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April 2000Vol. 1, No. 2Pediatricians Sharpen Focus on Violence Prevention

The American Academy of Pediatrics (AAP) has revised its guidelines for preventive pediatric health care to address violence prevention and published its recommendations in the March 2000 edition of AAP's journal, Pediatrics.

The new guidelines for violence prevention assessment and counseling are included in the category of "anticipatory guidance." AAP's revised guidelines recommend that violence prevention assessment accompany routine developmental and physical assessments, beginning before birth and continuing through adolescence.

The recommendations are based on a policy statement on the role of pediatricians in preventing youth violence that was published in the January 1999 issue of Pediatrics. The statement addressed the threats that domestic violence, child abuse, and other forms of violence pose to children's physical, emotional, and cognitive development.

"Because many pediatricians encounter children and youth who are experiencing or are at risk for violence, pediatricians are well situated to intervene," the statement says.

The guidelines include advice to give parents during all developmental stages for nurturing and limit setting. They also recommend focusing on the following areas for violence-related assessment and screening:

  • History of mental illness, previous domestic violence, or substance abuse in the parents or other family members
  • Family stresses that could lead to violence (e.g., unemployment, divorce, death)
  • Lack of appropriate supervision and care and support systems
  • Disciplinary attitudes and practices of the parents and caregivers
  • Exposure to violence in the home, school, or community
  • Degree of exposure to media violence
  • Access to firearms in their or a neighbor's home, or the community
  • Gang involvement or gang exposure in family, school, or neighborhood
  • Situations in which a child or adolescent experiences physical assault or sexual victimization from anyone
  • Presence of signs of poor self-esteem, or depression
  • Other factors affecting risk, such as poor school performance and physical, emotional, or developmental disabilities.

When any of the above risk factors are identified, pediatricians should be prepared to provide referrals to necessary intervention and follow-up services, such as child welfare agencies, mental health services, domestic violence counseling, substance abuse treatment, or high-risk youth services. The policy statement also recommends that pediatricians set clinical practice guidelines, advocate for violence prevention at the local and national level, enhance education for medical students and practicing pediatricians, and contribute to research for prevention and management of youth violence.

The January 1999 AAP policy statement on "The Role of the Pediatrician in Youth Violence Prevention in Clinical Practice and at the Community Level" is available online at:

The revised March 2000 AAP Recommendations for Preventive Pediatric Health Care, containing violence prevention guidelines, are available online at