American Academy of Pediatrics (AAP) Recommendations

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From car seats and vaccines to screen time and obesity, the American Academy of Pediatrics (AAP) routinely publishes guidelines and advice to help parents keep their kids safe and healthy. In fact, there is likely an AAP policy statement for just about every major pediatric issue.

The AAP even weighs in on issues like drug testing in schools. For instance, the AAP supports substance use prevention and intervention programs, but they conclude "that research evidence does not support the initiation or expansion of school-based drug testing programs at this time."

They also offer policy statements that address everything from contraception for teens to school start times and cheerleading injuries. Being aware of the latest policy statements and guidelines from the AAP can help you make the best decisions for your kids from birth through adolescence. Here is an overview of some of the top AAP guidelines for parents.

Autism Screening

The 2020 AAP Policy Statement "Identification and Evaluation of Children With Autism Spectrum Disorders" indicates the importance of pediatricians being able to recognize the signs and symptoms of autism spectrum disorders (ASD) and have a strategy for assessing them systematically.

Part of that strategy includes performing developmental surveillance at all visits as well as standardized autism-specific screening tests at both the 18- and 24-month well-child checkups. These screenings are in addition to looking for subtle red flags that indicate the possibility of an ASD. When results are positive or concerning, pediatricians should then:

  • Provide parents with education about autism.
  • Refer the child for a comprehensive ASD evaluation.
  • Respond to family concerns quickly to avoid delays in treatment.
  • Refer the child for early intervention and early childhood education services.
  • Refer the child for an audio-logic evaluation.
  • Schedule a follow-up visit.

Most importantly, pediatricians should not take a "wait-and-see" approach if a child has a positive screen result or has two or more positive risk factors.

Risk factors can include having an autistic sibling or a parent as well as having a pediatrician or other caregiver who is concerned about the child.

Breastfeeding Guidelines

The AAP's "Breastfeeding and the Use of Human Milk" policy statement is one of the organization's most accessed policies. The statement details not only the benefits of breastfeeding but also discusses the importance of breastfeeding high-risk infants and the role pediatricians play in promoting breastfeeding.

  • Human milk is the preferred feeding method for all infants, including premature and sick newborns, with rare exceptions.
  • Exclusive breastfeeding offers ideal nutrition and is sufficient to support optimal growth and development for approximately the first 6 months of life.
  • It is recommended that breastfeeding continues for at least 12 months, and thereafter for as long as mutually desired.

"Breastfeeding and the Use of Human Milk," reinforces the idea that breastfeeding provides short- and long-term medical and neurodevelopmental advantages. It also suggests that breastfeeding and infant nutrition also should be considered a public health issue and not just a lifestyle choice.

After all, breastfeeding and human milk are the normative standards for infant feeding and nutrition. To support effective breastfeeding and increase breastfeeding rates, the AAP also endorses the World Health Organization's "Ten Steps to Successful Breastfeeding" as well as recommends:

  • Encouraging exclusive breastfeeding for at least 6 months
  • Helping new mothers breastfeed as soon as possible after delivery
  • Offering no medically unnecessary supplements in the newborn period
  • Providing a formal evaluation of breastfeeding technique each nursing shift after the baby is born to document good position and latch
  • Avoiding pacifier use until babies are about 3 to 4 weeks old and nursing well
  • Indicating that babies should sleep close to their mothers

The AAP clinical report on the "Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infant and Young Children" does suggest that exclusively breastfed babies be supplemented with oral iron until they start eating age-appropriate iron-containing foods at 4 to 6 months of age. 

Vitamin D also is recommended for exclusively breastfed infants. Keep in mind that formula-fed infants also are supplemented with vitamin D and iron as it is added to their formula, in addition to many of the other things that are included in breast milk.

Bronchiolitis and RSV

Although many parents aren't familiar with bronchiolitis, they do know about the respiratory syncytial virus (RSV) that commonly causes it. Unlike the common cold, which is an upper respiratory tract infection, bronchiolitis is a lower respiratory tract infection. It is commonly caused by RSV and other viral infections, typically in the late winter and early spring.

Similarly to a cold, children with bronchiolitis can have a runny nose and cough, but they also can experience difficultly breathing and wheezing. It is these lower respiratory tract signs and symptoms that sometimes lead hospitalization, especially for babies who are just 1 or 2 months old.

Although RSV and bronchiolitis scare a lot of parents, it is important to keep in mind that in the highest risk group—newborns and younger infants—just 3% end up requiring hospitalization. Meanwhile, hospitalization rates are much lower for older infants and children.

If your child does get bronchiolitis, the AAP has some recommendations that were published in the November 2014 issue of Pediatrics. The following is an overview of those recommedations:

  • Most kids with bronchiolitis do not routinely need laboratory tests or x-rays. Bronchiolitis should usually be diagnosed based on the child's history of symptoms and physical exam. Routine testing to see if a child has RSV is also not recommended.
  • Albuterol is not a recommended treatment for bronchiolitis. Doctors used to try an albuterol breathing treatment in kids with bronchiolitis, and if it seemed to help, they continue the treatments. This albuterol trial is no longer recommended or thought to be helpful.
  • Other treatments that aren't recommended include epinephrine, nebulized hypertonic saline (unless the child is hospitalized), steroids, chest physiotherapy (CPT), oxygen (if saturations are above 90%), or the use continuous pulse oximetry.

The new recommendations also changed the recommendations for using Synagis (palivizumab), the monthly injection that can help to prevent RSV. It is now recommended that Synagis only be used in babies who were born before 29 weeks, unless they also have chronic lung disease or heart disease.

Car Seat Recommendations

The AAP policy statement on "Child Passenger Safety" provides recommendations on how kids should safely ride in a car. The following are the key points of car seat safety:

  • Infants and toddlers should ride in a rear-facing car seat for as long as possible. Many manufacturers have limits that allow for children to ride rear-facing for two years or more.
  • All children who have outgrown the rear-facing limits for height and weight for their car seat should sit in a forward-facing car seat with a harness for as long as possible—up to the highest weight and height allowed by the manufacturer.
  • Once children are above the height and weight requirements for their car seat, they should sit in a belt-positioning booster seat through ages 8 to 12 years. At this time, they are usually about 4 feet 9 inches tall and seat belts likely fit properly.
  • Children using a lap-and-shoulder seat belt once they have outgrown their booster seat should be old enough and large enough to use it alone.
  • All children younger than 13 years old should remain in the back seat and use appropriate seat belts.

While parents often focus on the brand when buying a car seat, it is important to keep in mind that all car seats rated by National Highway Traffic Safety Administration (NHTSA) meet federal safety standards and strict crash performance standards. Some seats are easier to use than others though, which might factor into which car seat you buy.

Most importantly, buy a car seat that is age and size appropriate for your child, fits in your car, and is easy for you to install and use. Also, remember that there are no absolute ages at which you should switch seats. The AAP provides guidelines, not deadlines. So you don't always have to switch your child from a rear-facing to a forward-facing car seat as soon as they are 2 years old.

Consider both your child's age and size when thinking about which car seat is best and safest. For example, smaller children might stay in a rear-facing car seat until they are 3 years old, in a forward-facing car seat until they are 7 years old, and in a booster seat until they are 12 years old.

And even though you may look forward to transitioning from one stage to the next, keep in mind that you should not rush through these transitions.

For instance, you should delay moving your child from a rear-facing car seat until your child fully outgrows the manufacturer's limits. Also make sure they are in the correct seat for their height and weight and the car seat hasn't been recalled. You also should double-check to ensure that the seat is installed correctly every time they ride in the car, especially if you frequently move the seat between vehicles.

Circumcision

The AAP's position on circumcision has evolved quite a bit over the years. For instance, the 1999 policy statement said that existing scientific evidence demonstrates potential medical benefits of newborn male circumcision. However, they also stated data was not sufficient to recommend routine circumcision during the neonatal period.

Meanwhile, the most current policy recommendation states that after evaluating the current evidence, the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it.

Specific benefits identified include prevention of urinary tract infections (UTIs), penile cancer, and transmission of some sexually transmitted infections (STIs), including HIV.

Still, the AAP also states that the health benefits are not great enough to recommend routine circumcision for all male newborns—even though it is usually well-tolerated with infrequent complications. They urge parents to weigh the medical information in the context of their own religious, ethical, and cultural beliefs and practices in order to make a decision.

First Doctor Visits

In addition to hearing about your child's first smile, first words, and first steps, your pediatrician will be more directly involved in many other firsts to keep your child healthy. For instance, the first visit to the pediatrician is typically by the time they are 3 to 5 days old, depending on how quickly they were discharged from the hospital.

In addition to a jaundice check, this first visit can help your pediatrician review how well your baby is feeding and gaining weight, or at least verify that they aren't losing too much weight. Here are some other firsts your pediatrician will be involved with:

  • Your infant will have their hematocrit or hemoglobin checked at 12 months to evaluate for iron deficiency anemia.
  • Your toddler will have their body mass index (BMI) measured by age 2 to evaluate for childhood obesity.
  • Your preschooler will have their first eye test by age 3.
  • Your preschooler will have their blood pressure checked for the first time by age 3.
  • Your preschooler will have their hearing tested for the first time by age 4.

Dentist

The first visit to the dentist should be by 1 year of age. Some parents, and even some family dentists, think that this is too early. But keep in mind that the 2014 AAP policy statement, "Maintaining and Improving the Oral Health of Young Children," which was reaffirmed in 2019, states that with an "early referral to a dental provider, there is an opportunity to maintain good oral health, prevent disease, and treat disease early."

Gynecologist

The first visit to the gynecologist should likely be when your pediatrician recognizes anything abnormal that might warrant a referral, according to the "Gynecologic Examination for Adolescents in the Pediatric Office Setting" statement, which was reaffirmed in 2013. Many pediatricians feel that with appropriate support from a gynecologist, most medical issues can be managed by the pediatrician.

The American College of Obstetricians and Gynecologists (ACOG) does recommend that girls have their first gynecologic visit between the ages of 13 and 15. However, the first pelvic exam typically isn't until a girl is sexually active or having abnormal bleeding. And the first Pap test usually doesn't occur until they are 21.

Family Doctor

The first visit to a non-pediatrician should be when your older teen is between 18 and 21 years old. While the transition from child- to adult-oriented health care depends on many factors, it is important to keep in mind that many pediatricians continue to see older teens and some young adults, especially if they have a long-standing relationship with them.

Immunization Schedules

Vaccines have been an important part of the history of pediatrics. That's not surprising, as many now vaccine-preventable diseases (such as smallpox, measles, polio, and diphtheria) were once common and potentially life-threatening childhood diseases that children have since been vaccinated against.

According to the Centers for Disease Control and Prevention (CDC), a yearly immunization schedule is published based on input from the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. Likewise, the president of the American Academy of Pediatrics, Sandra G. Hassink, MD, FAAP recommends that these immunization schedules be followed by both families and pediatricians.

Immunization Recommendations

  • All children should follow the recommended immunization schedule.
  • All members of the AAP should follow the approved immunization schedule and help educate families about the safety and effectiveness of childhood vaccines.

Advocacy of delayed or alternative immunization schedules increases the risks to all children. Likewise, in the "Responding to Parental Refusals of Immunization of Children" report, which was reaffirmed in 2013, the AAP recommends that pediatricians avoid releasing patients from their practices solely because their parents refuse to immunize them.

The AAP's approach for pediatricians and vaccine-hesitant parents has been that as respect, communication, and information build over time in a professional relationship, parents may be willing to reconsider previous vaccine refusals. However, the plan was never for pediatricians to pander to parent's fears about vaccines or even to contribute to them.

They also never intended for pediatricians to openly advocate for anything other than the recommended immunization schedule. Pediatricians who encourage parents to skip or delay vaccines that they have concerns about have helped contribute to current outbreaks of vaccine-preventable diseases.

Instead of making up their own immunization schedules or firing patients, pediatricians must be ready to respond to all myths and misinformation provided by the modern anti-vaccine movement.

Iodine for Breastfeeding Mothers

In the policy statement, "Iodine Deficiency, Pollutant Chemicals, and the Thyroid: New Information on an Old Problem," the AAP recommends that pregnant and breastfeeding women address potential iodine issues. Here is an overview of their recommendations:

  • Take a supplement with adequate iodide with at least 150 μg of iodide.
  • Avoid exposure to excess nitrate in drinking water, which may be a problem with well water, as well as avoid too many high nitrate vegetables including celery, lettuce, spinach, carrots, and beets.
  • Avoid exposure to thiocyanate by not smoking and avoiding secondhand smoke as well as not eating large amounts of cruciferous vegetables, especially when raw, including cabbage, turnips, broccoli, and brussel sprouts.
  • Use iodized table salt.

Although pregnant women should be aware of the issue, the AAP does state that very few women consume enough cruciferous, leafy, or root vegetables for these sources of thiocyanate to be of concern." What's more, table salt in the United States has long been fortified with iodine, but many people are surprised to learn that not all salts contain iodine:

  • Most brands of sea salt are not iodized or fortified with iodine.
  • Kosher salt is not iodized.
  • Processed foods are typically made with non-iodized salt.
  • Table salt is not fortified with iodine in all countries, especially Europe, where milk, sugar, and even cooking oil might be routinely iodized instead.

Most importantly, keep in mind that few foods are naturally good sources of iodine, and may include seafood, shellfish, and seaweed. The iodine content of foods also depends on where they were caught or grown, as the iodine content of seawater and soil varies in different locations.

The biggest food sources are typically those that are directly fortified with iodine or that involve the use of iodized animal feed such as meats and dairy products.

The American Thyroid Association also recommends that pregnant and lactating women take a supplement with adequate iodide.

Lipid Screening in Childhood

Because of the growing incidence of childhood obesity along with type 2 diabetes, hypertension, and cardiovascular disease in older children and adults, the AAP developed guidelines for lipid screening in children and adolescents.

By 2011, the AAP had endorsed the "The Expert Panel Report on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents" from the National Heart, Lung and Blood Institute. This endorsement provided pediatricians with new recommendations, including:

  • Implement universal lipid screening for high cholesterol between ages 9 to 11 and 17 to 21 years of age.
  • Utilize a targeted fasting lipid profile for children between the ages of 2 and 8 years old if they are at high risk.

Profile of High-Risk Kids

  • Have a parent with high cholesterol (total cholesterol greater than 240)
  • Are over the 95th percentile for BMI
  • Have diabetes, high blood pressure, or smoke cigarettes
  • Have a close relative who had a myocardial infarction, angina, stroke, and/or coronary artery bypass graft/stent/angioplasty before they were 55 years old (males) to 65 years old (females) old

Nutrition

The AAP offers a number of recommendations regarding healthy eating and nutrition. Here is an overview of the most pertinent recommendations regarding your child's nutrition.

Calcium and Vitamin D

Working to build healthy bones as well as preventing weak bones is an important consideration for parents as their children grow into adolescents and eventually become young adults. Consequently, it's important to ensure your kids are getting enough calcium and vitamin D in their diet.

For instance, they should do plenty of weight-bearing exercises and activities and address any chronic medical conditions. This type of activity is especially important if they take any medications that could cause reduced bone mass in children and teens. The AAP Clinical Report "Optimizing Bone Health in Children and Adolescents" recommends that pediatricians:

  • Ask whether your kids are getting enough calcium and vitamin D from food or supplements
  • Determine if your kids are drinking too much soda and getting enough exercise, especially at the 3-year-old, 9-year-old, and teen well-child visits
  • Make sure your kids get enough calcium and vitamin D containing foods and drinks in their diet each day
  • Encourage your kids to participate in weight-bearing activities, including running, jumping, and dancing

Overall, you should have your pediatrician check your child's vitamin D levels only as needed. Routine screening for vitamin D deficiency in healthy children is not recommended. If your kids don't like or can't drink milk, there are plenty of other good sources of calcium and vitamin D that you can consider to help your kids build healthy bones.

And because approximately 40% to 60% of adult bone mass is accrued during the adolescent years, getting adequate calcium and vitamin D isn't something to put off too long.

Fruits and Veggies

Do your kids eat enough fruits and vegetables each day? Do you even know how much they are supposed to be eating? In general, for your child to get enough fruits and veggies, the AAP recommends that you follow the USDA MyPlate recommendations and make half your plate fruits and vegetables.

More specifically, depending on their age and activity level, kids should eat about one to two cups of fruit per day. Here is a closer look at the recommendations:

  • 1 cup of fruit when they are 2 to 3 years old
  • 1 to 1 1/2 cups of fruit when they are 4 to 8 years old
  • 1 1/2 cups of fruit when they are 9 to 13 years old
  • 1 1/2 cups (girls) to 2 cups (boys) of fruit when they are 14 1o 18 years old

Recommendations for eating vegetables are similar. Kids should eat about one to three cups of vegetables per day depending on their age, sex, and activity level. Here is an overview of the recommendations:

  • 1 cup of vegetables when they are 2 to 3 years old
  • 1 1/2 cups of vegetables when they are 4 to 8 years old
  • 2 cups (girls) to 2 1/2 cups (boys) of vegetables when they are 9 to 13 years old
  • 2 1/2 cups (girls) to 3 cups (boys) of vegetables when they are 14 to 18 years old

It's also important that kids eat a variety of types of vegetables each week, including dark green vegetables, red and orange vegetables, beans and peas, starchy vegetables, and other vegetables like celery, cucumbers, and avocados.

Caffeine

Many parents probably don't realize that their kids drink a lot of caffeine—until they think about all of the caffeinated drinks that they might be consuming. Here are a few examples of beverages that contain caffeine.

  • Sweet tea
  • Caffeinated soda like Pepsi, Coca Cola, and Dr. Pepper
  • Energy drinks such as Red Bull, Monster, and Rockstar
  • Frappuccino and other coffee-based drink

Most likely, your kids are getting more caffeine than you imagine. Keep in mind that the AAP advises that children should not have caffeine at all.

In their clinical report on "Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?," the AAP also specifically warns that energy drinks aren't appropriate for children or teens and should never be consumed.

Sports Drinks and Energy Drinks

Because your pediatrician likely wants your kids out playing sports or other physical activities every day, you also might think sports drinks are OK. But, that's not the case. In fact, sports drinks, with their extra carbs and calories, are often misused by kids and parents.

In fact, the clinical report "Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?" indicates that sports drinks are not a healthy alternative to soda and are not needed during or after non-vigorous physical activities.

Likewise, energy drinks have potential health risks and should never be consumed by children or teenagers.

Instead, after drinking their recommended daily amounts of low-fat milk, water should be the primary way kids and teens stay hydrated. Sports drinks may have a place for children and teens involved in competitive endurance sports, but for most kids, water is the best choice.

Obesity

Childhood obesity has become a significant health issue. To help reverse this growing trend, the AAP recommends guidelines that encourage activity. Here is a general overview of their recommendations:

  • Kids should have no more than two hours each day of screen time.
  • Children should not have unmonitored Internet access or a television in their bedroom.
  • Nighttime screen media should be limited, and parents should monitor their access or watch television with them.
  • Kids need to be physically active for at least 60 minutes each day. They also should have unstructured or free play and moderately intense activities.
  • Parents should promote healthy eating patterns by offering nutritious snacks, such as vegetables and fruits, low-fat dairy foods, and whole grains.
  • Parents can encourage their child's autonomy in self-regulation of food intake and model healthy food choices.

Kids also should have their BMI plotted at each well-child checkup. Additionally, the amount of physical activity they have each day as well as the amount of time they spend in non-physical activities should be recorded as well.

Oral Health

In the "Maintaining and Improving the Oral Health of Young Children" policy statement, which was reaffirmed in 2019, the AAP advises that parents follow certain habits for healthy teeth. Here is an overview of their recommendations:

  • Start brushing twice a day as soon as they get their first tooth.
  • Use a smear or grain-of-rice-sized amount of fluoride toothpaste and then move up to a pea-sized amount of fluoride toothpaste by 3 years of age.
  • Schedule the first visit to a dentist by their first birthday.
  • Start flossing when your child's teeth are close enough together that you can't brush in between them well.
  • Help or monitor your child's brushing until they are at least 8 years old.
  • Consider having a dentist apply fluoride varnish or sealants if your child is at high risk for getting cavities.

Unfortunately, cavities are very common in kids. It's estimated that 24% of toddlers and preschoolers and almost half of older kids have cavities.

To help prevent cavities, in addition to the recommendations above, the AAP also recommends that parents:

  • Breastfeed babies if possible.
  • Clean their gums even before they get any teeth, with a soft washcloth or soft infant toothbrush and water each day.
  • Avoid allowing your baby to fall asleep with a bottle as well as wean them from their bottle by their first birthday.
  • Encourage them to drink fluoridated tap water between meals and limit sugary foods and drinks to mealtimes.
  • Limit 100% fruit juice to just 4 to 6 ounces each day and avoid other drinks with added sugar.
  • Continue to see a dentist every six months.

Child safety is a part of oral health, too. To prevent dental injuries, the AAP recommends that parents cover sharp corners of household furnishings and be aware that electrical cords can cause mouth injuries. An early visit to a pediatric dentist also can help ensure that you have a plan ready for emergency dental trauma should it occur.

Sexually Transmitted Infections

The policy statement from the AAP, "Screening for Nonviral Sexually Transmitted Infections in Adolescents and Young Adults," recommends that sexually active teens have yearly testing for certain diseases, including tests for the following diseases:

  • Chlamydia and gonorrhea: All sexually active females 25 years of age and under, as well as males who have sex with males, should be tested.
  • Syphilis: Males and females should be tested if they're at high risk.
  • Trichomoniasis: Females who are high risk, such as having multiple partners or a history of STIs, should be tested.

This testing or screening is in line with recommendations for STD and HIV screening from the CDC, which can help identify individuals with treatable infections. It also can help reduce transmission to others, avoid or minimize long-term consequences, identify other exposed and potentially infected individuals, and decrease the prevalence of infection in a community.

These STIs that they recommend testing for are common and can sometimes occur without any symptoms, especially chlamydia. The policy statement also recommends that those who are infected with chlamydia, gonorrhea, or trichomoniasis be retested in three months. The AAP also recommends:

  • Routine HIV screening for all teens by age 16 to 18 years old
  • Routine HIV screening for all sexually active teens
  • Annual HIV screening for high-risk teens

Setting Screen Limits

Parents often complain that their kids watch too much TV and spend too much time in front of screens, all the while giving them more and more access to these devices. But what are the AAP's recommendations about screen limits?

In the "Children, Adolescents, and the Media" policy statement, the AAP recommends limiting screen time:

  • Infants and toddlers less than 2 years old should be discouraged from having any screen time.
  • Children who are at least 2 years old should be limited to less than one to two hours of screen time each day.
  • Electronic devices, including a television, iPad, computer, or video game console such as Xbox, PlayStation, or Wii should be kept out of a child's bedroom and shouldn't be used during meals or before bedtime.
  • Parents should monitor what their kids are watching and playing on their screens.

Ironically, as many of us work to limit screen time at home and model appropriate screen use, kids seem to be getting more and more screen time at school. Consequently, the AAP also supports:

  • Implementing strong regulations to restrict advertising of fast food and junk food to kids
  • Developing new laws that would ban advertising of alcohol on TV
  • Making movies smoke-free
  • Maximizing prosocial media content and minimizing content that can be harmful, such as violence and characters who drink or smoke

Sports and Exercise

The AAP has several policy statements to help guide parents and encourage kids to participate in organized sports and be physically active. But according to the policy statement "Organized Sports for Children, Preadolescents, and Adolescents," parents should avoid taking that advice too far. Here is a closer look at their recommendations:

  • Organized sports should not take the place of free play.
  • Young children should avoid early sports specialization to promote sports safety, avoid burnout, and decrease injuries.
  • Children should be encouraged to participate in a variety of different activities while they are young.

To avoid overuse injuries it's also important that coaches, parents, and players recognize and prevent this common issue. For instance, early specialization in most instances can lead to overtraining and more injuries, including serious overuse injuries. What's more, burnout also can become an issue—especially if kids are getting pressure from parents, coaches, and teammates.

In some kids, burnout manifests itself as a syndrome which includes emotional and physical exhaustion, a reduced sense of accomplishment, and a devaluation of the sport. Signs and symptoms include muscle and joint pain, fatigue, elevated resting heart rate, decreased performance, lack of enthusiasm, and personality changes.

Kids need to be physically active though and parents are crucial in making sure this happens. The policy statement, "Physical Activity Assessment and Counseling in Pediatric Clinical Settings," advises that physical activity should be promoted at home, in the community, and at school.

From encouraging outside play, co-ed sports, and free play for younger kids to recommending competitive and non-competitive youth sports for older kids, daily physical activity in any form is important.

In fact, the AAP indicates that the development of physical literacy starts at home. Parents should not only serve as role models for movement and exercise, but also make sure they are playing with their children so that they can build a foundation of physical skills and abilities. Overall, children and teens should participate in moderate-intensity exercise for at least 60 minutes each day.

Starting Solids for Babies

During a child's first 6 months of life, water, juice, and other foods are generally unnecessary, especially for breastfed infants. However, a gradual introduction of iron-enriched solid foods after 6 months of age complements the breast milk diet as well as the diet of an infant drinking baby formula.

The "rules" of exactly when and how to start solid foods as part of your baby's feeding schedule has changed a lot over the years. The AAP clinical report, "Diagnosis and Prevention of Iron Deficiency and Iron-Deficiency Anemia in Infant and Young Children," does suggest that introducing iron-containing foods after 4 to 6 months of age helps meet an infant's iron needs.

One option for meeting the baby's iron requirements is to offer meat and vegetables. Iron-fortified cereals are also a good way to help meet your infant's need for iron at this age. And as for delaying some solids due to concerns about food allergies—this practice is no longer recommended.

In general, a clinical report from the AAP, "Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas," threw out a lot of food allergy-related advice. They concluded that there was no evidence that delaying the introduction of highly allergic foods such as fish, eggs, and peanuts would protect a child from developing atopic disease.

Recommendations for Solids

Here is an overview of the AAP's recommendations for beginning solids:

  • Start solid foods once your child is 4 to 6 months.
  • Introduce foods with higher iron content, including iron-fortified cereals, red meat, and vegetables such as green beans, peas, and spinach.
  • Give your exclusively-breastfed infant a vitamin with iron starting at 4 months of age until they are regularly eating baby foods with iron each day.
  • Avoid choke foods. For instance, remember that giving infants or toddlers foods containing peanut protein does not mean giving them whole peanuts; it also does not mean giving a piece of steak that they have to chew.
  • Hold off on switching to cow's milk until your child is at least 12 months old.
  • Offer only 4 to 6 ounces of 100% fruit juice in a cup once your infant is 6 months old or not at all. Keep in mind that this is more of a limit and not a daily recommended amount. Most kids don't need juice.
  • Offer some fluoridated water each day beginning at 6 months.
  • Start finger foods and table foods once your baby can sit up well and can easily pick up soft, small pieces of food that are well-cooked, finely chopped, or cut up.

Pediatricians recommend 4 to 6 months as the starting age because that's usually when most infants are developmentally ready for solid foods. Other signs babies are ready for solids include doubling their birth weight, having good head control, and appearing no longer satisfied with breastmilk or formula.

Once you think your baby is ready, the next big question will be what solid foods to start. Will you be traditional and start with an iron-fortified rice cereal, or will you start with fruit or meat?

Surprisingly, it doesn't matter. While many parents like to start with a cereal and then move to vegetables, fruits, and lastly meats, you can choose any order, as long as your baby gets a good mix of iron-rich foods.

Vitamin D for Breastfed Babies

Although breastfeeding and human milk are the preferred method for infant feeding and nutrition, the AAP indicates in "Breastfeeding and the Use of Human Milk" that it's important that breastfed infants receive an oral supplement of vitamin D beginning at hospital discharge.

Potential vitamin D supplements for breastfeeding infants and children might include Enfamil D-Vi-Sol and Baby D drops. Look for a liquid vitamin D supplement at a concentration of 400IU per drop, keeping in mind that much higher concentrations are also available.

Supplementing breastfed babies with vitamin D helps reduce rates of rickets and vitamin D deficiency, issues that can be attributed to decreased sunlight exposure, changes in lifestyle, different dress habits, and the use of topical sunscreens.

Keep in mind though that it isn't just breastfed babies who need vitamin D.

Non-breastfed babies, toddlers, and teens all need vitamin D, too. Hopefully, these children will get their vitamin D from other fortified sources though, including formula and vitamin D fortified milk.

A Word From Verywell

No matter what question you have or issue you're facing, the AAP probably has a policy statement that addresses it. So, while your pediatrician should be your go-to information source for advice and direction, you can supplement this advice with policy statements from the AAP.

Keep in mind though, that all policy statements from the AAP automatically expire five years after publication unless they are reaffirmed, revised, or retired before then. So, always be sure to check the AAP website for the most current recommendations.

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  1. Levy S, Schizer M. Adolescent drug testing policies in schools. Pediatrics. 2015;135(4):e1107-12. doi:10.1542/peds.2015-0055

  2. Hyman SL, Levy SE, Myers SM. Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics. 2020;145(1) doi:10.1542/peds.2019-3447

  3. American Academy of Pediatrics. Breastfeeding.

  4. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-41. doi:10.1542/peds.2011-3552

  5. Baker RD, Greer FR. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126(5):1040-50. doi:10.1542/peds.2010-2576

  6. Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474-502. doi:10.1542/peds.2014-2742

  7. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics. 2014;134(2):e620-38. doi:10.1542/peds.2014-1666

  8. American Academy of Pediatrics. RSV recommendations unchanged after review of new data.

  9. Durbin DR, Hoffman BD. Child passenger safety. Pediatrics. 2018;142(5). doi:10.1542/peds.2018-2460

  10. National Highway Traffic Safety Administration. Car seat ease-of-use ratings.

  11. Circumcision policy statement. Pediatrics. 2012;130(3):585-6. doi:10.1542/peds.2012-1989

  12. U.S. Department of Health and Human Services. The Basics: Well-Baby Visits. Updated February 5, 2020.

  13. Maintaining and improving the oral health of young children. Pediatrics. 2014;134(6):1224-9. doi:10.1542/peds.2014-2984

  14. Braverman PK, Breech L. American Academy of Pediatrics. Clinical report--gynecologic examination for adolescents in the pediatric office setting. Pediatrics. 2010;126(3):583-90. doi:10.1542/peds.2010-1564

  15. American College of Obstetricians and Gynecologists. Your first gynecologic visit. Updated March 2019.

  16. Centers for Disease Control and Prevention. Recommended child and adolescent immunization schedule for ages 18 years or younger. Updated February 3, 2020.

  17. American Academy of Pediatrics. AAP president calls on pediatricians to promote effectiveness of vaccines. AAP News. March 2015,36(3)1. doi:10.1542/aapnews.2015363-1

  18. Diekema DS. Responding to parental refusals of immunization of children. Pediatrics. 2005;115(5):1428-31. doi:10.1542/peds.2005-0316

  19. Rogan WJ, Paulson JA, Baum C, et al. Iodine deficiency, pollutant chemicals, and the thyroid: New information on an old problem. Pediatrics. 2014;133(6):1163-6. doi:10.1542/peds.2014-0900

  20. American Thyroid Association. Iodine deficiency.

  21. American Academy of Pediatrics. AAP endorsement: Screen all children ages 9-11 for cholesterol.

  22. National Heart, Lung, and Blood Institute. Integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report.

  23. Golden NH, Abrams SA. Optimizing bone health in children and adolescents. Pediatrics. 2014;134(4):e1229-43. doi:10.1542/peds.2014-2173

  24. Rehm CD, Drewnowski A. Dietary and economic effects of eliminating shortfall in fruit intake on nutrient intakes and diet cost. BMC Pediatr. 2016;16:83. doi:10.1186/s12887-016-0620-z

  25. U.S. Department of Agriculture (USDA), ChooseMyPlate. All about the fruit group.

  26. U.S. Department of Agriculture (USDA), ChooseMyPlate. All about the vegetable group.

  27. Sports drinks and energy drinks for children and adolescents: Are they appropriate?. Pediatrics. 2011;127(6):1182-9. doi:10.1542/peds.2011-0965

  28. Pujalte GGA, Ahanogbe I, Thurston MJ, White RO, Roche-Green A. Addressing pediatric obesity in clinic. Glob Pediatr Health. 2017. doi:10.1177%2F2333794X17736971

  29. Screening for nonviral sexually transmitted infections in adolescents and young adults. Pediatrics. 2014;134(1):e302-11. doi:10.1542/peds.2014-1024

  30. Centers for Disease Control and Prevention. Which STD tests should I get? Updated June 30, 2014.

  31. Children, adolescents, and the media. Pediatrics. 2013;132(5):958-961. doi: 10.1542/peds.2013-2656

  32. Logan K, Cuff S. Organized sports for children, preadolescents, and adolescents. Pediatrics. 2019:143(6) e2019099. doi:10.1542/peds.2019-0997

  33. Lobelo F, Muth ND, Hanson S, Nemeth BA. Physical activity assessment and counseling in pediatric clinical settings. Pediatrics. 2020;145(3). doi:10.1542/peds.2019-3992