The American Academy of Pediatrics recognizes insufficient sleep in adolescents as an important public health issue that significantly affects the health and safety, as well as the academic success, of our nation's middle and high school students. Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students' ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8:30 am) as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. Furthermore, a substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep (8.5-9.5 hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life.
The primary mission of any school system is to educate students. To achieve this goal, the school district must maintain a culture and environment where all students feel safe, nurtured, and valued and where order and civility are expected standards of behavior. Schools cannot allow unacceptable behavior to interfere with the school district' s primary mission. To this end, school districts adopt codes of conduct for expected behaviors and policies to address unacceptable behavior. In developing these policies, school boards must weigh the severity of the offense and the consequences of the punishment and the balance between individual and institutional rights and responsibilities. Out-of-school suspension and expulsion are the most severe consequences that a school district can impose for unacceptable behavior. Traditionally, these consequences have been reserved for offenses deemed especially severe or dangerous and/or for recalcitrant offenders. However, the implications and consequences of outof-school suspension and expulsion and "zero-tolerance" are of such severity that their application and appropriateness for a developing child require periodic review. The indications and effectiveness of exclusionary discipline policies that demand automatic or rigorous application are increasingly questionable. The impact of these policies on offenders, other children, school districts, and communities is broad. Periodic scrutiny of policies should be placed not only on the need for a better understanding of the educational, emotional, and social impact of out-of-school suspension and expulsion on the individual student but also on the greater societal costs of such rigid policies. Pediatricians should be prepared to assist students and families affected by out-of-school suspension and expulsion and should be willing to guide school districts in their communities to find more effective and appropriate alternatives to exclusionary discipline policies for the developing child. A discussion of preventive strategies and alternatives to out-of-school suspension and expulsion, as well as recommendations for the role of the physician in matters of out-of-school suspension and expulsion are included. School-wide positive behavior support/positive behavior intervention and support is discussed as an effective alternative. Pediatrics 2013;131:e1000-e1007 RATIONALE FOR OUT-OF-SCHOOL SUSPENSION AND EXPULSIONPerhaps no public institution more closely mirrors the community in which it is found than does the public school system. The school system comprises children from a wide variety of socioeconomic backgrounds COUNCIL ON SCHOOL HEALTH KEY WORDS suspension, expulsion, school, discipline ABBREVIATIONS AAP-American Academy of Pediatrics IEP-individualized education plan PBIS-positive behavior intervention and support SWBS-school-wide positive behavior support This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the A...
To the Editor.— I read with interest the article by Koren et al, "Tenfold Errors in Administration of Drug Doses: A Neglected Iatrogenic Disease in Pediatrics" (Pediatrics 1986;77:848-849). Errors such as those described by the author are perhaps most likely to occur during an emergency resuscitation situation. Several factors contribute to this increased likelihood. (1) emotional stress of the situation, (2) the urgency of need for the medications, leading to excessive haste in their preparation for administration and at the same time a decrease in the likelihood that the dose will be double checked before administration, and (3) the relative lack of familiarity of the members of the resuscitating team with the medications being used.
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