of Pediatrics (AAP) is the definitive arbiter of policies and practices when it comes to children’s health. And throughout the year, the organization reviews studies to see which policies and practices need updating. From breastfeeding to banking cord blood, here are the major baby-related updates the AAP made in 2017.

1. Donated Breast Milk

Because breast milk that hasn’t been properly screened, collected or stored can pose health risks to baby, potentially spreading diseases like tuberculosis and HIV, the FDA is hesitant to condone milk sharing. While formal milk banking services like the Human Milk Banking Association of North America exist to safely collect pasteurized donor milk for babies unable to nurse from their own mothers, there are only 20 banks in the United States. As a result, parents are turning to more easily-accessible, inexpensive and unregulated sources of donor milk, like Facebook groups. Because high-risk, low birthweight infants especially benefit from donor milk, the AAP offered the following points in their January policy statement:

  • Donor human milk may be used for high-risk infants when the mother’s milk is not available. Priority should be given to babies who weigh less than 1500 grams (3.3 pounds).
  • Human milk should be screened using methods established by the Human Milk Banking Association of North America, or other established commercial banks. It should be pasteurized.
  • Because of the risk of contamination, health care providers should discourage families from direct human milk sharing or purchasing human milk online.
  • Policies are needed to make donor milk affordable for families in need.

2. Immunization Schedules

While baby’s vaccination schedule remains largely unchanged, the AAP made a few tweaks in a March policy statement. The most widely applicable change for babies? Infants should receive a single dose of the Hepatitis B vaccine within 24 hours of birth.

3. Breastfeeding Support

Concerned that pediatricians weren’t doing enough to support breastfeeding moms in during their office visits, the AAP outlined a clinical report in May to review outpatient breastfeeding support practices. To encourage pediatricians to be as breastfeeding-friendly as possible, the report says doctors should:

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  • Establish a written breastfeeding-friendly office policy and create a designated nursing/pumping room.
  • Train staff in the skills necessary to support breastfeeding, especially nurses and medical assistants. Consider hiring an International Board Certified Lactation Consultant (IBCLC).
  • Introduce the subject of breastfeeding as early as possible, such as during prenatal visits.
  • Encourage exclusive breastfeeding through six months.
  • Schedule the first newborn visit by babies third to fifth day of life.
  • Discuss breastfeeding and returning to work.
  • Encourage breastfeeding in the waiting room.

4. Fruit Juice

While you might think juice is the easiest way to sneak some fruit into your child’s diet, the AAP is now encouraging you to hold off. This June, for the first time in 16 years, the AAP updated its fruit juice guidelines, adjusting the amount a child should be permitted based on age.

  • 0-6 months: No fruit juice—or fruit—allowed. The AAP emphasizes an exclusive breast milk diet.

  • 6-12 months: While old guidelines okayed fruit juice at this point, the updated version advises parents to avoid it. That’s because introducing juice before solid foods may cause baby to fill up on empty calories, resulting in a reduced intake of protein, fat, and essential vitamins and minerals.

  • 1 year-4 years: Children need a cup of fruit per day. The AAP says it’s okay if 4 ounces—or half—of that comes from juice. Opt for juices that are labeled 100 percent fruit juice or reconstituted fruit juice, not juice cocktails, sweetened fruit drinks or unpasteurized fruit juices.

5. Delayed Cord Clamping

In June, the AAP endorsed a publication from the American College of Obstetricians and Gynecologists (ACOG) about delayed umblical cord clamping. AAP and ACOG are now officially encouraging parents and health care professionals to opt for delayed cord clamping whenever possible. And by “delay,” they mean waiting 30 seconds to a minute after birth. During that time, the umbilical cord will continue to pulsate, giving baby nourishment and oxygen from the mother while he or she learns to breathe.

6. Car Seats

While not much has changed in the car seat safety realm, the AAP refreshed its age-by-age guide to different types of car seats in July so that parents could more easily digest the information:

  • 0-2: Since 2011, the AAP has recommended remaining in rear-facing position until children are at least 2 years old or until they reach the highest weight or height limit listed on the specific car seat model. This provides better protection for baby’s head, neck and spine in an accident. Infant car seats, convertible car seats and 3-in-1 car seats can all be used in a rear-facing mode.

  • Toddlers and preschoolers: Toddlers and preschoolers should be in a convertible or forward-facing seat with a harness once they have outgrown the rear-facing height and weight limit for their car seat. They should remain in the convertible or forward-facing seat with a harness for as long as possible, and until they have outgrown the weight and height limits for that seats. If their shoulders are above the highest harness slot, they’re probably read to graduated to a booster seat.

  • School aged children: A booster seat is used until the seat belt fits properly without the child needing to be raised up for proper positioning. This usually occurs when a child is 8 to 12 years old and has reached 4 feet, 9 inches tall.

7. Pediatric Waiting Rooms

Doctor’s offices are full of sick kids, and sick kids are full of germs. To keep the pediatric waiting room as sterile as possible, the AAP updated its 2007 guidelines in October. The most notable changes:

  • Flu shots are mandatory for all healthcare providers and office employees.
  • Alcohol-based sanitizers and face masks must be readily available.
  • The guidelines include special instructions for respiratory hygiene and cough etiquette strategies for patients with a respiratory tract infection.

8. Cord Blood Banking

Firm advocates of cord blood banking and its life saving abilities, the AAP recognized the confusion between public versus private banking. So they updated guidelines this October to help explain.

  • Public: Donation to a public bank is free and the cord blood stored is available for patients in need all over the world. The 28 public cord blood banks in North America are highly regulated by oversight accrediting institutions.

  • Private: Private banks store cord blood for the donor family’s personal use, but research shows this is rarely necessary, unless a family shares a particular genetic defect. Private banks charge a placement fee of $1,350 to $2,300, along with an annual fee of $100 to $175. Quality assessment reviews by both national and international accrediting bodies show that private banks are not as regulated for quality control and may not meet strict requirements.

As you probably guessed, the AAP recommends that parents who wish to bank their child’s cord blood use a public bank.

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

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