Volume 33 • Number 8 • August 2012
What high court’s ruling on health reform
law means for children and pediatricians
by Jamie Poslosky • Washington Correspondent
“The U.S. Supreme Court’s decision to uphold
the Affordable Care Act (ACA) preserves a law that
invests in children’s health from the ground up,” said
AAP President Robert W. Block, M.D., FAAP, following the high court’s ruling on June 28 upholding
the constitutionality of the health reform law.
“The Academy endorsed the Affordable Care Act
because it addresses the same ‘A-B-C’ goals that are
entrenched in our mission and in our 82 years of
child health advocacy: providing all children in this
country with Access to health care services, age-appropriate Benefits to meet their unique needs, and high-quality, affordable health care Coverage,” Dr. Block
said. See Health reform, page 5
Hidden pain Pediatricians urged to be alert to psychological maltreatment of children and intervene early
by Robert Musinski • Correspondent
When a caregiver constantly abuses a child physically or verbally, the abuse may not be easy for
pediatricians to detect because youngsters often
don’t admit to it, and adults are likely to hinder
That’s why it’s crucial for pediatricians to interview a child who shows possible signs of psychological maltreatment and intervene as necessary
before the abuse causes irreparable harm to the
child’s mental and physical well-being, say the lead
authors of an AAP clinical report.
“The high prevalence of psychological abuse in
advanced Western societies, along with the serious
consequences, point to the importance of successful management,” the authors said in the report,
Psychological Maltreatment, published in the August
issue of Pediatrics (2012;130:372-378; http://pedi
“Pediatricians should be alert to the occurrence
of psychological maltreatment and identify ways
to support families who have risk indicators for,
or evidence of, this problem.”
Defining psychological maltreatment
Sometimes, diagnosis of psychological maltreatment is obvious, especially when it is extreme
such as when a parent forces a child to live locked
in a dark basement.
Most often, the maltreatment is shrouded in gray
areas and might be paired with physical or sexual abuse.
“When it occurs by itself, it’s harder to identify,
harder to recognize,” said lead author Roberta Hib-
bard, M.D., FAAP, director, Section of Child Pro-
tection Programs, Riley Children’s Hospital, Indiana
University School of Medicine. “It has a negative
impact on a child’s growth and development. Parents
recognize the positive impact they have on a child.
We don’t always see the negative things we do.”
Psychological maltreatment most often is associated
with multiple family stresses, such as adult mental
health problems, substance abuse and family conflict.
Judge’s decision allows
to discuss gun safety
from the AAP Department of Community,
Chapter and State Affairs
U.S. District Judge Marcia G. Cooke granted a
permanent injunction blocking enforcement of a
Florida law that restricts pediatricians from asking
about firearms in the home. In her June 29 ruling,
the judge cited the law as unconstitutional.
The Privacy of Firearms Owners Act, signed into
law by Florida Gov. Rick Scott in June 2011, would
have restricted physicians, nurses and medical staff
from asking patients and their parents about firearms.
Physicians accused of violating the law would have
been sent before the Florida Board of Medicine for
Following passage of the law, the Florida chapters
of the Academy, American Academy of Family Physicians (AAFP) and American College of Physicians
(ACP), along with six individual physicians, filed a
lawsuit contending that the law substantially curtailed
their First Amendment rights to exchange information with patients about gun safety.
In her ruling, the judge sided with the Academy,
AAFP and ACP by ruling that the law interfered in
the patient-physician relationship by limiting practitioners’ ability to counsel patients and their families
on the importance of storing firearms safely. The judge
ruled that the law also harmed patients by imposing
restrictions that prevent them from hearing important
preventive health messages from their physicians.
Although Alabama, Minnesota, North Carolina,
Oklahoma, Tennessee and West Virginia have introduced similar bills in recent years, Florida is the only
state that has enacted legislation restricting physician
speech on firearms safety counseling.
For more information on the Florida lawsuit
restricting firearms safety counseling or state legislative
action, contact the AAP Division of State Government Affairs at email@example.com or 800-433-9016, ext.
7799 or visit www.aap.org/en-us/advocacy-and-pol
For speaking points to prepare for media interviews
on firearms legislation, log in to MyAAP and go to
In this issue
Want to make a difference in the
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are open from Aug. 31 to Oct. 1. Pages 17-21