by Susan J. Kressly, M.D., FAAP
While the Academy continues
to assert that the pediatric medical
home is the ideal place for children
to receive nonemergent acute care,
accessibility, convenience and market trends are leading families to seek out alternate
settings. Within the framework that all children
deserve to have safe and appropriate care, the Academy brought together pediatric stakeholders from
different care settings to create the policy statement
Nonemergency Acute Care: When It’s Not the Medical
The policy does not address acute care in the emer-
gency department nor is it intended to encourage
patient/family use of these alternate venues.
It recommends that pediatricians create local and
regional responses to increase appropriate access to
care for children in their communities and to work
so that all care is safe and of high quality. This may
include innovative ways to offer extended hours, de-
velop integrated telehealth programs extending the
medical home beyond the office walls and working
with appropriate pediatric resources in the commu-
nity to ensure adequate access.
Wherever children access the health
care system, there must be communication with the medical home,
according to the policy, which is
available at https://doi.org/10.1542/
peds.2017-0629 and is published in
the May issue of Pediatrics.
The policy emphasizes that to provide safe care, entities delivering acute
care services need to have an appropriate scope of practice that is aligned
with their pediatric expertise, and this
information should be transparent to
In addition, the policy states that
retail-based clinics, telehealth services
not directly connected with the medical home and acute care services that
lack pediatric expertise should not
provide care to children younger than
• maximizing continuity with the medical home,
including rapid communication;
• providing care based on the best available evi-
dence with clearly defined and transparent limits
of scope of service;
• ensuring staff have pediatric training and expe-
rience to provide the scope of services;
• establishing protocols for transitions of care
during emergencies, after hours and when care
is outside the entity’s scope of service; and
• implementing strategies for continuous assess-
ment of quality of care and patient safety.
Patients and families deserve to know — from a
trusted and transparent source — what constitutes
safe care for many common acute visits. An appendix
to the policy excerpts a page from HealthyChildren.
org that advises parents on the basics of safe and evidence-based care for common maladies, with links
to selected guidelines. Pediatricians are encouraged
to share this information with families and care providers in their community.
The policy is from the AAP Committee on Practice
and Ambulatory Medicine, Committee on Pediatric
Emergency Medicine, Section on Telehealth Care,
Section on Emergency Medicine Subcommittee on
Urgent Care and Task Force on Pediatric Practice
Dr. Kressly, a lead author of the policy,
is a member of the AAP Task Force on
Pediatric Practice Change.
AAP News Parent Plus
© 2017 American Academy of Pediatrics. This Parent Plus may be freely copied and distributed with proper attribution.
INFORMATION FROM YOUR PEDIATRICIAN
Don’t let lake, river recreational illness put a damper on summer fun
Warmer days are coming. For many families that
means it’s a perfect time to go swimming or boating in a nearby lake or river.
Before you dip your toe, check the health of the water.
Young children, those with weak immune systems and preg-
nant women can be at greater risk of getting sick from some
water illnesses. Watch for the following:
• Diarrheal illnesses caused by norovirus, Giardia, Cryp-
tosporidium, Shigella and Escherichia coli can be spread
when children swallow lake water that is polluted with
feces. Children and adults should avoid swimming if they
have diarrhea, according to the American Academy of Pe-
diatrics (AAP). Follow home care advice or seek medical treatment if necessary ( http://bit.ly/2p9jxiq). Before
visiting a beach, check for community health advisories ( https://watersgeo.epa.gov/beacon2/).
• Swimmer’s itch is caused by parasites found in snails in lakes. The tiny germs can cause an allergic rash
when they burrow into skin. Symptoms appear within two hours and include itchy, tingling or burning skin and
sometimes small red pimples or blisters. The rash usually disappears within two weeks. Use an anti-itch lotion
and cool compresses to relieve symptoms ( http://bit.ly/2oa49EU).
• The germ that causes hot tub rash is common in hot tubs but also can be found in lakes. The Pseudomonas
aeruginosa germ causes a rash and blisters. It usually clears up on its own. The same germ also can cause
swimmer’s ear, an infection that is treated with ear drops ( http://bit.ly/2oaz583).
• Leptospirosis infects about 100 to 200 people who canoe or swim in rivers and lakes each year. Bacteria enter
through cuts or the nose or mouth. Symptoms include fever, headache, muscle soreness in the calves and back,
red eyes, stomachache and a rash over the shins. The illness is treated with antibiotics ( http://bit.ly/2nL6keC).
• A rare illness caused by the Naegleria fowleri amoeba is found in warm freshwater lakes. It affects swim-mers by attacking the brain when it travels up the nose. Parents can remind children to plug their noses when
they jump or dive into the water to avoid getting lake water up their noses. Symptoms include fever, nausea,
headache, stiff neck, seizures and death. Only three people have survived out of 138 infected since 1962,
according to the Centers for Disease Control and Prevention.
Find more AAP water safety tips at http://bit.ly/2oak9qq.
— Trisha Korioth
Policy offers guidance for acute care services
delivered outside the medical home
Wherever children access the health care system, there must be
communication with the medical home, according to a new policy.
Pediatricians also can devise ways to offer extended hours, telehealth
and other programs to help draw in families.