AN E-NEWSLETTER FROM T(E OKLA(OMA C(APTER OF T(E AMER)CAN ACADEMY OF PED)ATR)CS

Letter from the President Resident in the Spotlight Free CME: Obesity in Primary Care Training Series Action Alert: (B Current (PV Vaccine Coverage in Oklahoma Your Voice is Needed Do You (ave an )dea for a Resolution? What’s New in Peanut Allergy The )mportance of Play Knowledge, Attitudes...about E(D) Systems )n the (eadlines

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Dear Colleagues, )t's flu season. ) hear the collective groan from every pediatrician in Okla-homa. Even if you don't see Medicaid patients in your office, or give vaccina-tions, or work in an outpatient setting, the words flu season probably still makes you groan. As a provider who works in both an inpatient and outpa-tient setting personally giving the flu vaccine and admitting/caring for pa-tients with influenza complications, ) find myself counseling parents about the flu vaccine for their child, about flu vaccines for themselves, and dispelling rumor after unfounded rumor about getting the flu from the vac-cine . This is what flu season means to someone like me and ) know )'m not alone. So it's with this premise in mind that ) have made a conscious decision to make a change in my office this flu season. )n years past, we had parents sign a separate consent form for the influenza vaccine being given in our office. We stopped doing that years ago. )n more recent years, my nurses were in the habit of asking, Do you want your baby/child to get a flu vaccine? This is the year ) decided to put an end to that ques-tion. Am ) out of my mind? Did ) decide to no longer give the flu vaccine in my office? No. I made a decision to stop ask-

ing and treating the flu vaccine differently than all the oth-er routinely recommended vaccines in my office. So now when a child between the ages of – months comes in for their routine checkup, unless directed to do so otherwise, we draw up ALL the recommended vaccines in-cluding the flu vaccine without that one clarification. So, yes, we assume that if you are coming in for vaccines, you're com-ing in for ALL your vaccines. My nurse draws them up and has them in the room ready for me, hands the parent a copy of their vaccination record, and ) ask if they have any questions

AAP Annual Leadership Forum- March -

Annual Chapter Meeting and CME Conference- April -

Content and articles published in the OKAAP eNewsletter reflect solely the ex-pressed views, opinions and experiences of the authors and do not necessarily represent the position of the OKAAP, the AAP or the leadership or member physi-cians of the OKAAP or AAP.

about their child's vaccines before ) give them at the end of the visit. )t had been driving me nuts for many years that we were treating the flu vaccine differently than we were treating the other vaccines – it felt as though we were vali-dating a parent's concern about giving a flu vaccine by sin-gling it out with a question. So this year, that practice has stopped. Now with any change, you can expect issues, right? Last month, ) had a mother call back after getting home and more closely examining her child's vaccination record that her month old had, indeed, received the flu vaccine. She was upset. She didn't want her to have the flu vaccine and, of course, gave us a few reasons for her reluctance nobody in her family gets them, they never get the flu, the flu vac-cine can give you the flu, etc., etc. . We did what we could to explain why the flu vaccine was recommended just like all the other vaccines and why her child received it just like the other recommended vaccines that she D)D want both my nurse and ) each spoke to her on the phone . Continued on page ...

AN E-NEWSLETTER FROM T(E OKLA(OMA C(APTER OF T(E AMER)CAN ACADEMY OF PED)ATR)CS

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Content and articles published in the OKAAP eNewsletter reflect solely the ex-pressed views, opinions and experiences of the authors and do not necessarily represent the position of the OKAAP, the AAP or the leadership or member physi-cians of the OKAAP or AAP.

Taylor Couch is currently in her first year of Pediatric Resi-dency at the University of Oklahoma School of Community Medicine in Tulsa, Oklahoma. Taylor grew up in Miami, Okla-homa and graduated from Miami (igh School. She then at-tended Oklahoma State University, graduating with a Bache-lor of Science degree in biological studies. After graduation, she completed her medical education at the University of Ok-lahoma School of Community Medicine in Tulsa. Growing up, Taylor did not know she wanted to be a doctor. She just knew that she wanted to help people in some way. Observing her mother return to Physician's Assistant school when Taylor was years old, she began to become interested in the sciences. Following her mother's completion of school, Taylor began to admire the impact her mother was able to make in people's lives, especially the children, as a physician assistant in a small town. Originally, she was planning on go-ing into dermatology; however, once in medical school, she discovered her passion for pediatrics. During her first year of medical school, Taylor was intrigued by the theory of adverse childhood experiences and how teaching resilience and changing behaviors could impact the patients at a young age to prevent disease as an adult. She was

able to be a part of a large project studying ACE scoring in adults and the adverse outcomes. This passion for recognizing adverse childhood events and teaching families resilience has grown as she has began to build a panel of her own continuity patients. During her second year of medical school, Taylor’s close friend gave birth to micro-premie twins, Brayden and Brody who became Taylor’s most influential teachers during medical school. She was fascinated by the complexity and simplicity of watching development occur outside the womb. Observing the holistic approach to family-centered care at the OU Chil-dren's (ospital in Oklahoma City taught her the importance of treating the whole family, not just the child as she became aware of the PTSD symptoms parents face and the constant ups and downs throughout the twins' lives. As the boys have grown up and graduated from the N)CU, she observed the im-portance of a good general pediatrician and the importance of differentiating between normal childhood ailments and com-plications of being born weeks early. She could not have asked for better inspiration and teachers. Taylor is still unsure of what she will choose to do following residency as far as fellowship versus general pediatrics, but she tries to keep an open mind to all the possibilities. She has come to have so many mentors throughout the OU Pediatrics network as well as in her hometown, especially Keith Mather. She is very thankful for such great support she has received from her loving, patient husband, Nolan, and their families throughout this adventure.

FREE CME Training The Oklahoma State Department of (ealth, the Oklahoma State Medical Association and the University of Oklahoma (ealth Sciences Center are pleased to offer you a FREE CME training series developed to improve the quality of pediatric obesity management in primary care. The training is offered through monthly webinars. For dates and details, click here for more information.

AN E-NEWSLETTER FROM T(E OKLA(OMA C(APTER OF T(E AMER)CAN ACADEMY OF PED)ATR)CS

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Content and articles published in the OKAAP eNewsletter reflect solely the ex-pressed views, opinions and experiences of the authors and do not necessarily represent the position of the OKAAP, the AAP or the leadership or member physi-cians of the OKAAP or AAP.

We made one change as the result of this conversation. The mother did point out to us that the list of routinely recommended vaccines and what ages we gave them at in the office that we had on the back of each exam room door, did not include the in-fluenza vaccine. OK, that was a good point – so we added a note to the bottom of each of these signs that says The influenza vaccine is routinely recommended for children - months of age during the fall/winter. ) can tell you all, though, that ) am the only one in the office that handles the flu vaccine this way. My partner's nurses always ask the question. So that made me wonder, how do you handle this issue in your office? )'m curious to know so )'ve linked a poll https://www.surveymonkey.com/r/LYW(WS to our OKAAP Facebook page https://www.facebook.com/OKAAPchapter/ to see what you do and what your comments are. Or, you can click here to go directly to the one-question poll: https://www.surveymonkey.com/r/LYW(WS This was a bit of a heavy-handed segue into another pressing issue – SB . Please read the information in this newsletter about this important senate bill which seeks to remove all non-medical vaccine exemptions in Oklahoma. The OKAAP has committed to supporting this bill and want you to help us strengthen the vaccination laws in Oklahoma. )'m hoping for a mild flu season this year but with the hospitalizations for influenza complications already making the rounds in the news reports, it's not looking like a skate in the park this year. <collective groan>

Eve Switzer, MD, FAAP

Help OKAAP Support HB 30

SB , authored by Senator Yen, seeks to remove all non-medical exemptions in Oklahoma.

As Pediatricians, we know the value of timely immuniza-tions and risks associated with non-medical vaccine ex-emptions on community immunity. The OKAAP supports Senator Yen and SB . A statewide poll conducted by SoonerPoll demonstrates that Oklahomans support strengthening child vaccination laws. )f you support strengthening Oklahoma’s child vaccination laws, then you can help the OKAAP and Senator Yen in sup-port of (B by donating. Any amount will be appreciated. Donate Now

Working Together to Reach National Goals for HPV Vaccination. The following is a link to the newest report provided by the CDC regarding Oklahoma’s (PV vaccine coverage.

October HPV Vaccination Report:

Oklahoma

The AAP states that the purpose of resolutions are to provide a formal mechanism whereby the members of the Academy can give input concerning Academy policy and ac-tivities. )f you have an idea for a resolution, the AAP offers the Resolution Template, Guidelines for Submitting Res-olutions, and Writing and Submitting a Resolution - Step by Step Tip Sheet. All of these resources can be accessed at https://www.aap.org/en-us/my-aap/chapters-and-districts/Resolutions/Pages/Submitting-Resolutions.aspx with your AAP membership log in and password. The deadline to sub-mit a resolution is December , .

AN E-NEWSLETTER FROM T(E OKLA(OMA C(APTER OF T(E AMER)CAN ACADEMY OF PED)ATR)CS

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Content and articles published in the OKAAP eNewsletter reflect solely the ex-pressed views, opinions and experiences of the authors and do not necessarily represent the position of the OKAAP, the AAP or the leadership or member physi-cians of the OKAAP or AAP.

AAP Elections Voting has started for the new AAP President-elect and a new District V)) member on the National Nominating Committee. The candidates for the AAP President-elect are Dr. Lynda Young of Worcester, MA and Dr. Fernando Stein of (ouston, TX. Eligible AAP members are encouraged to vote in the AAP elections which began on October and runs through November . The new person will assume office as President-elect on January , . All FAAPs, except corre-sponding fellows, are allowed to vote. Paper ballots will not be sent out, as the election will be conducted online. You should have received or will receive an e-mail with a unique link to the candidate information and ballot or you can log in to MyAAP on the aap.org site to access the ballot. )t takes less than a minute to vote! Please exercise your right to vote, as we choose new leaders in our AAP. Your voice is needed!

Dr. Lynda Young Dr. Fernando Stein

AN E-NEWSLETTER FROM T(E OKLA(OMA C(APTER OF T(E AMER)CAN ACADEMY OF PED)ATR)CS

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Content and articles published in the OKAAP eNewsletter reflect solely the ex-pressed views, opinions and experiences of the authors and do not necessarily represent the position of the OKAAP, the AAP or the leadership or member physi-

By Martha Tarpay, MD - Allergy, Asthma, & Clinical Research Center

There has been a concern about the increasing incidence of pea-nut allergy. The prevalence of peanut allergy quadrupled over the last years. Our recommendations regarding the preven-tion and management have changed over the years: )n the American Academy of Pediatrics AAP recommend-ed avoidance of peanut and peanut products until age in high risk children severe eczema, egg allergy, or both . Generally families in the USA avoided giving peanut to their children until age - years, even if they were not at high risk for peanut aller-gy. Avoidance of peanut until years of age did not decrease the rising incidence of peanut allergy. )n the AAP retracted the recommendation. This change of recommendation was supported by an observational study that found x higher incidence of peanut allergy in Jewish children living in the UK than it was in Jewish children living in )srael. Children in )srael eat peanut containing snacks during the first year of life, while peanut was avoided in children below - years of age in the UK. This study suggested that early introduc-tion of peanut in infant’s diet may lead to the prevention of pea-nut allergy. This theory was tested in the LEAP Learning Early about Peanut Allergy study. )n the LEAP study children with eczema or egg allergy who had no or slight sensitivity to peanut were divided into groups; peanut products were given regular-ly to one group, while the other avoided them. At years of age peanut challenge revealed . % peanut allergy in the peanut avoidance group in comparison with . % in the consumption group. Based on the above mentioned studies we expect new guidelines should be forth coming. There are still many unanswered ques-tions. )n the meantime, infants at high risk for peanut allergy should have skin testing for peanut between months and months of age. )f the test is negative the infant should be started on peanut products. )f the skin test shows mild sensitivity the patient should have peanut challenge, if it is negative the patient should be started on the peanut containing diet. From: Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High –risk Infants.

By Pathways.org

Play is critical for children’s development because it provides time and space for children to explore and gain skills needed for adult life. Children’s playtime has steadily decreased due to lim-ited access to play spaces, changes in the way children are ex-pected to spend their time, parent concerns for safety, and digi-tal media use. Between and , the amount of time chil-dren spent playing dropped by percent. During this same time period, children ages - lost hours a week of free time and spent more time at school, completing homework, and shopping with parents. Play can be defined as any spontaneous or organized activity that provides enjoyment, entertainment, amusement or diver-sion. When children play, they engage with their environment in a safe context in which ideas and behaviors can be combined and practiced. Children enhance their problem solving and flex-ible thinking, learn how to process and display emotions, man-age fears and interact with others. Free, unstructured play al-lows children to practice making decisions without prompted instructions or the aim of achieving an end goal. They can initi-ate their own freely chosen activities and experiment with open-ended rules. Social changes and new technologies have greatly impacted the way children play and the amount of free time they are given. Children’s playtime continues to decrease as a result of: Emphasis on academic preparation at an early age- % of American kindergarteners no longer have recess.

Electronic media replacing playtime- - year olds spend nearly hours a day engaging with different media, and % of children and teenagers have a TV in their bedroom

Less time spent playing outside-a study following young children’s play found that kids under years old some-times spend less than minutes a week outside. Perceived risk of play environments-in one study, % of parents cited safety concerns, e.g. street traffic and stranger danger, as a factor influencing where their children play.

Limited access to outdoor play spaces-only % of homes in the U.S. are located within a half-mile of a park.

Continued on page ...

AN E-NEWSLETTER FROM T(E OKLA(OMA C(APTER OF T(E AMER)CAN ACADEMY OF PED)ATR)CS

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Content and articles published in the OKAAP eNewsletter reflect solely the ex-pressed views, opinions and experiences of the authors and do not necessarily represent the position of the OKAAP, the AAP or the leadership or member physi-cians of the OKAAP or AAP.

Part – Children with Hearing Loss: Age of Di-agnosis Matters! )n - , the Oklahoma Newborn (earing Screening Program N(SP /Early (earing Detection and )ntervention E(D) system partnered with the National Center for (earing Assessment and Management NC(AM at Utah State University, Boys Town National Research (ospital, and the University of Oklahoma (ealth Sciences Center – Department of Communication Sciences and Disorders to conduct a nationwide survey with state-specific infor-mation to understand what physicians think, know, and feel about newborn hearing screening and follow up. Re-sults from the survey have been analyzed to develop re-sources for physicians and their patients related to new-born hearing screening/follow up. Despite Oklahoma leading the nation in terms of how quickly children can be diagnosed with hearing loss, only % of Oklahoma respondents to the survey indicated that the best estimate of the earliest age of which a newborn who does not pass a hearing screening should receive addi-tional testing was under one month. A total of % of Ok-lahoma physicians who responded indicated they estimat-ed that infants can receive definitive diagnosis of SNHL by months and % felt that a child can begin wearing hear-ing aids by months. Of the Oklahoma participants, % indicated a child with SNHL should be referred to early in-tervention by months. see table on the next page for de-tails Overall, Oklahoma respondents to the physician sur-vey had a poorer response than those in the study regarding newborn hearing screening follow-up time and age of hearing loss diagnosis. Encouragingly, however, the percentage of Oklahoma physicians who knew babies should get follow-up with hearing aids and early interven-tion within guidelines set by the CDC was equal to or great-er than the national percentage. Current CDC guidelines are as follows: screening by month, diagnosis by months and intervention including amplification if desired by months of life. An easy take home message for parents is: Children can be definitively diagnosed with any type of hearing loss from birth, can begin to wear hearing aids as soon as diagnosis is established, and should be re-ferred to early intervention at the same time. To assist Oklahoma Medical (ome providers with pediatric audiolo-gy resources regarding age of hearing loss diagnosis, the Oklahoma Audiology Task force provided more below. Continued on the next page...

As a result of reduced playtime, children are spending less time being active, interacting with other children, and building essen-tial life skills, such as executive functioning skills, that they will use as adults. During well-child visits, healthcare professionals can inquire about children’s playtime and media usage, and pro-vide suggestions to promote quality playtime. The American Academy of Pediatrics recommends health professionals pick two targeted questions to ask parents at well-child visits such as: . The number of hours the child spends engaged in screen time . Whether there are digital devices in the child’s bedroom. Children’s play behaviors may vary based on cultural norms and family preferences. While some cultures emphasize individual-ism and independent play, others engage in more parent-directed play and activities. This can influence how children play with toys and interact with their peers and family members. To help provide advice to families with different values, styles of play, and communication, health professionals can offer these recommendations from the American Academy of Pediatrics: Allow for hour a day of unstructured, free play

Limit child’s media time to less than to hours a day

No media usage for children under

Establish Screen free zones by keeping TVs, computers and video games out of children’s bedrooms

Limit background media use during playtime and family activities because it is distracting for children and adults

Establish a plan for media use, e.g. when and where media is used and length of time child uses media For more tips on how to encourage children’s play time check out this free brochure. About Pathways.org: Pathways.org is a national not-for-profit dedicated to maximiz-ing children’s development by providing free tools and re-sources for medical professionals and families. To help parents learn about important topics in development and milestones for their child, Pathways.org provides free supplemental materials for well child visits and parent classes. View our new play bro-chure here to access information created for parents on the im-portance of children’s play. [ ] Bishop, Ronald. Go out and play, but mean it: Using frame analysis to explore re-cent news media coverage of the rediscovery of unstructured play. The Social Science Journal. ; : - . [ ] S. (offerth, J.F. Sandberg, Changes in American children's time, – [ ] Parham, D & Fazio, S. Play in Occupational Therapy for Children: Second Edition. Mosby, inc; . [ ] Ginsburg, Kenneth R. The importance of play in promoting healthy child develop-ment and maintaining strong parent-child bonds. Pediatrics. Jan. : . Academ-ic OneFile. Web. Feb. . [ ] Children, Adolescents, and the Media. From the American Academy of Pediatrics: policy statement. Pediatrics. Nov. ; : - . [ ] Lillard, A. Peterson, J. The )mmediate )mpact of Different Types of Television on Young Children’s Executive Function. Pediatrics. Oct. . [ ] Farver, J.M, Y.K., & Lee, Y. Cultural Differences in Korean- and Anglo-American Preschoolers’ Social )nteraction and Play Behavior. JSTOR. Aug : ; -.

AN E-NEWSLETTER FROM T(E OKLA(OMA C(APTER OF T(E AMER)CAN ACADEMY OF PED)ATR)CS

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Content and articles published in the OKAAP eNewsletter reflect solely the ex-pressed views, opinions and experiences of the authors and do not necessarily represent the position of the OKAAP, the AAP or the leadership or member physi-cians of the OKAAP or AAP.

ASK THE EXPERT: Dr. Jessica Ballard, Audiologist )n a world full of sound, it is no surprise that hearing has long been considered a foundation for language development and communication in children. Deafness in infancy and early childhood occurs in an estimated three children per and is a serious concern because it interferes with language acquisition as well as social, emotional, and cognitive devel-opment. )n recent years, a number of research studies have also illustrated how age of diagnosis can have a significant impact a child’s auditory development and subsequent language and educational outcomes. Understanding the im-portance of age of diagnosis for children with hearing loss is crucial for physicians to best facilitate early intervention and optimal outcomes for the hearing impaired child. Age of Diagnosis The term neuroplasticity has become very familiar in hearing healthcare. Neuroplasticity plays an important role in outcomes for a child with hearing loss, especially as we consider age of diagnosis. The human cochlea has normal adult function by the th week of gestation Johansson et al, , so infants are literally born hearing sound and pre-wired to learn language at birth. (owever, we must consider that hearing only occurs when sounds transmitted from the cochlea and eighth cranial nerve, are processed in the brain and auditory cortex. Numerous research studies have shown that although brain cell formation at birth is complete, the maturation and development of the neural pathways is most rapidly changing during the first three years and especially the first months of age. Although first words usu-ally don’t emerge until one year of age, the early months are a key developmental period for the auditory cortex and speech and language centers of the brain. (earing during this time in an infant’s life is crucial to development of speech and language. The use of electrophysiologic testing to assess Central Auditory Evoked Potentials CAEPs is one test which has objec-tively illustrated the impact of age of diagnosis and intervention on children with hearing loss. )n , Sharma and col-leagues reported that CAEPs demonstrate a critical period of time during the first . years of life . Continued on the next page...

AN E-NEWSLETTER FROM T(E OKLA(OMA C(APTER OF T(E AMER)CAN ACADEMY OF PED)ATR)CS

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Content and articles published in the OKAAP eNewsletter reflect solely the ex-pressed views, opinions and experiences of the authors and do not necessarily represent the position of the OKAAP, the AAP or the leadership or member physi-cians of the OKAAP or AAP.

Children with hearing loss who received appropriate intervention including identification, amplification/implantation, and habilitation during this critical window of time had cortical responses comparable to a child with normal hearing; whereas, children who did not receive intervention during this period showed abnormal or significantly delayed re-sponses. Research related to language outcomes also strongly supports the concept of neuroplasticity and the need for early di-agnosis of hearing loss. An example of this was a hallmark study by Yoshinaga-)tano and colleagues , where it was shown that children who are identified with hearing loss and receive appropriate intervention by six months of age developed language skills within the normal range of development on standardized language tests as compared to chil-dren identified at after months of age. With this substantial body of research supporting the need for early diagnosis of hearing loss, the Joint Committee on )nfant (earing JC)( have determined all children should be screened for hearing loss no later than month of age; and when hearing loss is identified, early intervention services should begin no later than months of age to ensure optimal auditory development as well as speech, language and educational outcomes. Oklahoma hospitals routinely screen for hearing loss, and infants who refer on their newborn hearing screening should then be referred for additional diagnos-tic testing. On average, just over % of newborn children with hearing loss in Oklahoma are diagnosed by months of age. As we consider long term outcomes, age of diagnosis does matter. )t is critical that Physicians and other health care providers continue to facilitate early diagnosis of hearing loss to ensure optimal outcomes for each child. Special Note: Of the children diagnosed with hearing loss each year in Oklahoma, at least - of those children are diagnosed and fit with hearing aids if desired by the first week of life. This far exceeds national expectations; thus Ok-lahoma has paved the way for possible new national standards of early identification. Summary: • Hearing loss in children is a developmental emergency due to potential impact on language, as well as, social, emotional, and cognitive development. • Age of diagnosis matters! Children who are identified and receive intervention within the first six months of life can develop language skills similar to hearing peers. • Early diagnosis and appropriate intervention allows access for growth and development of auditory brain centers for listening, language, reading and general learning. Additional Resources: • http://nhsp.healthok.gov • www.infanthearing.org • Guidelines for Pediatric Medical (ome Providers: http://www.asha.org/policy/PS - /#AP

To receive a copy of the previous articles in this series, please send an email to NewBornScreen@health.ok.gov

Dr. Jessica Ballard is a member of the Oklahoma Audiology Taskforce. She has practiced as a Cochlear )mplant Audiologist with children and adults; she now works for Cochlear Americas.

The Chapter would like to acknowledge and congratulate Dr. Marny Dunlap whose Promoting Early Developmental Screening PEDS Project was recently awarded a CATC( )mplementation cycle grant. Dr. Dunlap’s application was one of only selected proposals out of applications. The AAP Friends of Children Fund provided funding specifically to address poverty and Early Brain and Child De-velopment EBCD . Congratulations, Dr. Dunlap, and we wish you much success with your CATC( project!

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Content and articles published in the OKAAP eNewsletter reflect solely the ex-pressed views, opinions and experiences of the authors and do not necessarily represent the position of the OKAAP, the AAP or the leadership or member physi-cians of the OKAAP or AAP.

AN E-NEWSLETTER FROM T(E OKLA(OMA C(APTER OF T(E AMER)CAN ACADEMY OF PED)ATR)CS

% of doctors don’t strongly endorse HPV vaccination Some parents choose not to get their child vaccinated against the (PV virus. Now, a new study suggests the deci-sion to avoid vaccination may largely be down to discour-agement from doctors. Read More

Organic foods may lower levels of pesti-cides in children Recent organic diet intervention studies suggest that diet is a significant source of pesticide exposure in young children. Read the full study...

Many young children have their own mobile device by age Nearly half percent of children under age used a mobile device on a daily basis to play games, watch vide-os, or use apps. The percentage increased to percent in

-year-olds and plateaued after that. Read the Article

AAP issues recommendations on tobacco & e-cigarettes E-cigarettes are threatening to addict a new generation to nicotine. )n a comprehensive set of policies issued during the NCE, the AAP presents extensive recommenda-tions to protect youth from nicotine and tobacco. Watch

Auvi-Q epinephrine injectors recalled Sanofi U.S. is voluntarily recalling all Auvi-Q epinephrine auto-injectors due to suspected malfunctions that could deliver the wrong dose of medication. .Read More

The AAP tackles football injuries With football remaining one of the most popular sports for children and teens, the American Academy of Pediatrics AAP is issuing new recommendations to improve the safety of all players while on the field. Learn More

Study identifies roadblocks for mental health services for bullied adolescents Nearly one in three U.S. adolescents are affected by bully-ing, placing them at risk for health problems including attention deficit hyperactivity disorder, anxiety, depres-sion and self-harm. Read the full article

Most parents form vaccination preferences before becoming pregnant Study finds nearly three-quarters of mothers and fathers began deciding which vaccines they want to give to their child before they knew they were having a baby. See More

Oklahoma Chapter AAP S. Trenton Ave. Tulsa, OK www.okaap.org

Eve H. Switzer, MD, FAAP President

Laura J. McGuinn, MD, FAAP Vice President

Dwight T. Sublett, MD, FAAP Secretary/Treasurer

Amy Prentice Executive Director

apre ice@upal.co Phone: - - Toll Free: - -