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

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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.

†"Do you think sudden confusion or trouble speaking are symptoms of stroke?" "Do you think sudden numbness or weakness of face, arm, or leg, especially on one side, are symptoms of stroke?" "Do you think sudden trouble seeing in one or both eyes is a symptom of stroke?" "Do you think sudden trouble walking, dizziness, or loss of balance are symptoms of stroke?" "Do you think a severe headache with no known cause is a symptom of stroke?"

I nvestigators from Yale University examined reports from unannounced licensing inspections of child care and group child care centers in Connecticut in order to determine factors associated with regulatory compliance. Inspection reports from visits to centers caring for children <6 years old between 2006 and 2008 were reviewed. Investigators examined the association between regulatory compliance and the following factors of interest: (a) accreditation by the National Association for the Education of Young Children (NAEYC), (b) center funding source, (c) compliance with a weekly child care health consultant visit, (d) compliance with 20 hours of child care provider continuing education, and (e) median household income of the area where the child care center was located.The study team grouped 72 regulations into 9 categories that pertained to all child care centers and 4 that pertained only to centers providing infant and toddler care. The 9 categories pertaining to all centers were outdoor safety, indoor safety, indoor health, child and staff documentation, emergency preparedness, child physical health, child supervision, program documentation, and educational programming. The infant and toddler categories were indoor safety, outdoor safety, health, and development. Overall compliance with each category of regulation was calculated. Regression analysis was used to identify the association of each of the 5 factors of interest with compliance in each of the regulatory categories. A total of 676 child care centers were inspected during the study period. A high degree of compliance (>96%) was found for child physical health (eg, nutritious meals), child supervision for preschool children, program documentation (eg, posting a license), and educational programming. Child care centers serving all ages were noncompliant most frequently (48%) with the regulation requiring a hazard-free playground. Infant and toddler centers were most frequently noncompliant with regulations in indoor safety and health categories. For example, 28% of infant and toddler centers had choking hazards such as plastic bags and balloons within the reach of children.Compliance with the regulation requiring evidence that each full-time provider has completed 20 hours of continuing education per year was the factor most strongly associated with compliance with other regulatory requirements. NAEYC accreditation and child care location in areas with higher household income were also significantly associated with increased compliance for some of the regulatory categories. There were no consistent associations between child care funding source and compliance.The authors conclude that continuing education for child care providers is an important intervention to improve the health and safety of children in child care centers and that analysis of licensing reports can assist efforts to improve the quality of child care. Commentary byJacqueline R. Dougé, MD, MPH, FAAP, Frederick, MD Dr Dougé has disclosed no financial relationship relevant to this commentar...