Indian Academy of Pediatrics Consensus Guidelines on Prevention and Management of Suicidal Behavior in Adolescents

Justification: Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. Objectives: To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. Process: Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. Guidelines: Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.

Indian Academy of Pediatrics Consensus Guidelines for Adolescent Friendly Health Services

Justification: Adolescent health is critical to the current and future well- being of the world. Pediatricians need country specific guidelines in accordance with international and national standards to establish comprehensive adolescent friendly health services in clinical practice. Process: Indian Academy of Pediatrics (IAP) in association with Adolescent Health Academy formed a committee of subject experts in June, 2019 to formulate guidelines for adolescent friendly health services. After a review of current scientific literature and drafting guidelines on each topic, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by discussions over e-mail and refining of draft recommendations. The final guidelines were approved by the IAP Executive Board in December, 2021. Objective: To formulate guidelines to enable pediatricians to establish adolescent friendly health services. Recommendations: Pediatricians should coordinate healthcare for adolescents and plan for transition of care to an adult physician by 18 years of age. Pediatricians should establish respectful, confidential and quality adolescent friendly health services for both out-patient and in-patient care. The healthcare facility should provide preventive, therapeutic, and health promoting services. Pediatricians should partner with the multidisciplinary speciality services, community, and adolescents to expand the scope and reach of adolescent friendly health services.

Indian Academy of Pediatrics Guidelines on Screen Time and Digital Wellness in Infants, Children and Adolescents

Justification: Screen-based media have become an important part of human lifestyle. In view of their easy availability and increasing use in Indian children, and their excessive use being linked to physical, developmental and emotional problems, there is a need to develop guidelines related to ensure digital wellness and regulate screen time in infants, children, and adolescents. Objectives: To review the evidence related to effects of screen-based media and excessive screen time on children’s health; and to formulate recommendations for limiting screen time and ensuring digital wellness in Indian infants, children and adolescents. Process: An Expert Committee constituted by the Indian Academy of Pediatrics (IAP), consisting of various stakeholders in private and public sector, reviewed the literature and existing guidelines. A detailed review document was circulated to the members, and the National consultative meet was held online on 26th March 2021 for a day-long deliberation on framing the guidelines. The consensus review and recommendations formulated by the Group were circulated to the participants and the guidelines were finalized. Conclusions: Very early exposure to screen-based media and excessive screen time (>1-2h/d) seems to be widely prevalent in Indian children. The Group recommends that children below 2 years age should not be exposed to any type of screen, whereas exposure should be limited to a maximum of one hour of supervised screen time per day for children 24-59 months age, and less than two hours per day for children 5-10 years age. Screen time must not replace other activities such as outdoor physical activities, sleep, family and peer interaction, studies, and skill development, which are necessary for overall health and development of the children and adolescents. Families should ensure a warm, nurturing, supportive, fun filled and secure environment at home, and monitor their children’s screen use to ensure that the content being watched is educational, ageappropriate and non-violent. Families, schools and pediatricians should be educated regarding the importance of recording screen exposure and digital wellness as a part of routine child health assessment, and detect any signs of cyberbullying or media addiction; and tackle it timely with expert consultation if needed.

Recommendations on Recognition and Response to Child Abuse and Neglect in the Indian Setting.

Justification: Pediatricians are usually the first point of contact of children with the health system. Studies worldwide have shown that there is insufficient knowledge about child abuse recognition and management among health workers. Presently no uniform guidelines exist in India for pediatricians regarding the appropriate response to child abuse. Process: As part of the Child Rights and Protection Programme (CRPP) under IAP VISION 2007 of Indian Academy of Pediatrics, a ‘Training of Trainers (TOT) Workshop on Child Rights and Protection’ was held in Mumbai in January 2007. It was attended by participants from all over the country. The workshop recommended ‘developing country-specific teaching and training material’. A Task force of IAP CRPP was formed and it developed a module for ‘Training of Trainers Workshops for Pediatricians’. A National Consultative Meet was held in October, 2007 at New Delhi, where the program was discussed and ratified. Objectives: To train pediatricians to: recognize and respond to child abuse; engage in a multi-disciplinary networking mode to deal with child abuse; and, document, record and report instances of child abuse. Recommendations: Guidelines for recognition and management of child abuse are presented. All pediatricians should assess suspected harm with the same thoroughness and attention as they would do with a life threatening condition. Poor management after disclosure can increase psychological damage. Pediatrician should believe, support, reassure, treat and ensure rehabilitation of victims of child abuse, keeping the best interest of the child as the primary goal.