The American Academy of Pediatrics and breastfeeding.

The American Academy of Pediatrics (AAP) was founded in 1930. There were 35 pediatricians who met at a Detroit (MI) hospital and decided that things needed to be done differently for children and for pediatricians. A lot of the issues they had with the American Medical Association were related to infant and childhood nutrition and processing of milk. In addition, pediatricians could not get adequate continuing medical education within the American Medical Association. So these 35 physicians formed the AAP. AAP’s current headquarters are in Elk Grove Village, IL, and it has a simple mission statement: to assure the health and life success for all children. But while doing that, also support the pediatricians who care for those children. There are about 62,000 members of the AAP, representing almost three-quarters of all practicing pediatricians in the country. There are chapters in all 50 states, Canada, and the Virgin Islands. The AAP is the largest pediatric organization in the world and has extensive interactions with international pediatric organizations. The AAP mission statement supports the health and well-being of all children, not just children in America. Forty-two percent of AAP members are young, so it is a vibrant young specialty. Over half of the membership is female, which is reflective of several different areas of medicine, but certainly the Academy is on the forefront of this trend. Almost all the residents, the physicians in training to be pediatricians, are already members of the AAP. There are three of us on the National Executive Committee who help oversee the day-to-day business of the Academy. Each of the 10 districts has a chairperson, and these chairs represent the remainder of the Board of Directors, which meets three times a year in person and every month by conference call. Within each district, there are three or more state chapters, normally one per state, but sometimes there are several chapters in one state. There are 49 Sections, breastfeeding being one of those, nine Councils, and 28 National Committees, all actively staffed by the Academy in Elk Grove Village. These entities produce most of our policy and science. Committees are normally scientific or topic task-oriented groups as opposed to sections, which also have an advocacy agenda. The Section on Breastfeeding has about 500 members and is growing. There are 78 Chapter Breastfeeding Coordinators who work at the local level. The Section has an Executive committee and a 15-person Leadership Team. There is a six-person Chapter Breastfeeding Coordinator Steering Committee, which identifies and disseminates the latest ‘‘best practices’’ relating to promoting breastfeeding and advocating for breastfeeding. The Academy has had a number of successes in recent years, including the Affordable Care Act, which contains improved payments for pediatricians and a good healthcare benefit package for children that reflects our Bright Futures Guidelines for Health Supervision. Everything the Academy undertakes is based on its pillars, principles, and/or strategic priorities, which make up the strategic agenda. The pillars are access, quality, and finance. The principles are health equity, medical homes, and the profession of pediatrics. These rarely change. What does change are AAP strategic priorities. The current strategic priorities of the AAP are special health care needs of foster children, early brain and child development, and epigenetics. These are in either the planning, implementation, or integration stages. Eventually they will become operational programs of the Academy. This assures ongoing attention to important issues relating to child health and pediatric practice. Past strategic priorities, such as tobacco, obesity, and disaster preparedness, are now a part of the operation of the Academy. Consider tobacco. The Richmond Center is funded by the Flight Attendants Medical Research Foundation, and it is an ongoing part of Academy activity. Evidence-based literature is rapidly accumulating that factors related to epigenetics and early brain and child development determine life course and success. As with previous strategic priorities, these will eventually be ongoing operations within the Academy. Epigenetics research has revealed that there are changes in gene expression that do not necessarily manifest themselves with changes in DNA structure or alignment. There are actions and reactions, including DNA methylation, histone modification, and micro-RNAs, that affect the genes of children, sometimes even prenatally. These changes are related to environmental, parental, and other influences that can affect lifelong health, success, and well-being. The AAP has established a Primary Care Institute to look at how we infuse epigenetics into the field of general pediatrics and how pediatricians can help assure that epigenetics facilitates and enhances the success of a child’s life, as opposed to detracting from it. Early brain and child development is similar. There are things that happen to mommy and daddy before they even know each other, before they conceive, and certainly after