The American Academy of Pediatrics is committed to addressing the factors that affect child and adolescent health with a focus on issues that may leave some children more vulnerable than others. Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families. Although progress has been made toward racial equality and equity, the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear. The objective of this policy statement is to provide an evidence-based document focused on the role of racism in child and adolescent development and health outcomes. By acknowledging the role of racism in child and adolescent health, pediatricians and other pediatric health professionals will be able to proactively engage in strategies to optimize clinical care, workforce development, professional education, systems engagement, and research in a manner designed to reduce the health effects of structural, personally mediated, and internalized racism and improve the health and well-being of all children, adolescents, emerging adults, and their families. STATEMENT OF THE PROBLEM Racism is a "system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call 'race') that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources." 1 Racism is a social determinant of health 2 that has a profound impact on the health status of children, adolescents, emerging adults, and their families. 3-8 Although progress has been made toward racial equality and equity, 9 the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear. 10 Failure to address racism will

reopened. During influenza outbreaks, reopening has been associated with the risk of epidemic resurgence. The best solution for the COVID-19 pandemic is not known. It has been suggested that children who test positive on serologic tests that identify IgG against SARS-CoV-2 could beadmittedtoschool.Itissupposedthatpositivitycouldallowtheidentificationofchildrenwhohavealreadybeeninfected,canbeconsidered protected, and can attend school without posing risks per se to other children. However, the use of this procedure can be strongly criticized. The sensitivity of the presently available antibody tests is suboptimal. Most children have an asymptomatic infection, and as the immune response to SARS-CoV-2 infection has been found to be greater the more serious the disease is, it seems likely that most children will have a low antibody titer that is inadequate for obtaining positivity on tests with relatively low sensitivity. 10 Moreover, even when IgG levels are measured, it is not possible to state whether children are protected or how long the protection may last. The antibody protective level and secondary immune response to SARS-CoV-2 are not known. Taken together, these factors seem to indicate that most children with IgG positivity cannot be identified and, even if identified, cannot be considered protected for the long term. Other criteria, such as a systematic adoption of face masks with some lessons on this issue and on all hygiene measures for COVID-19 prevention, screening with temperature measurements, or closing classrooms with infected students, must be followed when school is resumed.

Fever is a common childhood condition that is often misunderstood and incorrectly managed by parents. This study uses a questionnaire about fever administered to a convenience sample of Spanish-speaking-only parents bringing their child to a hospital-based urban pediatric clinic. The questionnaire elicits information about definition and cause of fever, concerns about fever, methods of temperature measurement, and treatment modalities used by the parents. Latino parents have numerous misconceptions about fever and its role in illness. Educational interventions should target fever definition, clarification of cause and potential harm of elevated temperatures, temperature monitoring, and safe treatment modalities. Owning a thermometer is strongly associated with correct knowledge of temperature values. Providing parents with a thermometer and educating them about its proper use may lead to an increase in appropriate monitoring and medical treatment of the febrile child.

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Association of family member detention or deportation with Latino or Latina adolescents' later risks of suicidal ideation, alcohol use, and externalizing problems.

Introduction: A large body of evidence links exposure to childhood trauma with negative health outcomes. Training future physicians to recognize and respond to trauma is paramount, and engaging medical students in the preclinical years affords the opportunity to foster the development of a trauma-informed lens that can then be solidified during clinical clerkships. Methods: We developed and implemented a 4-hour trauma-informed care (TIC) symposium for 179 second-year medical students at the George Washington University School of Medicine and Health Sciences during the Patients, Populations, and Systems course. The symposium included three interactive didactic sessions focusing on the connection between trauma and health and TIC principles. A facilitated small-group discussion allowed students to apply TIC principles to a patient case, followed by reflection and evaluation. Results: The overall rating of the TIC symposium was 4 out of 5. Strengths included integration of a small-group case with discussion on application of TIC in practice, experience of the lecturers and small-group facilitators, and review of research relating adversity to specific health outcomes. Suggestions for improvement included incorporating role-play and standardized patients. Content analysis of student reflections mapped to the domains of physician competency. Discussion: A 4-hour symposium can affect student knowledge and understanding of TIC. Teaching TIC presents an opportunity to prepare medical students for a career in medicine through cultivation of required physician competencies. Next steps include enhanced opportunities to practice TIC and follow-up analysis of participants to determine behavior change during clinical years.

We are clinicians in busy health centers, and we are seeing the impact of school closures for in-person learning-including school disengagement, mental health challenges, unhealthy weight gain, food insecurity, immunization delay, and soaring rates of new-onset type 2 diabetes. 1 These immediate, visible consequences of school closures are harbingers of long-term outcomes, including decreased life expectancy for US schoolchildren. 2 Across the country, jurisdictions have eased restrictions, reopened schools, and returned to business as usual, and vaccine eligibility has expanded to include children 5 years and older. It is easy to focus primarily on these hopeful signs of progress during the pandemic, and fall back on the argument that children are resilient. However, we cannot waver in our focus on children. Children are resilient, but this resiliency requires individual support, systemic scaffolding, societal investment, and scientific research into the short-, medium-, and long-term impacts of the pandemic on children. In this issue of JAMA Pediatrics, Viner et al 3 present an important international review of the impacts of school closures on the health and well-being of children during the first wave of the pandemic (February through June 2020) and urge a balance between measures to contain infectious disease and to bolster the physical and mental health of children. The findings in this study can help identify clinical practices, policy and systems interventions, and research priorities that may mitigate the harms caused by school closures.In their research, the authors conducted a review following Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines to examine school closures during social lockdown and mental health, health behaviors, and child well-being during the first wave of the pandemic. Their search strategy used a machine learning approach and included both medical and educational research databases as well as consultation with experts in the field to identify any studies that may have been missed. They initially identified more than 16 000 possible studies, of which they conducted a full review of 151 and then deemed 36 of those to be relevant. They presented a narrative review that grouped studies by outcome(s) of interest and weighted studies based on type and quality. The heterogeneity of the studies precluded a metaanalysis. As a result of this approach, they were able to take a wide-ranging look at research during the initial phase of the pandemic, and ultimately report findings from 36 studies representing 11 countries. Outcome measures were mental health and well-being; child abuse notifications; sleep; health behaviors including physical activity, screen time, and diet; and overweight.

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